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Electroconvulsive Therapy-Induced Cortisol Release: Changes with Depressive State.

Conrad M. Swartz1, Jang-Jun Chen

  • 1Department of Psychiatry, UHS/The Chicago Medical School and Veterans Administration Medical Center, North Chicago, Illinois, USA.

Convulsive Therapy
|January 1, 1985
PubMed
Summary
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Electroconvulsive therapy (ECT) significantly impacts cortisol levels in depression patients. Cortisol elevation decreases with treatment, suggesting improved cortisol regulation in responders.

Area of Science:

  • Neuroendocrinology
  • Psychiatry

Background:

  • Depression is associated with dysregulated cortisol secretion.
  • The dexamethasone suppression test (DST) is used to assess cortisol regulation.
  • Electroconvulsive therapy (ECT) is an effective treatment for severe depression.

Purpose of the Study:

  • To investigate serum cortisol level changes in response to electroconvulsive therapy (ECT) in patients with depression.
  • To compare cortisol responses to initial versus final ECT sessions.
  • To explore the relationship between cortisol regulation and treatment response.

Main Methods:

  • Twelve drug-free patients with melancholic or psychotic depression received at least six ECT sessions.
  • Dexamethasone (2 mg) was administered 9 hours prior to ECT.

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  • Serum cortisol levels were measured before and 30 minutes after the first and last ECT sessions.
  • Treatment response was defined as a reduction in Carroll rating scale scores.

    • Main Results:

    • Initial ECT induced a 575% average cortisol elevation over baseline, significantly higher than previously reported studies without dexamethasone.
    • Cortisol elevation decreased to 181% with the final ECT (p < 0.01).
    • Post-ECT cortisol levels and elevations were significantly lower after the final ECT compared to the initial ECT (p < 0.005).
    • 10 out of 11 responders showed reduced cortisol elevations, while the non-responder exhibited increased elevation.

    Conclusions:

    • ECT treatment is associated with a significant reduction in cortisol elevation.
    • Improved cortisol regulation, indicated by lower post-ECT cortisol levels, correlates with treatment response in depression.
    • Cortisol regulation defects may be more prevalent in depression than indicated by the DST.