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Stuiver S, Pottkämper JCM, Verdijk JPAJ, Ten Doesschate F, Aalbregt E, van Putten MJAM, Hofmeijer J, van Waarde JA. Cortical excitation/inhibition ratios in patients with major depression treated with electroconvulsive therapy: an EEG analysis. Eur Arch Psychiatry Clin Neurosci 2024; 274:793-802. [PMID: 37947826 PMCID: PMC11127883 DOI: 10.1007/s00406-023-01708-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/15/2023] [Indexed: 11/12/2023]
Abstract
Electroconvulsive therapy (ECT) is an effective treatment for major depression, but its working mechanisms are poorly understood. Modulation of excitation/inhibition (E/I) ratios may be a driving factor. Here, we estimate cortical E/I ratios in depressed patients and study whether these ratios change over the course of ECT in relation to clinical effectiveness. Five-minute resting-state electroencephalography (EEG) recordings of 28 depressed patients were recorded before and after their ECT course. Using a novel method based on critical dynamics, functional E/I (fE/I) ratios in the frequency range of 0.5-30 Hz were estimated in frequency bins of 1 Hz for the whole brain and for pre-defined brain regions. Change in Hamilton Depression Rating Scale (HDRS) score was used to estimate clinical effectiveness. To account for test-retest variability, repeated EEG recordings from an independent sample of 31 healthy controls (HC) were included. At baseline, no differences in whole brain and regional fE/I ratios were found between patients and HC. At group level, whole brain and regional fE/I ratios did not change over the ECT course. However, in responders, frontal fE/I ratios in the frequencies 12-28 Hz increased significantly (pFDR < 0.05 [FDR = false discovery rate]) over the ECT course. In non-responders and HC, no changes occurred over time. In this sample, frontal fE/I ratios increased over the ECT course in relation to treatment response. Modulation of frontal fE/I ratios may be an important mechanism of action of ECT.
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Affiliation(s)
- Sven Stuiver
- Technical Medical Centre, Faculty of Science and Technology, Clinical Neurophysiology, University of Twente, Hallenweg 15, 7522NB, Enschede, The Netherlands.
- Department of Psychiatry, Rijnstate Hospital, Wagnerlaan 55, P.O. Box 9555, 6815AD, Arnhem, The Netherlands.
| | - Julia C M Pottkämper
- Technical Medical Centre, Faculty of Science and Technology, Clinical Neurophysiology, University of Twente, Hallenweg 15, 7522NB, Enschede, The Netherlands
- Department of Psychiatry, Rijnstate Hospital, Wagnerlaan 55, P.O. Box 9555, 6815AD, Arnhem, The Netherlands
- Department of Neurology, Rijnstate Hospital, Wagnerlaan 55, 6815AD, Arnhem, The Netherlands
| | - Joey P A J Verdijk
- Technical Medical Centre, Faculty of Science and Technology, Clinical Neurophysiology, University of Twente, Hallenweg 15, 7522NB, Enschede, The Netherlands
- Department of Psychiatry, Rijnstate Hospital, Wagnerlaan 55, P.O. Box 9555, 6815AD, Arnhem, The Netherlands
| | - Freek Ten Doesschate
- Department of Psychiatry, Rijnstate Hospital, Wagnerlaan 55, P.O. Box 9555, 6815AD, Arnhem, The Netherlands
| | - Eva Aalbregt
- Department of Surgery, Amsterdam UMC Location Vumc, Boelelaan 1108, 1081HZ, Amsterdam, The Netherlands
| | - Michel J A M van Putten
- Technical Medical Centre, Faculty of Science and Technology, Clinical Neurophysiology, University of Twente, Hallenweg 15, 7522NB, Enschede, The Netherlands
| | - Jeannette Hofmeijer
- Technical Medical Centre, Faculty of Science and Technology, Clinical Neurophysiology, University of Twente, Hallenweg 15, 7522NB, Enschede, The Netherlands
- Department of Neurology, Rijnstate Hospital, Wagnerlaan 55, 6815AD, Arnhem, The Netherlands
| | - Jeroen A van Waarde
- Department of Psychiatry, Rijnstate Hospital, Wagnerlaan 55, P.O. Box 9555, 6815AD, Arnhem, The Netherlands
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Toffanin T, Cattarinussi G, Ghiotto N, Lussignoli M, Pavan C, Pieri L, Schiff S, Finatti F, Romagnolo F, Folesani F, Nanni MG, Caruso R, Zerbinati L, Belvederi Murri M, Ferrara M, Pigato G, Grassi L, Sambataro F. Effects of electroconvulsive therapy on cortical thickness in depression: a systematic review. Acta Neuropsychiatr 2024:1-15. [PMID: 38343196 DOI: 10.1017/neu.2024.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is one of the most studied and validated available treatments for severe or treatment-resistant depression. However, little is known about the neural mechanisms underlying ECT. This systematic review aims to critically review all structural magnetic resonance imaging studies investigating longitudinal cortical thickness (CT) changes after ECT in patients with unipolar or bipolar depression. METHODS We performed a search on PubMed, Medline, and Embase to identify all available studies published before April 20, 2023. A total of 10 studies were included. RESULTS The investigations showed widespread increases in CT after ECT in depressed patients, involving mainly the temporal, insular, and frontal regions. In five studies, CT increases in a non-overlapping set of brain areas correlated with the clinical efficacy of ECT. The small sample size, heterogeneity in terms of populations, comorbidities, and ECT protocols, and the lack of a control group in some investigations limit the generalisability of the results. CONCLUSIONS Our findings support the idea that ECT can increase CT in patients with unipolar and bipolar depression. It remains unclear whether these changes are related to the clinical response. Future larger studies with longer follow-up are warranted to thoroughly address the potential role of CT as a biomarker of clinical response after ECT.
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Affiliation(s)
- Tommaso Toffanin
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Giulia Cattarinussi
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
- Padova Neuroscience Center, University of Padova, Padua, Italy
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Niccolò Ghiotto
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
| | | | - Chiara Pavan
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
| | - Luca Pieri
- Department of Medicine, University of Padova, Padua, Italy
| | - Sami Schiff
- Department of Medicine, University of Padova, Padua, Italy
| | - Francesco Finatti
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
| | - Francesca Romagnolo
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Federica Folesani
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Maria Giulia Nanni
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Rosangela Caruso
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Luigi Zerbinati
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Martino Belvederi Murri
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Maria Ferrara
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Giorgio Pigato
- Department of Psychiatry, Padova University Hospital, Padua, Italy
| | - Luigi Grassi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Fabio Sambataro
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
- Padova Neuroscience Center, University of Padova, Padua, Italy
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3
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Seymour J, Mathers N. Placebo stimulates neuroplasticity in depression: implications for clinical practice and research. Front Psychiatry 2024; 14:1301143. [PMID: 38268561 PMCID: PMC10806142 DOI: 10.3389/fpsyt.2023.1301143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/26/2023] [Indexed: 01/26/2024] Open
Abstract
Neither psychological nor neuroscientific investigations have been able to fully explain the paradox that placebo is designed to be inert in randomized controlled trials (RCTs), yet appears to be effective in evaluations of clinical interventions in all fields of medicine and alternative medicine. This article develops the Neuroplasticity Placebo Theory, which posits that neuroplasticity in fronto-limbic areas is the unifying factor in placebo response (seen in RCTs) and placebo effect (seen in clinical interventions) where it is not intended to be inert. Depression is the disorder that has the highest placebo response of any medical condition and has the greatest potential for understanding how placebos work: recent developments in understanding of the pathophysiology of depression suggest that fronto-limbic areas are sensitized in depression which is associated with a particularly strong placebo phenomenon. An innovative linkage is made between diverse areas of the psychology and the translational psychiatry literature to provide supportive evidence for the Neuroplasticity Placebo Theory. This is underpinned by neuro-radiological evidence of fronto-limbic change in the placebo arm of antidepressant trials. If placebo stimulates neuroplasticity in fronto-limbic areas in conditions other than depression - and results in a partially active treatment in other areas of medicine - there are far reaching consequences for the day-to-day use of placebo in clinical practice, the future design of RCTs in all clinical conditions, and existing unwarranted assertions about the efficacy of antidepressant medications. If fronto-limbic neuroplasticity is the common denominator in designating placebo as a partially active treatment, the terms placebo effect and placebo response should be replaced by the single term "placebo treatment."
