REGIONAL CEREBRAL BLOOD-FLOW IN MOOD DISORDERS .3. TREATMENT AND CLINICAL-RESPONSE

Background: Global and regional deficits in cerebral blood flow and gl ucose metabolism have been reported in major depression, but there is limited information on the effects of somatic treatment and clinical r ecovery on these abnormalities. Methods: We assessed cortical blood fl ow with the xenon 133 technique in depressed patients prior to a cours e of electroconvulsive therapy (ECT), 30 minutes before and 50 minutes after a single treatment, and during the week following ECT. Acute (p reictal and postictal) effects of a single treatment also were studied in manic patients. Results: In the depressed and manic groups, larger blood flow reductions in the acute period, both globally and in parti cular patterns of brain regions, were associated with a superior clini cal outcome following the treatment course. In depressed patients, sim ilar patterns were observed for the blood flow changes over a full tre atment course. Blood flow reductions in anterior cortical regions were strongly associated with a positive clinical response in both depress ion and mania. Conclusions: The findings indicated that cerebral blood flow abnormalities in major depression were not reversed by successfu l treatment with ECT. Rather, particularly in responders, ECT resulted in additional perfusion reductions. The therapeutic properties of ECT are related to reduced functional brain activity in specific neural r egions.