99mTc-HMPAO SPECT Study of Cerebral Perfusion After Treatment with Medication and Electroconvulsive Therapy in Major Depression

Compromised regional cerebral blood flow (rCBF) in major de­ pressive disorder may be partly reversed by successful antide­ pressant treatment. However, it is not known if the reversal of rCBF compromise is dependant on the mode of antidepressant treatment. The current study aimed to address this question. Methods: Thirty-three patients (19 women and 14 men; mean age:': SO, 53 :': 16 y) with moderate major depressive disorder were studied before 6 wk of treatment with tricyclic antideDres­ sants, selective serotonin reuptake inhibitors, ora course ofelec­ troconvulsive therapy, and 31 ofthese patients were also studied afterward. A comparison group of 25 healthy volunteers (13 women and 12 men; mean age, 49 15 y) were studied once. rCBF was assessed using 99mTc-hexamethylpropyleneamine oxime SPECT. Images were analyzed using globally normalized statistical parametric mapping localized to the Montreal Neuro­ logic Institute brain atlas. Results: Baseline rCBF was lower in depressed patients than in controls in the frontal cortex and sub­ cortical nuclei bilaterally. A response to medication was associ­ ated with normalization of rCBF deficits, whereas a response to electroconvulsive therapy was associated with an additional rCBF decrease in the parietotemporal and cerebellar regions bi­ iaterally. Conclusion: Hypoperfusion in major depressive disor­ der largely normalizes after a response to pharmacotherapy. Perfusion changes after a response to electroconvulsive therapy