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Affiliation(s)
- Jeremy Seymour
- Retired Consultant Psychiatrist, Rotherham Doncaster and South Humber NHS Trust, Rotherham, United Kingdom
| | - Nigel Mathers
- Emeritus Professor, Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom
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Deng ZD, Robins PL, Regenold W, Rohde P, Dannhauer M, Lisanby SH. How electroconvulsive therapy works in the treatment of depression: is it the seizure, the electricity, or both? Neuropsychopharmacology 2024; 49:150-162. [PMID: 37488281 PMCID: PMC10700353 DOI: 10.1038/s41386-023-01677-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/27/2023] [Accepted: 07/14/2023] [Indexed: 07/26/2023]
Abstract
We have known for nearly a century that triggering seizures can treat serious mental illness, but what we do not know is why. Electroconvulsive Therapy (ECT) works faster and better than conventional pharmacological interventions; however, those benefits come with a burden of side effects, most notably memory loss. Disentangling the mechanisms by which ECT exerts rapid therapeutic benefit from the mechanisms driving adverse effects could enable the development of the next generation of seizure therapies that lack the downside of ECT. The latest research suggests that this goal may be attainable because modifications of ECT technique have already yielded improvements in cognitive outcomes without sacrificing efficacy. These modifications involve changes in how the electricity is administered (both where in the brain, and how much), which in turn impacts the characteristics of the resulting seizure. What we do not completely understand is whether it is the changes in the applied electricity, or in the resulting seizure, or both, that are responsible for improved safety. Answering this question may be key to developing the next generation of seizure therapies that lack these adverse side effects, and ushering in novel interventions that are better, faster, and safer than ECT.
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Affiliation(s)
- Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Pei L Robins
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - William Regenold
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Paul Rohde
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Moritz Dannhauer
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Sarah H Lisanby
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA.
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Brooks JO, Kruse JL, Kubicki A, Hellemann G, Espinoza RT, Irwin MR, Narr KL. Structural brain plasticity and inflammation are independently related to changes in depressive symptoms six months after an index ECT course. Psychol Med 2024; 54:108-116. [PMID: 36600668 DOI: 10.1017/s0033291722003555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is effective for treatment-resistant depression and leads to short-term structural brain changes and decreases in the inflammatory response. However, little is known about how brain structure and inflammation relate to the heterogeneity of treatment response in the months following an index ECT course. METHODS A naturalistic six-month study following an index ECT course included 20 subjects with treatment-resistant depression. Upon conclusion of the index ECT course and again after six months, structural magnetic resonance imaging scans and peripheral inflammation measures [interleukin-6 (IL-6), IL-8, tumor necrosis factor (TNF-α), and C-reactive protein] were obtained. Voxel-based morphometry processed with the CAT-12 Toolbox was used to estimate changes in gray matter volume. RESULTS Between the end of the index ECT course and the end of follow-up, we found four clusters of significant decreases in gray matter volume (p < 0.01, FWE) and no regions of increased volume. Decreased HAM-D scores were significantly related only to reduced IL-8 level. Decreased volume in one cluster, which included the right insula and Brodmann's Area 22, was related to increased HAM-D scores over six months. IL-8 levels did not mediate or moderate the relationship between volumetric change and depression. CONCLUSIONS Six months after an index ECT course, multiple regions of decreased gray matter volume were observed in a naturalistic setting. The independent relations between brain volume and inflammation to depressive symptoms suggest novel explanations of the heterogeneity of longer-term ECT treatment response.
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Affiliation(s)
- John O Brooks
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Jennifer L Kruse
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Antoni Kubicki
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Neurology, Ahmanson-Lovelace Brain Mapping Center, Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | | | - Randall T Espinoza
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Michael R Irwin
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Katherine L Narr
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Neurology, Ahmanson-Lovelace Brain Mapping Center, Geffen School of Medicine at the University of California, Los Angeles, CA, USA
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6
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Kolasa M, Faron-Górecka A. Preclinical models of treatment-resistant depression: challenges and perspectives. Pharmacol Rep 2023; 75:1326-1340. [PMID: 37882914 PMCID: PMC10661811 DOI: 10.1007/s43440-023-00542-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/06/2023] [Accepted: 10/06/2023] [Indexed: 10/27/2023]
Abstract
Treatment-resistant depression (TRD) is a subgroup of major depressive disorder in which the use of classical antidepressant treatments fails to achieve satisfactory treatment results. Although there are various definitions and grading models for TRD, common criteria for assessing TRD have still not been established. However, a common feature of any TRD model is the lack of response to at least two attempts at antidepressant pharmacotherapy. The causes of TRD are not known; nevertheless, it is estimated that even 60% of TRD patients are so-called pseudo-TRD patients, in which multiple biological factors, e.g., gender, age, and hormonal disturbances are concomitant with depression and involved in antidepressant drug resistance. Whereas the phenomenon of TRD is a complex disorder difficult to diagnose and successfully treat, the search for new treatment strategies is a significant challenge of modern pharmacology. It seems that despite the complexity of the TRD phenomenon, some useful animal models of TRD meet the construct, the face, and the predictive validity criteria. Based on the literature and our own experiences, we will discuss the utility of animals exposed to the stress paradigm (chronic mild stress, CMS), and the Wistar Kyoto rat strain representing an endogenous model of TRD. In this review, we will focus on reviewing research on existing and novel therapies for TRD, including ketamine, deep brain stimulation (DBS), and psychedelic drugs in the context of preclinical studies in representative animal models of TRD.
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Affiliation(s)
- Magdalena Kolasa
- Department of Pharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, Smętna 12, 31-343, Kraków, Poland
| | - Agata Faron-Górecka
- Department of Pharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, Smętna 12, 31-343, Kraków, Poland.
