Increased cerebral blood flow in depressed patients responding to electroconvulsive therapy

Considerable data support the existence of impaired regional cerebral blood flow (rCBF) in major depression. We compared rCBF in depressed patients before and after electroconvulsive therapy (ECT) to define whether the impairment is a ''state''-related property or a trait phenomenon. Methods: Twenty patients with a major depressive disorder were studied by Tc-99m-HMPAO brain SPECT, 2-4 days before and 5-8 days after a course of ECT. Three transaxial brain slices delineating anatomically defined regions of interest at approximately 4, 6 and 7 cm above the orbitomeatal line were used, with the average number of counts for each region of interest normalized to the area of maximal cerebellar uptake. Results: Technetium-99m-HMPAO uptake significantly increased in patients who responded to ECT but remained unchanged in patients who did not respond to the treatment (response defined as a reduction of at least 60% on the Hamilton Depression Rating Scale). An inverse correlation was observed between severity of depression and HMPAO uptake, and clinical improvement was positively correlated with the increase in tracer uptake. Conclusions: These findings imply that reduced rCBF in depression, as reflected in brain Tc-99m-HMPAO uptake, is a ''state''-related property and is reversible by successful treatment. Technetium-99m-HMPAO uptake may serve as an objective state marker for depression, as an indicator of the severity of depression and as an objective means of evaluating response to treatment.