ABSTRACT
OBJECTIVE: To determine a) whether clinical response to electroconvulsive therapy (ECT) is associated with decreased platelet activation in patients with major depressive disorder (MDD) and b) if any medical/demographic characteristics predict response to ECT or changes in platelet activation. Increased platelet activation may underlie the increased risk of coronary artery disease (CAD) in patients with MDD. METHODS: Before their first and sixth ECT treatments, study patients (n = 44) completed the Beck Depression Inventory (BDI) to assess the severity of depressive symptoms. Activity of the platelet thromboxane (TBX) A(2) pathway was assessed by measuring the morning spot urinary concentrations of 11-dehydroxy-thromboxane B(2) (11-D-TBX B(2)), a major metabolite of platelet-derived TBX A(2). RESULTS: Multivariate logistic regression analyses revealed that improvement on the BDI was significantly more likely in patients without a history of hypertension (p = .02) and in patients who were prescribed a greater number of "platelet-altering" medications (p = .03). During a course of ECT, a decrease in urinary 11-D-TBX B(2) was significantly more likely to occur in ECT nonresponders (p = .01) and younger patients (p = .02). CONCLUSIONS: Clinical response to ECT coadministered may not be associated with decreases in platelet-derived TBX. Future studies will confirm which somatic "antidepression" treatments offer optimal thrombovascular benefits for depressed patients with multiple risk factors for, or clinically evident, cerebral disease or CAD.
Subject(s)
Depressive Disorder, Major/blood , Depressive Disorder, Major/therapy , Electroconvulsive Therapy , Thromboxane A2/blood , Adolescent , Adult , Aged , Aged, 80 and over , Coronary Artery Disease/blood , Depressive Disorder, Major/psychology , Female , Humans , Hypertension/blood , Male , Middle Aged , Multivariate Analysis , Personality Inventory , Platelet Activation/physiology , Risk Factors , Thromboxane B2/analogs & derivatives , Thromboxane B2/urine , Treatment OutcomeABSTRACT
This case report reviews the treatment of a 74-year-old man with an abdominal aortic aneurysm, bipolar affective disorder, and Lewy body dementia who demonstrated a remarkable positive response to an acute and maintenance course of electroconvulsive therapy (ECT) treatment. This is the first report with serial imaging of an abdominal aortic aneurysm during maintenance ECT. There are limited alternative therapies for those patients who do not meet surgical criteria for an abdominal aortic repair because of dementing disorders. In patients who suffer comorbid mood disorders, ECT has been shown to be an effective option in preserving quality of life and successfully stabilizing the level of agitation.