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7
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Belge JB, van Eijndhoven P, Mulders PCR. Mechanism of Action of ECT in Depression. Curr Top Behav Neurosci 2023. [PMID: 37962811 DOI: 10.1007/7854_2023_450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Electroconvulsive therapy (ECT) remains the most potent antidepressant treatment available for patients with major depressive disorder (MDD). ECT is highly effective, achieving a response rate of 70-80% and a remission rate of 50-60% even in treatment-resistant patients. The underlying mechanisms of ECT are not fully understood, although several hypotheses have been proposed, including the monoamine hypothesis, anticonvulsive hypothesis, neuroplastic effects, and immunomodulatory properties. In this paper, we provide an overview of magnetic resonance imaging evidence that addresses the neuroplastic changes that occur after ECT at the human systems level and elaborate further on ECTs potent immunomodulatory properties. Despite a growing body of evidence that suggests ECT may normalize many of the structural and functional changes in the brain associated with severe depression, there is a lack of convergence between neurobiological changes and the robust clinical effects observed in depression. This may be due to sample sizes used in ECT studies being generally small and differences in data processing and analysis pipelines. Collaborations that acquire large datasets, such as the GEMRIC consortium, can help translate ECT's clinical efficacy into a better understanding of its mechanisms of action.
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Affiliation(s)
- Jean-Baptiste Belge
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Philip van Eijndhoven
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Centre for Medical Neuroscience, Nijmegen, The Netherlands
| | - Peter C R Mulders
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Centre for Medical Neuroscience, Nijmegen, The Netherlands
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Petzi M, Singh S, Trappenberg T, Nunes A. Mechanisms of Sustained Increases in γ Power Post-Ketamine in a Computational Model of the Hippocampal CA3: Implications for Ketamine's Antidepressant Mechanism of Action. Brain Sci 2023; 13:1562. [PMID: 38002522 PMCID: PMC10670117 DOI: 10.3390/brainsci13111562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/31/2023] [Accepted: 11/04/2023] [Indexed: 11/26/2023] Open
Abstract
Subanaesthetic doses of ketamine increase γ oscillation power in neural activity measured using electroencephalography (EEG), and this effect lasts several hours after ketamine administration. The mechanisms underlying this effect are unknown. Using a computational model of the hippocampal cornu ammonis 3 (CA3) network, which is known to reproduce ketamine's acute effects on γ power, we simulated the plasticity of glutamatergic synapses in pyramidal cells to test which of the following hypotheses would best explain this sustained γ power: the direct inhibition hypothesis, which proposes that increased γ power post-ketamine administration may be caused by the potentiation of recurrent collateral synapses, and the disinhibition hypothesis, which proposes that potentiation affects synapses from both recurrent and external inputs. Our results suggest that the strengthening of external connections to pyramidal cells is able to account for the sustained γ power increase observed post-ketamine by increasing the overall activity of and synchrony between pyramidal cells. The strengthening of recurrent pyramidal weights, however, would cause an additional phase shifted voltage increase that ultimately reduces γ power due to partial cancellation. Our results therefore favor the disinhibition hypothesis for explaining sustained γ oscillations after ketamine administration.
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Affiliation(s)
- Maximilian Petzi
- Faculty of Computer Science, Dalhousie University, Halifax, NS B3H 4R2, Canada; (M.P.); (T.T.)
| | - Selena Singh
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON L8S 4L6, Canada;
| | - Thomas Trappenberg
- Faculty of Computer Science, Dalhousie University, Halifax, NS B3H 4R2, Canada; (M.P.); (T.T.)
| | - Abraham Nunes
- Faculty of Computer Science, Dalhousie University, Halifax, NS B3H 4R2, Canada; (M.P.); (T.T.)
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H 4K3, Canada
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Vega-Rivera NM, González-Trujano ME, Luna-Angula A, Sánchez-Chapul L, Estrada-Camarena E. Antidepressant-like effects of the Punica granatum and citalopram combination are associated with structural changes in dendritic spines of granule cells in the dentate gyrus of rats. Front Pharmacol 2023; 14:1211663. [PMID: 37900157 PMCID: PMC10613096 DOI: 10.3389/fphar.2023.1211663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/31/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction: Natural products such as phytoestrogens-enriched foods or supplements have been considered as an alternative therapy to reduce depressive symptoms associated with menopause. It is known that the aqueous extract of Punica granatum (AE-PG) exerts antidepressant-like effects by activating β-estrogen receptors and facilitates the antidepressant response of the clinical drug citalopram (CIT). However, the effects on neuroplasticity are unknown. Objectvie investigated the antidepressant-like response of combining AE-PG and CIT at sub-optimal doses, analyzing their effects on the formation and maturation of dendrite spines in granule cells as well as on the dendrite complexity. Methods: Ovariectomized Wistar rats (3-month-old) were randomly assigned to one of the following groups: A) control (saline solution as vehicle of CIT and AE-PG, B) AE-PG at a sub-threshold dose (vehicle of CIT plus AE-PG at 0.125 mg/kg), C) CIT at a sub-threshold dose (0.77 mg/kg plus vehicle of AE-PG), and D) a combination of CIT plus AE-PG (0.125 mg/kg and 0.77 mg/kg, respectively). All rats were treated intraperitoneally for 14 days. Antidepressant-like effects were evaluated using the force swimming test test (FST). The complexity of dendrites and the number and morphology of dendrite spines of neurons were assessed in the dentate gyrus after Golgi-Cox impregnation. The expressions of the mature brain-derived neurotrophic factor (mBDNF) in plasma and of mBDNF and synaptophysin in the hippocampus, as markers of synaptogenesis, were also determined. Results: Administration of CIT combined with AE-PG, but not alone, induced a significant antidepressant-like effect in the FST with an increase in the dendritic complexity and the number of dendritic spines in the dentate gyrus (DG) of the hippocampus, revealed by the thin and stubby categories of neurons at the granular cell layer. At the same time, an increase of mBDNF and synaptophysin expression was observed in the hippocampus of rats that received the combination of AE-PG and CIT.
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Affiliation(s)
- Nelly-Maritza Vega-Rivera
- Laboratorio de Neuropsicofarmacología, Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría “Ramón de la Fuente Muñiz”, Mexico City, Mexico
| | - María Eva González-Trujano
- Laboratorio de Neurofarmacología de Productos Naturales, Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Alexandra Luna-Angula
- Laboratorio de Enfermedades Neuromusculares, División de Neurociencias Clínicas, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Mexico City, Mexico
| | - Laura Sánchez-Chapul
- Laboratorio de Enfermedades Neuromusculares, División de Neurociencias Clínicas, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Mexico City, Mexico
| | - Erika Estrada-Camarena
- Laboratorio de Neuropsicofarmacología, Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría “Ramón de la Fuente Muñiz”, Mexico City, Mexico
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Kaurani L, Besse M, Methfessel I, Methi A, Zhou J, Pradhan R, Burkhardt S, Kranaster L, Sartorius A, Habel U, Grözinger M, Fischer A, Wiltfang J, Zilles-Wegner D. Baseline levels of miR-223-3p correlate with the effectiveness of electroconvulsive therapy in patients with major depression. Transl Psychiatry 2023; 13:294. [PMID: 37699900 PMCID: PMC10497550 DOI: 10.1038/s41398-023-02582-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 09/14/2023] Open
Abstract
There is a strong medical need to develop suitable biomarkers to improve the diagnosis and treatment of depression, particularly in predicting response to certain therapeutic approaches such as electroconvulsive therapy (ECT). MicroRNAs are small non-coding RNAs that have the ability to influence the transcriptome as well as proteostasis at the systems level. Here, we investigate the role of circulating microRNAs in depression and response prediction towards ECT. Of the 64 patients with treatment-resistant major depression (MDD) who received ECT treatment, 62.5% showed a response, defined as a reduction of ≥50% in the MADRS total score from baseline. We performed smallRNA sequencing in blood samples that were taken before the first ECT, after the first and the last ECT. The microRNAome was compared between responders and non-responders. Co-expression network analysis identified three significant microRNA modules with reverse correlation between ECT- responders and non-responders, that were amongst other biological processes linked to inflammation. A candidate microRNA, namely miR-223-3p was down-regulated in ECT responders when compared to non-responders at baseline. In line with data suggesting a role of miR-223-3p in inflammatory processes we observed higher expression levels of proinflammatory factors Il-6, Il-1b, Nlrp3 and Tnf-α in ECT responders at baseline when compared to non-responders. ROC analysis of confirmed the diagnostic power of miR-223-3p demarcating ECT-responders from non-responder subjects (AUC = 0.76, p = 0.0031). Our data suggest that miR-223-3p expression and related cytokine levels could serve as predictors of response to ECT in individuals with treatment-resistant depressive disorders.
