Basal plasma dehydroepiandrosterone sulfate level: A possible predictor for response to electroconvulsive therapy in depressed psychotic inpatients

Background: Dehydroepiandrosterone (DHEA) and its sulfate derivative DHEAS are neuroactive steroids. In the brain, they interact with gamma -aminobuty ric acid (GABA,) receptors, which are involved in the regulation of anxiety and mood. The relevance of circulatory neurosteroids to psychiatric disord ers and biological treatment is unknown, Methods: Basal plasma levels of cortisol, DHEA, and DHEAS and the DHEAS-DHE A ratio were determined in 17 psychiatric inpatients before and after six e lectroconvulsive (ECT) therapy sessions, and all changes were statistically analyzed For baseline values, 25 healthy individuals sewed as control subj ects. Severity of depression and psychosis in the patients was measured wit h the Hamilton Depression Rating Scale (HDRS) and the Brief Psychiatric Rat ing Scale, respectively. Results: Both basal and post-ECT levels of cortisol, DHEA, and DHEAS were s ignificantly higher in the patients than in the control subjects. DHEAS lev els in responding patients were higher at completion of treatment than at b aseline. Patients defined as ECT nonresponders (change in HDRS < 30% from b efore treatments) exhibited elevated basal DHEAS levels compared with ECT r esponders. Conclusions: Markedly elevated basal DHEAS levels (mean + 2 SD of control v alue) are associated with resistance to ECT and may serve as a potential pr edictive marker of nonresponsiveness to ECT in depressed patients. (C) 2000 Society of Biological Psychiatry.