Basal plasma dehydroepiandrosterone sulfate level: a possible predictor for response to electroconvulsive therapy in depressed psychotic inpatients

Maayan, Rachel; Yagorowski, Yana; Grupper, Daniel; Weiss, Mordechai; Shtaif, Biana; Kaoud, Mahmoud Abou; Weizman, Abraham

doi:10.1016/s0006-3223(00)00848-9

Cited by 61 publications

(21 citation statements)

References 59 publications

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“…In depressive patients, a diurnal hypersecretion of both cortisol and DHEA has been found during pulsatile 24-h sampling (Heuser et al, 1998). Interestingly, increased concentrations of DHEA sulfate have recently been shown to predict also nonresponse to electroconvulsive therapy (Maayan et al, 2000), which is in line with our results. Our observation that baseline cortisol levels did not differ between responders and nonresponders to PSD may be due to the fact that single-point measurements of basal cortisol secretion are often insufficient and intensive monitoring of HPA axis hormones over time is needed to detect elevated cortisol levels in depression (Posener et al, 2000).…”

Section: Discussionsupporting

confidence: 91%

Influence of Sleep Deprivation on Neuroactive Steroids in Major Depression

Schüle

Michele

Baghai

et al. 2002

Neuropsychopharmacol

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There is evidence from preclinical and clinical studies that concentrations of neuroactive steroids are altered in depression and normalize after antidepressant pharmacotherapy. However, no data are available concerning the impact of sleep deprivation on the concentrations of neuroactive steroids. A total of 29 drug-free patients (12 men, 17 women) suffering from major depression according to DSM-IV criteria were treated with partial sleep deprivation (PSD). Response to PSD was defined as a reduction of at least 30% according to the six-item version of the Hamilton depression scale (6-HAMD). Plasma samples were taken the day before and after PSD (days 0 and 1) and after one night of recovery sleep (day 2) at 8:00 am. The samples were quantified for neuroactive steroids by means of a highly sensitive and specific combined gas chromatography/mass spectrometry analysis. There was no influence of PSD on the concentrations of neuroactive steroids either in PSD responders (n ¼ 20) or in nonresponders (n ¼ 9). However, nonresponders showed significantly higher concentrations of 3a,5a-tetrahydroprogesterone (3a,5a-THP), 3a,5b-tetrahydroprogesterone (3a,5b-THP), and dehydroepiandrosterone (DHEA) before or after PSD compared to responders. In contrast to antidepressant drugs, which correct the dysequilibrium of neuroactive steroids in major depression within several weeks, PSD does not affect the concentrations of neuroactive steroids either in responders or in nonresponders.

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Section: Discussionsupporting

confidence: 91%

Influence of Sleep Deprivation on Neuroactive Steroids in Major Depression

Schüle

Michele

Baghai

et al. 2002

Neuropsychopharmacol

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“…In view of recent molecular data showing that selective serotonin reuptake inhibitors may shift the activity of the 3 ␣ -hydroxysteroid oxidoreductase toward the reductive direction, thereby increasing the formation of endogenous 3 ␣ -reduced neuroactive steroids (Griffin and Mellon 1999), it is of particular interest to investigate the action of non-pharmacological antidepressant interventions on the concentrations of neuroactive steroids. Increased concentrations of DHEAS, the sulfate derivative of DHEA, have been suggested to predict non-response to electroconvulsive therapy (ECT) (Maayan et al 2000). However, concentrations of 3 ␣ -reduced neuroactive steroids during ECT have not been investigated to date.…”

Section: Discussionmentioning

confidence: 99%

Plasma Concentrations of Neuroactive Steroids before and after Repetitive Transcranial Magnetic Stimulation (rTMS) in Major Depression