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Affiliation(s)
- Lalit Kaurani
- Department for Epigenetics and Systems Medicine in Neurodegenerative Diseases, German Center for Neurodegenerative Diseases Goettingen, 37075, Goettingen, Germany
| | - Matthias Besse
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, 37075, Goettingen, Germany
| | - Isabel Methfessel
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, 37075, Goettingen, Germany
| | - Aditi Methi
- Department for Epigenetics and Systems Medicine in Neurodegenerative Diseases, German Center for Neurodegenerative Diseases Goettingen, 37075, Goettingen, Germany
| | - Jiayin Zhou
- Department for Epigenetics and Systems Medicine in Neurodegenerative Diseases, German Center for Neurodegenerative Diseases Goettingen, 37075, Goettingen, Germany
| | - Ranjit Pradhan
- Department for Epigenetics and Systems Medicine in Neurodegenerative Diseases, German Center for Neurodegenerative Diseases Goettingen, 37075, Goettingen, Germany
| | - Susanne Burkhardt
- Department for Epigenetics and Systems Medicine in Neurodegenerative Diseases, German Center for Neurodegenerative Diseases Goettingen, 37075, Goettingen, Germany
| | - Laura Kranaster
- Department of Psychiatry, Vitos Klinikum Heppenheim, 64646, Heppenheim, Germany
| | - Alexander Sartorius
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim and University of Heidelberg, 68159, Mannheim, Germany
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, 52074, Aachen, Germany
| | - Michael Grözinger
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, 52074, Aachen, Germany
| | - Andre Fischer
- Department for Epigenetics and Systems Medicine in Neurodegenerative Diseases, German Center for Neurodegenerative Diseases Goettingen, 37075, Goettingen, Germany.
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, 37075, Goettingen, Germany.
- Cluster of Excellence MBExC, University of Göttingen & University Medical Center Goettingen, 37075, Göttingen, Germany.
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, 37075, Goettingen, Germany.
- Clincal Science Group, German Center for Neurodegenerative Diseases (DZNE), 37075, Goettingen, Germany.
- Neurosciences and Signaling Group, Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, 3810-193, Aveiro, Portugal.
| | - David Zilles-Wegner
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, 37075, Goettingen, Germany.
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11
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Chen X, Yang H, Cui LB, Li X. Neuroimaging study of electroconvulsive therapy for depression. Front Psychiatry 2023; 14:1170625. [PMID: 37363178 PMCID: PMC10289201 DOI: 10.3389/fpsyt.2023.1170625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
Electroconvulsive therapy (ECT) is an important treatment for depression. Although it is known as the most effective acute treatment for severe mood disorders, its therapeutic mechanism is still unclear. With the rapid development of neuroimaging technology, various neuroimaging techniques have been available to explore the alterations of the brain by ECT, such as structural magnetic resonance imaging, functional magnetic resonance imaging, magnetic resonance spectroscopy, positron emission tomography, single photon emission computed tomography, arterial spin labeling, etc. This article reviews studies in neuroimaging on ECT for depression. These findings suggest that the neurobiological mechanism of ECT may regulate the brain functional activity, and neural structural plasticity, as well as balance the brain's neurotransmitters, which finally achieves a therapeutic effect.
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Affiliation(s)
- Xiaolu Chen
- The First Branch, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hanjie Yang
- Department of Neurology, The Thirteenth People’s Hospital of Chongqing, Chongqing, China
| | - Long-Biao Cui
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Schizophrenia Imaging Lab, Fourth Military Medical University, Xi’an, China
| | - Xiao Li
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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12
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Kawashima H, Yamasaki S, Kubota M, Hazama M, Fushimi Y, Miyata J, Murai T, Suwa T. Commonalities and differences in ECT-induced gray matter volume change between depression and schizophrenia. Neuroimage Clin 2023; 38:103429. [PMID: 37150022 PMCID: PMC10193002 DOI: 10.1016/j.nicl.2023.103429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/01/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is one of the most effective treatments for depression and schizophrenia, particularly in urgent or treatment-resistant cases. After ECT, regional gray matter volume (GMV) increases have been repeatedly reported both in depression and schizophrenia. However, the interpretation of these findings remains entangled because GMV changes do not necessarily correlate with treatment effects and may be influenced by the intervention itself. We hypothesized that the comparison of longitudinal magnetic resonance imaging data between the two diagnostic groups will provide clues to distinguish diagnosis-specific and transdiagnostic changes. METHOD Twenty-nine Japanese participants, including 18 inpatients with major depressive disorder and 11 with schizophrenia, underwent longitudinal voxel-based morphometry before and after ECT. We investigated GMV changes common to both diagnostic groups and those specific to each group. Moreover, we also evaluated potential associations between GMV changes and clinical improvement for each group. RESULTS In both diagnostic groups, GMV increased in widespread areas after ECT, sharing common regions including: anterior temporal cortex; medial frontal and anterior cingulate cortex; insula; and caudate nucleus. In addition, we found a schizophrenia-specific GMV increase in a region including the left pregenual anterior cingulate cortex, with volume increase significantly correlating with clinical improvement. CONCLUSIONS Transdiagnostic volume changes may represent the effects of the intervention itself and pathophysiological changes common to both groups. Conversely, diagnosis-specific volume changes are associated with treatment effects and may represent pathophysiology-specific impacts of ECT.
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Affiliation(s)
- Hirotsugu Kawashima
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Shimpei Yamasaki
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Manabu Kubota
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masaaki Hazama
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasutaka Fushimi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Jun Miyata
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshiya Murai
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Taro Suwa
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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13
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Ji GJ, Li J, Liao W, Wang Y, Zhang L, Bai T, Zhang T, Xie W, He K, Zhu C, Dukart J, Baeken C, Tian Y, Wang K. Neuroplasticity-Related Genes and Dopamine Receptors Associated with Regional Cortical Thickness Increase Following Electroconvulsive Therapy for Major Depressive Disorder. Mol Neurobiol 2023; 60:1465-1475. [PMID: 36469225 DOI: 10.1007/s12035-022-03132-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 11/08/2022] [Indexed: 12/08/2022]
Abstract
Electroconvulsive therapy (ECT) is an effective neuromodulatory therapy for major depressive disorder (MDD). Treatment is associated with regional changes in brain structure and function, indicating activation of neuroplastic processes. To investigate the underlying neurobiological mechanism of macroscopic reorganization following ECT, we longitudinally (before and after ECT in two centers) collected magnetic resonance images for 96 MDD patients. Similar patterns of cortical thickness (CT) changes following ECT were observed in two centers. These CT changes were spatially colocalized with a weighted combination of genes enriched for neuroplasticity-related ontology terms and pathways (e.g., synaptic pruning) as well as with a higher density of D2/3 dopamine receptors. A multiple linear regression model indicated that the region-specific gene expression and receptor density patterns explained 40% of the variance in CT changes after ECT. In conclusion, these findings suggested that dopamine signaling and neuroplasticity-related genes are associated with the ECT-induced morphological reorganization.
