Cardiac implications of increased arterial entry and reversible 24-h central and peripheral norepinephrine levels in melancholia
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Why the study?
Does melancholic depression increase central and peripheral norepinephrine levels, and are these levels reversible with electroconvulsive therapy?
Population
22 medication-free patients with melancholic depression and 23 healthy controls. Severe depression group…
Comparison
Electroconvulsive therapy administered every… vs Healthy volunteers and intra-subject pre-ECT…
Design
Cohort
Follow-up
28 +/- 8.6 days after ECT completion
Authors
Discussion
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Implication
Melancholic depression was associated with reversible catecholamine excess; hypothesis-generating for mechanistic links to HF mortality, pending prospective trials.
Structured PICO
Does melancholic depression increase central and peripheral norepinephrine levels, and are these levels reversible with electroconvulsive therapy?
P
Population
22 medication-free patients with melancholic depression (10 with severe depression, 11 with mild-to-moderate depression) and 23 healthy controls. Severe depression group: mean age 40.9, 80% female. Mild-moderate group: mean age 39.8, 27% female. Key inclusion: met DSM III-R and ICD-10 criteria for unipolar major depression with classic melancholic features, medication-free for at least 3 weeks.
I
Intervention
Electroconvulsive therapy (ECT) administered every other day, 3 times per week (mean 9.2 treatments) in severely depressed patients; yohimbine (0.125 mg/kg bolus, followed by 0.001 mg/kg/min infusion) and psychological stressor (video game) in mild-to-moderate depressed patients.
C
Comparator
Healthy volunteers (for baseline comparisons) and intra-subject pre-ECT baseline (for longitudinal ECT study).
O
Outcome
Around-the-clock levels of cerebrospinal fluid (CSF) norepinephrine (NE), plasma NE, plasma epinephrine (EPI), and plasma cortisol measured hourly for 30 hours; basal and stress-mediated arterial NE-appearance rate.surrogate
Melancholic depression is associated with sustained, treatment-reversible increases in central and peripheral norepinephrine, providing a physiological mechanism for the increased mortality observed in depressed patients with chronic heart failure.
Limitations
- Findings will not apply to all clinical subtypes of major depression
- Unequal numbers of males and females in the patient and control groups
Cite This Study
Gold et al. (2005) studied this question.
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