Padberg

Michele

Zwanzger

et al. 2002

Neuropsychopharmacology

151

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There is evidence for altered levels of neuroactive steroids in major depression that normalize after successful antidepressant pharmacotherapy. Currently it is not known whether this is a general principle of clinically effective antidepressant therapy or a pharmacological effect of antidepressants. Here, we investigated whether repetitive transcranial magnetic stimulation (rTMS) may affect plasma concentrations of neuroactive steroids in a similarway as antidepressant pharmacotherapy. Progesterone, 3 ␣ ,, 3 ␣ ,, 3 ␤ , NO . 5 Neuroactive Steroids before and after rTMS 875 action (Fleischmann et al. 1995;Zyss et al. 1997;Ben-Shachar et al. 1999;Kole et al. 1999;Keck et al. 2000). Neuroactive steroids interacting with the ␥ -aminobutyric acid type A (GABA A ) benzodiazepine receptor complex have been suggested to be involved in the pathophysiology of major depression and the action of antidepressant pharmacotherapy (George et al. 1994;Romeo et al. 1998;Uzunova et al. 1998;Rupprecht and Holsboer 1999;Rupprecht et al. 2001). Lowered levels of 3 ␣ -reduced neuroactive steroids have been found in plasma and cerebrospinal fluid (CSF) of depressed patients (Romeo et al. 1998;Uzunova et al. 1998), which normalized following successful treatment with fluoxetine (Romeo et al. 1998;Uzunova et al. 1998) and other antidepressant drugs (Romeo et al. 1998). On the other hand, dehydroepiandrosterone (DHEA) has been shown to exert beneficial effects on depressive symptoms in a placebo-controlled study (Wolkowitz et al. 1999). In rodents, 3 ␣ -reduced neuroactive steroids and dehydroepiandrosterone sulfate (DHEAS) have been found to exert antidepressant-like effects in the forced swim test Urani et al. 2001). In addition, the formation of 3 ␣ -reduced neuroactive steroids is enhanced by treatment with selective serotonin reuptake inhibitors (SSRI) (Uzunov et al. 1996;Griffin and Mellon 1999). Currently it is not known whether the normalization of altered neuroactive steroid concentrations is a prerequisite for the alleviation of depressive symptoms or due to a specific pharmacological action of antidepressant drugs. In the present study we therefore investigated whether repetitive transcranial magnetic stimulation (rTMS) as a novel non-pharmacological treatment in major depression affects plasma concentrations of neuroactive steroids. METHODSThirty-seven inpatients were included in an open-label protocol (age: 51.5 Ϯ 14.8 years, 23 women, 14 men). Patients met DSM-IV criteria for a major depressive episode. All patients gave their written informed consent for this study after the procedure had been fully explained. The study was approved by the local ethical committee. Prior to the study, antidepressant medication and benzodiazepines were washed out for at least seven days and patients remained medication-free during the entire study.Repetitive transcranial magnetic stimulation was applied as reported elsewhere (Padberg et al. 2002a). Patients underwent 10 sessions of rTMS (10 Hz, 15 trains of 10 s each, 30 s inter-train in...

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“…Furthermore, recently, remission of late-life depression has been associated with a decline in DHEA/DHEAS levels, an effect that was not observed in nonremitted patients [28]. In line with these observations, elevated baseline concentrations of DHEAS have been shown to predict nonresponse to electroconvulsive therapy (ECT) in depressed psychotic patients [32]. …”

Section: Neuroactive Steroids As Endogenous Modulators Of Depression mentioning

confidence: 96%

Neuroactive Steroids in Depression and Anxiety Disorders: Clinical Studies

et al. 2006

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Certain neuroactive steroids modulate ligand-gated ion channels via non-genomic mechanisms. Especially 3α-reduced pregnane steroids are potent positive allosteric modulators of the γ-aminobutyric acid type A (GABA_A) receptor. During major depression, there is a disequilibrium of 3α-reduced neuroactive steroids, which is corrected by clinically effective pharmacological treatment. To investigate whether these alterations are a general principle of successful antidepressant treatment, we studied the impact of nonpharmacological treatment options on neuroactive steroid concentrations during major depression. Neither partial sleep deprivation, transcranial magnetic stimulation, nor electroconvulsive therapy affected neuroactive steroid levels irrespectively of the response to these treatments. These studies suggest that the changes in neuroactive steroid concentrations observed after antidepressant pharmacotherapy more likely reflect distinct pharmacological properties of antidepressants rather than the clinical response. In patients with panic disorder, changes in neuroactive steroid composition have been observed opposite to those seen in depression. However, during experimentally induced panic induction either with cholecystokinine-tetrapeptide or sodium lactate, there was a pronounced decline in the concentrations of 3α-reduced neuroactive steroids in patients with panic disorder, which might result in a decreased GABAergic tone. In contrast, no changes in neuroactive steroid concentrations could be observed in healthy controls with the exception of 3α,5α-tetrahydrodeoxycorticosterone. The modulation of GABA_A receptors by neuroactive steroids might contribute to the pathophysiology of depression and anxiety disorders and might offer new targets for the development of novel anxiolytic compounds.

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Basal plasma dehydroepiandrosterone sulfate level: a possible predictor for response to electroconvulsive therapy in depressed psychotic inpatients

Cited by 61 publications

References 59 publications

Influence of Sleep Deprivation on Neuroactive Steroids in Major Depression

Influence of Sleep Deprivation on Neuroactive Steroids in Major Depression

Plasma Concentrations of Neuroactive Steroids before and after Repetitive Transcranial Magnetic Stimulation (rTMS) in Major Depression

Neuroactive Steroids in Depression and Anxiety Disorders: Clinical Studies

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