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Affiliation(s)
- Gong-Jun Ji
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, The School of Mental Health and Psychological Sciences, Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, 230032, China. .,Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, 230088, China. .,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230032, China. .,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Anhui Province, Hefei, 230032, China.
| | - Jiao Li
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 610000, China.,MOE Key Lab for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, 610000, China
| | - Wei Liao
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 610000, China.,MOE Key Lab for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, 610000, China
| | - Yingru Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, The School of Mental Health and Psychological Sciences, Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, 230032, China.,Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, 230088, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230032, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Anhui Province, Hefei, 230032, China
| | - Lei Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, The School of Mental Health and Psychological Sciences, Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, 230032, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230032, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Anhui Province, Hefei, 230032, China
| | - Tongjian Bai
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, The School of Mental Health and Psychological Sciences, Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, 230032, China.,Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, 230088, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230032, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Anhui Province, Hefei, 230032, China
| | - Ting Zhang
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, 230088, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230032, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Anhui Province, Hefei, 230032, China.,Department of Psychiatry, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wen Xie
- Department of Psychiatry, Anhui Mental Health Center, Hefei, 230022, China
| | - Kongliang He
- Department of Psychiatry, Anhui Mental Health Center, Hefei, 230022, China
| | - Chuyan Zhu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, The School of Mental Health and Psychological Sciences, Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, 230032, China.,Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, 230088, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230032, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Anhui Province, Hefei, 230032, China
| | - Juergen Dukart
- Institute of Neuroscience and Medicine, Brain and Behaviour, Research Centre Jülich, INM-7), Jülich, Germany.,Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, 40210, Düsseldorf, Germany
| | - Chris Baeken
- Experimental Psychiatry Lab, Department of Head and Skin, Ghent University, Ghent, Belgium.,Department of Psychiatry, Free University Brussels, Brussels, Belgium.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Yanghua Tian
- Department of Neurology, The Second Affiliated Hospital of Anhui Medical University , Hefei, China.
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, The School of Mental Health and Psychological Sciences, Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei, 230032, China. .,Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, 230088, China. .,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230032, China. .,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Anhui Province, Hefei, 230032, China. .,Anhui Institute of Translational Medicine, Hefei, China.
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14
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Bracht T, Walther S, Breit S, Mertse N, Federspiel A, Meyer A, Soravia LM, Wiest R, Denier N. Distinct and shared patterns of brain plasticity during electroconvulsive therapy and treatment as usual in depression: an observational multimodal MRI-study. Transl Psychiatry 2023; 13:6. [PMID: 36627288 PMCID: PMC9832014 DOI: 10.1038/s41398-022-02304-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/16/2022] [Accepted: 12/30/2022] [Indexed: 01/11/2023] Open
Abstract
Electroconvulsive therapy (ECT) is a highly effective treatment for depression. Previous studies point to ECT-induced volume increase in the hippocampi and amygdalae, and to increase in cortical thickness. However, it is unclear if these neuroplastic changes are associated with treatment response. This observational study aimed to address this research question by comparing neuroplasticity between patients with depression receiving ECT and patients with depression that respond to treatment as usual (TAU-responders). Twenty ECT-patients (16 major depressive disorder (MDD), 4 depressed bipolar disorder), 20 TAU-responders (20 MDD) and 20 healthy controls (HC) were scanned twice with multimodal magnetic resonance imaging (structure: MP2RAGE; perfusion: arterial spin labeling). ECT-patients were scanned before and after an ECT-index series (ECT-group). TAU-responders were scanned during a depressive episode and following remission or treatment response. Volumes and cerebral blood flow (CBF) of the hippocampi and amygdalae, and global mean cortical thickness were compared between groups. There was a significant group × time interaction for hippocampal and amygdalar volumes, CBF in the hippocampi and global mean cortical thickness. Hippocampal and amygdalar enlargements and CBF increase in the hippocampi were observed in the ECT-group but neither in TAU-responders nor in HC. Increase in global mean cortical thickness was observed in the ECT-group and in TAU-responders but not in HC. The co-occurrence of increase in global mean cortical thickness in both TAU-responders and in ECT-patients may point to a shared mechanism of antidepressant response. This was not the case for subcortical volume and CBF increase.
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Affiliation(s)
- Tobias Bracht
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland. .,Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland.
| | - Sebastian Walther
- grid.5734.50000 0001 0726 5157Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland ,Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | - Sigrid Breit
- grid.5734.50000 0001 0726 5157Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland ,Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | - Nicolas Mertse
- grid.5734.50000 0001 0726 5157Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland ,Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | - Andrea Federspiel
- grid.5734.50000 0001 0726 5157Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland ,Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | - Agnes Meyer
- grid.5734.50000 0001 0726 5157Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Leila M. Soravia
- grid.5734.50000 0001 0726 5157Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland ,Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | - Roland Wiest
- Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland ,grid.5734.50000 0001 0726 5157Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Bern, Switzerland
| | - Niklaus Denier
- grid.5734.50000 0001 0726 5157Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland ,Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
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15
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Kerr WT, Tatekawa H, Lee JK, Karimi AH, Sreenivasan SS, O'Neill J, Smith JM, Hickman LB, Savic I, Nasrullah N, Espinoza R, Narr K, Salamon N, Beimer NJ, Hadjiiski LM, Eliashiv DS, Stacey WC, Engel J, Feusner JD, Stern JM. Clinical MRI morphological analysis of functional seizures compared to seizure-naïve and psychiatric controls. Epilepsy Behav 2022; 134:108858. [PMID: 35933959 DOI: 10.1016/j.yebeh.2022.108858] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/26/2022] [Accepted: 07/15/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE Functional seizures (FS), also known as psychogenic nonepileptic seizures (PNES), are physical manifestations of acute or chronic psychological distress. Functional and structural neuroimaging have identified objective signs of this disorder. We evaluated whether magnetic resonance imaging (MRI) morphometry differed between patients with FS and clinically relevant comparison populations. METHODS Quality-screened clinical-grade MRIs were acquired from 666 patients from 2006 to 2020. Morphometric features were quantified with FreeSurfer v6. Mixed-effects linear regression compared the volume, thickness, and surface area within 201 regions-of-interest for 90 patients with FS, compared to seizure-naïve patients with depression (n = 243), anxiety (n = 68), and obsessive-compulsive disorder (OCD, n = 41), respectively, and to other seizure-naïve controls with similar quality MRIs, accounting for the influence of multiple confounds including depression and anxiety based on chart review. These comparison populations were obtained through review of clinical records plus research studies obtained on similar scanners. RESULTS After Bonferroni-Holm correction, patients with FS compared with seizure-naïve controls exhibited thinner bilateral superior temporal cortex (left 0.053 mm, p = 0.014; right 0.071 mm, p = 0.00006), thicker left lateral occipital cortex (0.052 mm, p = 0.0035), and greater left cerebellar white-matter volume (1085 mm3, p = 0.0065). These findings were not accounted for by lower MRI quality in patients with FS. CONCLUSIONS These results reinforce prior indications of structural neuroimaging correlates of FS and, in particular, distinguish brain morphology in FS from that in depression, anxiety, and OCD. Future work may entail comparisons with other psychiatric disorders including bipolar and schizophrenia, as well as exploration of brain structural heterogeneity within FS.
