Trends in Psychiatry and Psychotherapy
https://trends.org.br/article/doi/10.1590/2237-6089-2014-0031
Trends in Psychiatry and Psychotherapy
Original Article

Variation of plasma cortisol levels in patients with depression after treatment with bilateral electroconvulsive therapy

Variação de cortisol plasmático em pacientes deprimidos após tratamento com eletroconvulsoterapia bilateral

Daniel Fortunato Burgese; Débora Pastore Bassitt

http://dx.doi.org/10.1590/2237-6089-2014-0031 Trends Psychiatry Psychother, vol.37, n1, p.27-36, 2015
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Abstract

Introduction: More than 60 years after the introduction of modern psychopharmacology, electroconvulsive therapy (ECT) continues to be an essential therapeutic modality in the treatment of mental disorders, but its mechanism of action remains unclear. Hormones play an essential role in the development and expression of a series of behavioral changes. One aspect of the influence of hormones on behavior is their potential contribution to the pathophysiology of psychiatric disorders and the mechanism of action of psychotropic drugs and ECT.Objective: We measured blood levels of the hormone cortisol in patients with unipolar depression according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) and compared results with levels found in healthy adults.Method: Blood cortisol levels were measured before the beginning of treatment with ECT, at the seventh session, and at the last session, at treatment completion. Depression symptoms were assessed using the Beck Depression Inventory (BDI).Results: Cortisol levels remained stable in both men and women between the seventh and the last sessions of ECT; values ranged from 0.686±9.6330 g/dL for women, and there was a mean decrease of 5.825±6.0780 g/dL (p = 0.024). Mean number of ECT sessions was 12. After the seventh and the last ECT sessions, patients with depression and individuals in the control group had similar cortisol levels, whereas BDI scores remained different.Conclusion: Cortisol levels decreased during ECT treatment. ECT seems to act as a regulator of the hypothalamic-pituitaryadrenal axis.

Keywords

Depression, cortisol, ECT, endocrine disorders, hypothalamic-pituitary-adrenal axis

Resumo

Introdução: Mais de 60 anos após a introdução da moderna psicofarmacologia, a eletroconvulsoterapia (ECT) continua essencial para o tratamento de distúrbios mentais, mas seu mecanismo de ação ainda não é totalmente conhecido. Certos hormônios têm um papel fundamental no desenvolvimento e expressão de uma série de alterações comportamentais. Um aspecto da influência dos hormônios nos comportamentos é sua contribuição potencial para a patofisiologia dos distúrbios psiquiátricos e o mecanismo de ação de psicotrópicos e da ECT.Objetivo: Os níveis do hormônio cortisol no sangue foram medidos em pacientes com depressão unipolar classificados de acordo com a 4ª edição do Manual Estatístico e Diagnóstico de Transtornos Mentais (DSM-IV), e os resultados foram comparados com os níveis encontrados em adultos saudáveis.Métodos: Os níveis de cortisol no sangue foram medidos antes do início do tratamento com ECT, na sétima e na última sessão, após a conclusão do tratamento. Os sintomas de depressão foram avaliados usando o Inventário de Depressão de Beck (BDI).Resultados: Os níveis de cortisol permaneceram estáveis tanto nos pacientes masculinos quanto femininos entre a sétima e a última sessão de ECT; os valores variaram 0,686±9,6330 g/ dL entre as pacientes femininas, e houve uma diminuição de 5,825±6,0780 g/dL (p = 0,024). O número médio de sessões de ECT foi 12. Após a sétima e a última sessão de ECT, os níveis de cortisol nos pacientes com depressão e nos indivíduos no grupo controle foram semelhantes, enquanto os resultados da escala BDI permaneceram diferentes.Conclusão: Os níveis de cortisol diminuíram durante o tratamento com ECT. A ECT parece atuar como reguladora do eixo hipotalâmico-hipofisário-adrenal.

Palavras-chave

Depressão, cortisol, ECT, distúrbios endócrinos, eixo hipotalâmico-hipofisário-adrenal

References

Lisanby SH. Electroconvulsive therapy for depression. N Engl J Med. 2007;357:1939-45.

Antunes PB, Rosa MA, Belmonte-de-Abreu PS, Lobato MIR, Fleck MP. Eletroconvulsoterapia na depressão maior: aspectos atuais. Rev Bras Psiquiatr. 2009;31:S26-33.

Grover S, Mattoo SK, Gupta N. Theories on mechanism of action of electroconvulsive therapy. German J Psychiatry. 2005;8:70-84.

