Patients who did not respond to two different, adequately applied antidepressants were considered as treatment-resistant. Our prospective pilot study included 29 patients (9 male and 20 female) suffering from treatment-resistant MDD according to the ICD-10 (International Statistical Classification of Diseases and Related Health Problems 10th Revision) criteria. Therefore, this exploratory study evaluates the acute and longitudinal effects of ECT on plasma (nor-) epinephrine and serum cortisol levels in relation to clinical outcome. However, little is known about how and if ECT-associated alterations of (nor-) epinephrine and cortisol levels in blood affect the short- and long-term clinical outcome of patients suffering from MDD. Studies have shown that suicidal subjects had significantly higher 24-h urinary levels of cortisol and significantly lower 24-h urinary norepinephrine to epinephrine ratios than non-suicidal patients (Ostroff et al. The monoamine hypothesis suggests-among others-a deficiency of norepinephrine neurotransmission in the brain leading to depression (Ruhé et al.

ECT has been shown to affect the hypothalamic–pituitary–adrenal (HPA) axis by normalizing the results of the dexamethasone suppression test in a sub-group of severely depressed patients (Yuuki et al. Electroconvulsive therapy (ECT) is considered an effective treatment option for patients with previous pharmacotherapy failure as well as for patients with Major Depressive Disorder (MDD) (Gaynes et al.

Sigmaplot 11 do not test bonferroni