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Affiliation(s)
- Wesley T Kerr
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA.
| | - Hiroyuki Tatekawa
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - John K Lee
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Amir H Karimi
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Siddhika S Sreenivasan
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Joseph O'Neill
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA; Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA
| | - Jena M Smith
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - L Brian Hickman
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ivanka Savic
- Department of Women's and Children's Health, Karolinska Institute and Neurology Clinic, Karolinksa University Hospital, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Nilab Nasrullah
- Department of Women's and Children's Health, Karolinska Institute and Neurology Clinic, Karolinksa University Hospital, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Randall Espinoza
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Katherine Narr
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Noriko Salamon
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Nicholas J Beimer
- Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Lubomir M Hadjiiski
- Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Dawn S Eliashiv
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - William C Stacey
- Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Jerome Engel
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA; Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA; Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jamie D Feusner
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA; Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - John M Stern
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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16
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Leaver AM, Espinoza R, Wade B, Narr KL. Parsing the Network Mechanisms of Electroconvulsive Therapy. Biol Psychiatry 2022; 92:193-203. [PMID: 35120710 PMCID: PMC9196257 DOI: 10.1016/j.biopsych.2021.11.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/03/2021] [Accepted: 11/19/2021] [Indexed: 12/17/2022]
Abstract
Electroconvulsive therapy (ECT) is one of the oldest and most effective forms of neurostimulation, wherein electrical current is used to elicit brief, generalized seizures under general anesthesia. When electrodes are positioned to target frontotemporal cortex, ECT is arguably the most effective treatment for severe major depression, with response rates and times superior to other available antidepressant therapies. Neuroimaging research has been pivotal in improving the field's mechanistic understanding of ECT, with a growing number of magnetic resonance imaging studies demonstrating hippocampal plasticity after ECT, in line with evidence of upregulated neurotrophic processes in the hippocampus in animal models. However, the precise roles of the hippocampus and other brain regions in antidepressant response to ECT remain unclear. Seizure physiology may also play a role in antidepressant response to ECT, as indicated by early positron emission tomography, single-photon emission computed tomography, and electroencephalography research and corroborated by recent magnetic resonance imaging studies. In this review, we discuss the evidence supporting neuroplasticity in the hippocampus and other brain regions during and after ECT, and their associations with antidepressant response. We also offer a mechanistic, circuit-level model that proposes that core mechanisms of antidepressant response to ECT involve thalamocortical and cerebellar networks that are active during seizure generalization and termination over repeated ECT sessions, and their interactions with corticolimbic circuits that are dysfunctional prior to treatment and targeted with the electrical stimulus.
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Affiliation(s)
- Amber M Leaver
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Evanston, Illinois.
| | - Randall Espinoza
- Department of Psychiatry and Behavioral Sciences, Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Benjamin Wade
- Department of Neurology, Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Katherine L Narr
- Department of Neurology, Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Department of Psychiatry and Behavioral Sciences, Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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17
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Multimodal multi-center analysis of electroconvulsive therapy effects in depression: Brainwide gray matter increase without functional changes. Brain Stimul 2022; 15:1065-1072. [DOI: 10.1016/j.brs.2022.07.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 11/18/2022] Open
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18
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Kang Y, Kang W, Han KM, Tae WS, Ham BJ. Associations between cognitive impairment and cortical thickness alterations in patients with euthymic and depressive bipolar disorder. Psychiatry Res Neuroimaging 2022; 322:111462. [PMID: 35231679 DOI: 10.1016/j.pscychresns.2022.111462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Youbin Kang
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Wooyoung Kang
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyu-Man Han
- Department of Psychiatry, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Woo-Suk Tae
- Korea University, Brain Convergence Research Center
| | - Byung-Joo Ham
- Department of Psychiatry, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
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19
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Gong J, Cui LB, Zhao YS, Liu ZW, Yang XJ, Xi YB, Liu L, Liu P, Sun JB, Zhao SW, Liu XF, Jia J, Li P, Yin H, Qin W. The correlation between dynamic functional architecture and response to electroconvulsive therapy combined with antipsychotics in schizophrenia. Eur J Neurosci 2022; 55:2024-2036. [PMID: 35388553 DOI: 10.1111/ejn.15664] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 11/26/2022]
Abstract
Attempts to determine why some patients respond to electroconvulsive therapy (ECT) are valuable in schizophrenia. Schizophrenia is associated with aberrant dynamic functional architecture, which might impact the efficacy of ECT. We aimed to explore the relationship between pre-treatment temporal variability and ECT acute efficacy. Forty-eight patients with schizophrenia and thirty healthy controls underwent functional magnetic resonance imaging to examine whether patterns of temporary variability of functional architecture differ between high responders (HR) and low responders (LR) at baseline. Compared with LR, HR exhibited significantly abnormal temporal variability in right inferior front gyrus (IFGtriang.R), left temporal pole (TPOsup.L) and right middle temporal gyrus (MTG.R). In the pooled patient group, ∆PANSS was correlated with the temporal variability of these regions. Patients with schizophrenia with a distinct dynamic functional architecture appear to reveal differential response to ECT. Our findings provide not only an understanding of the neural functional architecture patterns that are found in schizophrenia but also the possibility of using these measures as moderators for ECT selection.
