Reversal
of enhanced noradrenaline levels in melancholia
by electroconvulsive therapy
When
major depression coexists with chronic heart
failure (CHF) the mortality of CHF
doubles. The mortality of CHF also doubled
when the plasma noradrenaline levels in CHF
patients are 40% or more higher than control
values. Studies investigating the possibility
that the enhancement of noradrenaline secretion
in major depression could explain increased
mortality in patients with depressed CHF are
however contradictory. To throw light on this
subject a recent study has investigated this
hypothesis of noradrenaline increase in patients
with melancholic depression, supposing that they
would be the group most likely to have
noradrenaline hypersecretion.
Cerebrospinal fluid (CSF) noradrenaline, plasma
noradrenaline, plasma adrenaline, and plasma
cortisol were measured hourly for 30 h in 10
unmedicated patients with severe melancholic
depression and 12 healthy controls, before and
after electroconvulsive therapy (ECT).
Heart rates and blood pressure were higher in
patients than in controls. Patients had higher
levels of CSF noradrenaline, plasma
noradrenaline, plasma adrenaline, and plasma
cortisol than controls. Levels of catecholamines
rose together progressively during the night and
peaked in the morning, when symptoms of
melancholic depression are worst, and when
maximal vulnerability to myocardial infarction
and sudden death occur. ECT produced significant
decreases in pulse rates and blood pressure, and
the levels of all of catecholamines and
cortisol, reducing them to control values.
The fact that ECT could decrease the
central and peripheral activity of noradrenergic
systems in depressed patients parallels the
observation that antidepressants decrease the
firing rate of locus coeruleus in conscious,
freely moving rats. These findings emphasize the
urgent need of diagnosing and treating major
depression in patients with CHF and concurrent
melancholic depression to avoid the increased
mortality in these exposed patients. Gold
PW, Wong ML, Goldstein DS, Gold HK, Ronsaville
DS, Esler M, Alesci S, Masood A, Licinio J,
Geracioti TD Jr, Perini G, DeBellis MD, Holmes
C, Vgontzas AN, Charney DS, Chrousos GP, McCann
SM, Kling MA. Cardiac implications of increased
arterial entry and reversible 24-h central and
peripheral norepinephrine levels in melancholia.
Proc Natl Acad Sci U S A 2005,
102:8303-8308.