Effects of electroconvulsive therapy on plasma levels of neuroactive steroids in inpatients with major depression.

OBJECTIVE: Neuroactive steroids (NAS) are neuroactive molecules that have been shown to be associated with various psychiatric disorders. There are some inconclusive findings about the alteration in neuroactive steroid levels after the treatment of depression and ECT is still one of the most effective treatment choices for treatment resistant depression. Thus, we aimed to investigate the alterations of several NAS in plasma after ECT in inpatients with treatment resistant depression. METHODS: In this study we enrolled 19 consecutive patients, 12 female and 7 male inpatients with major depression, who were not responding to medication, for whom ECT was Indicated, and were not taking any antidepressant treatment for at least a week prior to enrolment. We measured plasma progesterone, testosterone, pregnenolone, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate, and estradiol levels before and after ECT. RESULTS: The mean age of the participants was 38.3 ± 9.4 years. The mean plasma neuroactive steroid levels were insignificant between baseline and post ECT in patients with treatment resistant depression. CONCLUSIONS: ECT does not seem to influence plasma neuroactive steroid levels in patients with treatment resistant depression. Additionally, plasma dehydroepiandrosterone and pregnenolone levels might be associated with improvement in depressive symptoms after ECT.

Cerebral blood flow changes in patients with probable medication-overuse headache.

Transcranial Doppler (TCD) is a non-invasive method for measuring blood flow velocity (BFV), and a marker of vessel diameter. In this study, intracranial BFV was investigated, by means of TCD, in patients suffering from probable medication-overuse headache (PMOH). Twenty-three female patients with probable ergotamine- overuse headache (PEOH), 23 female patients with probable analgesic-overuse headache (PAOH), and 15 healthy female controls participated in the study. The mean BFVs of the bilateral middle and anterior cerebral arteries (MCA and ACA) and basilar artery (BA) were measured by TCD. The mean BFVs of the BA and MCA were found to be significantly increased in the PEOH group when compared with those of the PAOH and control groups (p<0.05). No significant differences in BFV of the ACA were observed between any groups (p>0.05). The mean BFV of all the vessels in the PAOH group was found to be lower than that of the control group but no statistical significance was found (p>0.05). Our results show that ergotamine increases BFV via vasoconstriction, especially of the BA and MCA. We also suggest that 5HT1B/1D receptors are mainly localized in the BA and MCA, and that analgesic overuse results in a functional disorder of neuronal receptor and neurovascular reflexes and may cause a reduction of intracerebral vessel tone, leading to vasodilatation.