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Affiliation(s)
- Jie Gong
- Engineering Research Center of Molecular and Neuroimaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Long-Biao Cui
- Department of Radiology, The Second Medical Center, Chinese PLA General Hospital, Beijing, China.,Department of Clinical Psychology, School of Medical Psychology, Fourth Military Medical University, Xi'an, China
| | - Ying-Song Zhao
- Engineering Research Center of Molecular and Neuroimaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Zhao-Wen Liu
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Xue-Juan Yang
- Engineering Research Center of Molecular and Neuroimaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Yi-Bin Xi
- Department of Radiology, Xi'an People's Hospital, Xi'an, China
| | - Lin Liu
- Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Peng Liu
- Engineering Research Center of Molecular and Neuroimaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Jin-Bo Sun
- Engineering Research Center of Molecular and Neuroimaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Shu-Wan Zhao
- Department of Clinical Psychology, School of Medical Psychology, Fourth Military Medical University, Xi'an, China.,Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xiao-Fan Liu
- Department of Clinical Psychology, School of Medical Psychology, Fourth Military Medical University, Xi'an, China.,Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jie Jia
- Department of Early Intervention, Xi'an Mental Health Center, Xi'an, Shaanxi, China
| | - Ping Li
- Department of Medical Imaging, Xi'an Mental Health Center, Xi'an, Shaanxi, China
| | - Hong Yin
- Department of Radiology, Xi'an People's Hospital, Xi'an, China.,Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Wei Qin
- Engineering Research Center of Molecular and Neuroimaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, China
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20
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Ousdal OT, Brancati GE, Kessler U, Erchinger V, Dale AM, Abbott C, Oltedal L. The Neurobiological Effects of Electroconvulsive Therapy Studied Through Magnetic Resonance: What Have We Learned, and Where Do We Go? Biol Psychiatry 2022; 91:540-549. [PMID: 34274106 PMCID: PMC8630079 DOI: 10.1016/j.biopsych.2021.05.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 05/12/2021] [Accepted: 05/12/2021] [Indexed: 12/14/2022]
Abstract
Electroconvulsive therapy (ECT) is an established treatment choice for severe, treatment-resistant depression, yet its mechanisms of action remain elusive. Magnetic resonance imaging (MRI) of the human brain before and after treatment has been crucial to aid our comprehension of the ECT neurobiological effects. However, to date, a majority of MRI studies have been underpowered and have used heterogeneous patient samples as well as different methodological approaches, altogether causing mixed results and poor clinical translation. Hence, an association between MRI markers and therapeutic response remains to be established. Recently, the availability of large datasets through a global collaboration has provided the statistical power needed to characterize whole-brain structural and functional brain changes after ECT. In addition, MRI technological developments allow new aspects of brain function and structure to be investigated. Finally, more recent studies have also investigated immediate and long-term effects of ECT, which may aid in the separation of the therapeutically relevant effects from epiphenomena. The goal of this review is to outline MRI studies (T1, diffusion-weighted imaging, proton magnetic resonance spectroscopy) of ECT in depression to advance our understanding of the ECT neurobiological effects. Based on the reviewed literature, we suggest a model whereby the neurobiological effects can be understood within a framework of disruption, neuroplasticity, and rewiring of neural circuits. An improved characterization of the neurobiological effects of ECT may increase our understanding of ECT's therapeutic effects, ultimately leading to improved patient care.
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Affiliation(s)
- Olga Therese Ousdal
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway; Centre for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway.
| | - Giulio E Brancati
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ute Kessler
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Vera Erchinger
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Anders M Dale
- Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, California; Department of Radiology, University of California San Diego, La Jolla, California; Department of Neurosciences, University of California San Diego, La Jolla, California
| | - Christopher Abbott
- Department of Psychiatry, University of New Mexico, Albuquerque, New Mexico
| | - Leif Oltedal
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
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21
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Deng ZD, Argyelan M, Miller J, Quinn DK, Lloyd M, Jones TR, Upston J, Erhardt E, McClintock SM, Abbott CC. Electroconvulsive therapy, electric field, neuroplasticity, and clinical outcomes. Mol Psychiatry 2022; 27:1676-1682. [PMID: 34853404 PMCID: PMC9095458 DOI: 10.1038/s41380-021-01380-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/20/2021] [Accepted: 10/26/2021] [Indexed: 01/08/2023]
Abstract
Electroconvulsive therapy (ECT) remains the gold-standard treatment for patients with depressive episodes, but the underlying mechanisms for antidepressant response and procedure-induced cognitive side effects have yet to be elucidated. Such mechanisms may be complex and involve certain ECT parameters and brain regions. Regarding parameters, the electrode placement (right unilateral or bitemporal) determines the geometric shape of the electric field (E-field), and amplitude determines the E-field magnitude in select brain regions (e.g., hippocampus). Here, we aim to determine the relationships between hippocampal E-field strength, hippocampal neuroplasticity, and antidepressant and cognitive outcomes. We used hippocampal E-fields and volumes generated from a randomized clinical trial that compared right unilateral electrode placement with different pulse amplitudes (600, 700, and 800 mA). Hippocampal E-field strength was variable but increased with each amplitude arm. We demonstrated a linear relationship between right hippocampal E-field and right hippocampal neuroplasticity. Right hippocampal neuroplasticity mediated right hippocampal E-field and antidepressant outcomes. In contrast, right hippocampal E-field was directly related to cognitive outcomes as measured by phonemic fluency. We used receiver operating characteristic curves to determine that the maximal right hippocampal E-field associated with cognitive safety was 112.5 V/m. Right hippocampal E-field strength was related to the whole-brain ratio of E-field strength per unit of stimulation current, but this whole-brain ratio was unrelated to antidepressant or cognitive outcomes. We discuss the implications of optimal hippocampal E-field dosing to maximize antidepressant outcomes and cognitive safety with individualized amplitudes.
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Affiliation(s)
- Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Miklos Argyelan
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA
- Center for Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA
- Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry, Hempstead, NY, USA
| | - Jeremy Miller
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Davin K Quinn
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Megan Lloyd
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Thomas R Jones
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Joel Upston
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Erik Erhardt
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, NM, USA
| | - Shawn M McClintock
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
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22
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Li XK, Qiu HT. Current progress in neuroimaging research for the treatment of major depression with electroconvulsive therapy. World J Psychiatry 2022; 12:128-139. [PMID: 35111584 PMCID: PMC8783162 DOI: 10.5498/wjp.v12.i1.128] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/20/2021] [Accepted: 09/06/2021] [Indexed: 02/06/2023] Open
Abstract
Electroconvulsive therapy (ECT) uses a certain amount of electric current to pass through the head of the patient, causing convulsions throughout the body, to relieve the symptoms of the disease and achieve the purpose of treatment. ECT can effectively improve the clinical symptoms of patients with major depression, but its therapeutic mechanism is still unclear. With the rapid development of neuroimaging technology, it is necessary to explore the neurobiological mechanism of major depression from the aspects of brain structure, brain function and brain metabolism, and to find that ECT can improve the brain function, metabolism and even brain structure of patients to a certain extent. Currently, an increasing number of neuroimaging studies adopt various neuroimaging techniques including functional magnetic resonance imaging (MRI), positron emission tomography, magnetic resonance spectroscopy, structural MRI, and diffusion tensor imaging to reveal the neural effects of ECT. This article reviews the recent progress in neuroimaging research on ECT for major depression. The results suggest that the neurobiological mechanism of ECT may be to modulate the functional activity and connectivity or neural structural plasticity in specific brain regions to the normal level, to achieve the therapeutic effect.
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Affiliation(s)
- Xin-Ke Li
- College of Medical Informatics, Chongqing Medical University, Chongqing 400016, China
| | - Hai-Tang Qiu
- Mental Health Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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23
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Pizzagalli DA, Roberts AC. Prefrontal cortex and depression. Neuropsychopharmacology 2022; 47:225-246. [PMID: 34341498 PMCID: PMC8617037 DOI: 10.1038/s41386-021-01101-7] [Citation(s) in RCA: 151] [Impact Index Per Article: 75.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 01/03/2023]
Abstract
The prefrontal cortex (PFC) has emerged as one of the regions most consistently impaired in major depressive disorder (MDD). Although functional and structural PFC abnormalities have been reported in both individuals with current MDD as well as those at increased vulnerability to MDD, this information has not translated into better treatment and prevention strategies. Here, we argue that dissecting depressive phenotypes into biologically more tractable dimensions - negative processing biases, anhedonia, despair-like behavior (learned helplessness) - affords unique opportunities for integrating clinical findings with mechanistic evidence emerging from preclinical models relevant to depression, and thereby promises to improve our understanding of MDD. To this end, we review and integrate clinical and preclinical literature pertinent to these core phenotypes, while emphasizing a systems-level approach, treatment effects, and whether specific PFC abnormalities are causes or consequences of MDD. In addition, we discuss several key issues linked to cross-species translation, including functional brain homology across species, the importance of dissecting neural pathways underlying specific functional domains that can be fruitfully probed across species, and the experimental approaches that best ensure translatability. Future directions and clinical implications of this burgeoning literature are discussed.
