background Some previous studies suggest that cortisol might be a predictor for electroconvulsive therapy (ect) response.
aim This prospective study assessed the relation between pre-treatment cortisol levels and the efficacy of ect, as measured with the reduction in ham-d score in a population of drug-free inpatients with severe major depression.
methods At the inpatient depression unit of the Erasmus mc Rotterdam, eighteen patients meeting dsm-iv-criteria for depressive disorder were treated with bilateral ect twice a week. The 17-item ham-d evaluated the severity of the depression and was routinely performed within three days prior to ect, weekly during the course of ect and within three days after the last treatment. The reduction in ham-d score posttreatment compared to pre-treatment evaluated the efficacy of the ect course. Following 0.5 mg dexamethasone ingestion, salivary cortisol was assessed the next day at two points in time. The relation between salivary cortisol levels and reduction in ham-d score was analysed.
results Twenty-six patients participated in the study, 18 of them were included in the analysis. There is a negative relation between baseline post-dexamethasone salivary cortisol levels at 9 am and reduction in ham-d score: higher baseline levels of salivary cortisol at 9 am after 0.5 mg dexamethasone ingestion are associated with a greater reduction in ham-d score .
conclusion This study suggests that higher baseline levels of post-dexamethasone salivary cortisol at 9 am are predictive of ect efficacy.