Merkl A, Heuser I, Bajbouj M. Antidepressant electroconvulsive therapy: mechanism of action, recent advances and limitations. Exp Neurol. 2009;219:20-6.

Madsen TM, Treschow A, Bengzon J, Bolwig TG, Lindvall O, Tingstrom A. Increased neurogenesis in a model of electroconvulsive therapy. Biol Psychiatry. 2000;47:1043-9.

McEwen BS, Davis PG, Parsons B, Pfaff DW. The brain as a target for steroid hormone action. Annu Rev Neurosci. 1992;2:65-112.

Saraiva EM, Fortunato JMS, Gavina C. Oscilações do cortisol na depressão e sono/vigília. Rev Port Psicossomática. 2005;7:89-100.

Juruena MF, Cleare AJ, Pariante CM. O eixo hipotálamo-pituitária-adrenal, a função dos receptores de glicocorticóides e sua importância na depressão. Rev Bras Psiquiatr. 2004;26:189-201.

Alheira FV, Brasil MAA. O papel dos glicocorticóides na expressão dos sintomas de humor: uma revisão. Rev Psiquiatr Rio Gd Sul. 2005;27:177-86.

Murphy BE. Steroids and depression. J Steroid Biochem Mol Biol. 1991;38:537-59.

Zobel AW, Yassouridis A, Frieboes RM, Holsboer F. Prediction of medium-term outcome by cortisol response to the combined dexamethasone-CRH test in patients with remit ted depression. Am J Psychiatry. 1999;156:949-51.

Young EA, Lopes JF, Murphy-Weinberg V, Watson SJ, Akil H. Mineralocorticoid receptor function in major depression. Arch Gen Psychiatry. 2003;60:24-8.

Stefos G. [Neuroendocrine tests and sleep EEG anomalies in psychotic depression]. Acta Psychiatr Belg. 1993;93:311-21.

Nelson JC, Davis JM. DST studies in psychotic depression: a meta-analysis. Am J Psychiatry. 1997;154:1497-503.

Sapolsky RM. Depression, antidepressants, and the shirinking hippocampus. Proc Natl Acad Sci U S A. 2001;98:12320-2.

Aperia B, Thoren M, Zettergren M, Wetterberg L. Plasma pattern of adrenocorticotropin and cortisol during electroconvulsive therapy in patients with major depressive illness. Acta Psychiatr Scand. 1984;70:361-9.

Widerlov E, Ekman R, Jensen L, Borglund L, Nyman K. Arginine vasopressin, but not corticotropin releasing factor, is a potent stimulator of adrenocorticotropic hormone following electroconvulsive treatment. J Neural Transm. 1989;75:101-9.

Kronfol Z, Hamdan-Allen G, Goel K, Hill EM. Effects of single and repeated electroconvulsive therapy sessions on plasma ACTH, prolactin, growth hormone and cortisol concentrations. Psychoneuroendocrinology. 1991;16:345-52.

Florkowski CM, Crozier IG, Nightingale S, Evans MJ, Ellis MJ, Joyce P, et al. Plasma cortisol, PRL, ACTH, AVP and corticotrophin releasing hormone responses to direct current cardioversion and electroconvulsive therapy. Clin Endocrinol (Oxf). 1996;44:163-8.

Aperia B, Bergman H, Engelbrektson K, Thoren M, Wetterberg L. Effects of electroconvulsive therapy on neuropsychological function and circulating levels of ACTH, cortisol, prolactin, and TSH in patients with major depressive illness. Acta Psychiatr Scand.. 1985;72:536-41.

Cooper SJ, Kelly JG, King DJ. Adrenergic receptors in depression. Effects of electroconvulsive therapy. Br J Psychiatry. 1985;147:23-9.

Aperia B. Hormone pattern and post-treatment attitudes in patients with major depressive disorder given electroconvulsive therapy. Acta Psychiatr Scand. 1986;73:271-4.

Weizman A, Gil-Ad I, Grupper D, Tyanos S, Laron Z. The effect of acute and repeated electroconvulsive treatment on plasma beta-endorphin, growth hormone, prolactin and cortisol secretion in depressed patients. Psychopharmacology (Berl). 1987;93:122-6.

Whalley LJ, Eagles JM, Bowler GM, Bennie JG, Dick HR, McGuire RJ, et al. Selective effects of ECT on hypothalamic-pituitary activity. Psychol Med. 1987;17:319-28.

Smith J, Williams K, Birkett S, Nicholson H, Glue P, Nutt DJ. Neuroendocrine and clinical effects of electroconvulsive therapy and their relationship to treatment outcome. Psychol Med. 1994;24:547-55.

Werstiuk ES, Coote M, Griffith L, Shannon H, Steiner M. Effects of electroconvulsive therapy on peripheral adrenoceptors, plasma, noradrenaline, MHPG and cortisol in depressed patients. Br J Psychiatry. 1996;169:758-65.

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). 1994.

Zis AP, Yatham LN, Lam RW, Clark CM, Srisurapanont M, McGarvey K. Effect of stimulus intensity on prolactin and cortisol release induced by unilateral electroconvulsive therapy. Neuropsychopharmacology. 1996;15:263-70.

Shapira B, Newman ME, Gelfin Y, Lerer B. Blunted temperature and cortisol responses to ipsapirone in major depression: lack of enhancement by electroconvulsive therapy. Psychoneuroendocrinoly. 2000;25:421-38.

Castro M, Moreira AC. Análise crítica do cortisol salivar na avaliação do eixo hipotálamo-hipófise-adrenal. Arq Bras Endocrinol Metab. 2003;47:358-67.

Schatzberg AF, Lindley S. Glucocorticoid antagonists in neuropsychiatric [corrected] disorders. Eur J Pharmacol. 2008;583:358-64.

Gronli O, Stensland GØ, Wynn R, Olstad R. Neurotrophic factors in serum following ECT: a pilot study. World J Biol Psychiatry. 2009;10:295-301.

Abrams R, Taylor MA. Diencephalic stimulation and the effects of ECT in endogenous depression. Br J Psychiatry. 1976;129:482-5.

Fink M, Nemeroff CB. A neuroendocrine view of ECT. Convuls Ther. 1989;5:296-304.

Wolkowitz OM, Reus VI. Treatment of depression with antiglucocorticoid drugs. Psychosom Med. 1999;61:698-711.

Keller J, Buckluy TM, Shatzber AF. Hypothalamic-pituitary-adrenal axis activity. The pychobiology of late life depression. 2004:157-64.

Fink M, Ottosson JO. A theory of convulsive therapy in endogenous depression: significance of hypothalamic functions. Psychiatry Res. 1980;2:49-61.

Markianos M, Hatzimanolis J, Lykouras L. Serotonergic and dopaminergic neuroendocrine responses of male depressive patients before and after a therapeutic ECT course. Eur Arch Psychiatry Clin Neurosci. 2002;252:172-6.

McKay MS, Zakzanis KK. The impact of treatment on HPA axis activity in unipolar major depression. J Psychiatr Res. 2010;44:183-92.

Ozsoy S, Esel E, Hacimusalar Y, Candan Z, Kula M, Turan T. [Acute and chronic effects of electroconvulsive therapy on neuroactive steroids in patients with major depressive disorder]. Turk Psikiyatri Derg. 2008;19:341-8.

Fluitman SHA, Heijnen CJ, Denys DA, Nolen WA, Balk FJ, Westenberg HG. Electroconvulsive therapy has acute immunological and neuroendocrine effects in patients with major depressive disorder. J Affect Disord. 2011;131:388-92.

Sapolsky RM, Krey LC, Mcewen BS. Prolonged glucocorticoid exposure reduces hippocampal neuron number: implications for aging. J Neurosci. 1985;5:1222-7.

Sapolsky RM, Krey LC, McEwen BS. The neuroendocrinology of stress and aging: The glucocorticoid cascade hypothesis. Endocrine Rev. 1986;7:284-301.

Pariante CM, Miller AH. Glucocorticoid receptors in major depression: relevance to pathophysiology and treatment. Biol Psychiatry. 2001;49:391-404.

Soskin DP, Cassiello C, Isacoff O, Fava M. The inflammatory hypothesis of depression. Focus. 2012;10:413-21.

Von Cauter E, Leproult R, Kupfer DJ. Effects of gender and age on the levels and circadian rhythmicity of plasma cortisol. J Clin Endocrinol Metab. 1996;81:2468-73.

Harman SM. Endocrine changes with aging. 2014.

Young EA, Haskett RF, Murphy-Weinberg V, Watson SJ, Akil H. Loss of glucocorticoid fast feedback in depression. Arch Gen Psychiatry. 1991;48:693-9.

Neylan TC, Canick JD, Hall SE, Reus VI, Sapolsky RM, Wolkowitz OM. Cortisol levels predict cognitive impairment induced by electroconvulsive therapy. Biol Psychiatry. 2001;50:331-6.

O'Brien JT, Lloyd A, Mckeith I, Gholkar A, Ferrier N. A longitudinal study oh hippocampal volume, cortisol levels and cognition in older depressed subjects. Am J Psychiatry. 2004;161:2081-90.

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