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Affiliation(s)
- Diego A Pizzagalli
- Department of Psychiatry, Harvard Medical School & McLean Hospital, Belmont, MA, USA.
| | - Angela C Roberts
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK.
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24
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Yin X, Chen L, Ma M, Zhang H, Gao M, Wu X, Li Y. Altered Brain Structure and Spontaneous Functional Activity in Children With Concomitant Strabismus. Front Hum Neurosci 2021; 15:777762. [PMID: 34867247 PMCID: PMC8634149 DOI: 10.3389/fnhum.2021.777762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
Strabismus occurs in about 2% of children and may result in amblyopia or lazy eyes and loss of depth perception. However, whether/how long-term strabismus shapes the brain structure and functions in children with concomitant strabismus (CS) is still unclear. In this study, a total of 26 patients with CS and 28 age-, sex-, and education-matched healthy controls (HCs) underwent structural and resting-state functional magnetic resonance imaging examination. The cortical thickness and amplitude of low-frequency fluctuation (ALFF) were calculated to assess the structural and functional plasticity in children with CS. Compared with HCs group, patients with CS showed increased cortical thickness in the precentral gyrus and angular gyrus while decreased cortical thickness in the left intraparietal sulcus, parieto-occipital sulcus, superior and middle temporal gyrus, right ventral premotor cortex, anterior insula, orbitofrontal cortex, and paracentral lobule. Meanwhile, CS patients exhibited increased ALFF in the prefrontal cortex and superior temporal gyrus, and decreased ALFF in the caudate and hippocampus. These results show that children with CS have abnormal structure and function in brain regions subserving eye movement, controls, and high-order cognitive functions. Our findings revealed the structural and functional abnormalities induced by CS and may provide new insight into the underlying neural mechanisms for CS.
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Affiliation(s)
- Xiaohui Yin
- Department of Radiology, The Affiliated Xi'an Central Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lingjun Chen
- Department of Radiology, Gaoling District Hospital, Xi'an, China
| | - Mingyue Ma
- Department of Radiology, The Affiliated Xi'an Central Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hong Zhang
- Department of Radiology, The Affiliated Xi'an Central Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ming Gao
- Department of Radiology, The Affiliated Xi'an Central Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaoping Wu
- Department of Radiology, The Affiliated Xi'an Central Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yongqiang Li
- Department of CT and MRI, Weinan Hospital of Traditional Chinese Medicine, Weinan, China
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25
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Brancati GE, Brekke N, Bartsch H, Evjenth Sørhaug OJ, Ousdal OT, Hammar Å, Schuster PM, Oedegaard KJ, Kessler U, Oltedal L. Short and long-term effects of single and multiple sessions of electroconvulsive therapy on brain gray matter volumes. Brain Stimul 2021; 14:1330-1339. [PMID: 34464746 DOI: 10.1016/j.brs.2021.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) has been shown to induce broadly distributed cortical and subcortical volume increases, more prominently in the amygdala and the hippocampus. Structural changes after one ECT session and in the long-term have been understudied. OBJECTIVE The aim of this study was to describe short-term and long-term volume changes induced in cortical and subcortical regions by ECT. METHODS Structural brain data were acquired from depressed patients before and 2 h after their first ECT session, 7-14 days after the end of the ECT series and at 6 months follow up (N = 34). Healthy, age and gender matched volunteers were scanned according to the same schedule (N = 18) and patients affected by atrial fibrillation were scanned 1-2 h before and after undergoing electrical cardioversion (N = 16). Images were parcelled using FreeSurfer and estimates of cortical gray matter volume and subcortical volume changes were obtained using Quarc. RESULTS Volume increase was observable in most of gray matter regions after 2 h from the first ECT session, with significant results in brain stem, bilateral hippocampi, right putamen and left thalamus, temporal and occipital regions in the right hemisphere. At the end of treatment series, widespread significant volume changes were observed. After six months, the right amygdala volume was still significantly increased. No significant changes were observed in the comparison groups. CONCLUSIONS Volume increases in gray matter areas can be detected 2 h after a single ECT session. Further studies are warranted to explore the underlying molecular mechanisms.
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Affiliation(s)
| | - Njål Brekke
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Hauke Bartsch
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | | | - Olga Therese Ousdal
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway; Centre for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Åsa Hammar
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Biological and Medical Psychology, University of Bergen, Norway
| | - Peter Moritz Schuster
- Department of Clinical Science, University of Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Ketil Joachim Oedegaard
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Ute Kessler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Leif Oltedal
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
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26
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Kruse JL, Olmstead R, Hellemann G, Breen EC, Tye SJ, Brooks JO, Wade B, Congdon E, Espinoza R, Narr KL, Irwin MR. Interleukin-8 and lower severity of depression in females, but not males, with treatment-resistant depression. J Psychiatr Res 2021; 140:350-356. [PMID: 34139457 PMCID: PMC8319139 DOI: 10.1016/j.jpsychires.2021.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/17/2021] [Accepted: 06/04/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION In cross-sectional studies of depressed patients, relationships between depression and levels of IL-8 are inconsistent, and have not been examined in relation to sex. Given identified sex differences in longitudinal data, it is important to evaluate sex-specific cross-sectional relationships between IL-8 and depressive symptoms, which may explain some inconsistency in the extant literature. It is further unknown whether IL-8 levels may relate to specific symptom profiles among depressed patients, with or without regard to sex. METHODS Among 108 patients with treatment resistant depression (50 females), we evaluated cross-sectional relationships between IL-8 and depression severity, as measured by the Hamilton Depression Rating Scale [HAM-D] Score, and examined sex-specific relationships, as well as relationships with depressive symptom profiles. Other inflammatory markers (IL-6, IL-10, TNF-α, CRP) were also explored in relation to HAM-D. RESULTS Higher IL-8 was associated with lower total HAM-D score (standardized β = -0.19, p = 0.049). Sex-specific effects were identified (IL-8 x sex interaction: p = 0.03), in which higher IL-8 related to lower HAM-D score in females (standardized β = -0.41, p = 0.004, effect size (sr2) = 0.17), but not males (standardized β = 0.02, p = 0.91). Among a subset of 94 patients (41 females) who had individual HAM-D items available, we evaluated relationships between IL-8 and HAM-D factor subscores. Across sexes, higher IL-8 was associated with lower anxiety/hypochondriasis subscores (standardized β = -0.31, p = 0.002; sex interaction: p = 0.99). Sex differences were identified for relationships between IL-8 and two other HAM-D factor subscores. CONCLUSIONS IL-8 may be related to anxiety symptoms across sexes, but may have a sex-specific relationship with other depressive symptoms. Further evaluation of sex-specific relationships between IL-8, depression symptom profiles, treatment response, and potential neurobiological correlates, may inform mechanisms of depression pathophysiology and aid in development of precision medicine strategies.
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Affiliation(s)
- Jennifer L Kruse
- Cousins Center for Psychoneuroimmunology, United States; Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, United States.
| | - Richard Olmstead
- Cousins Center for Psychoneuroimmunology, United States; Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, United States
| | - Gerhard Hellemann
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, United States
| | - Elizabeth C Breen
- Cousins Center for Psychoneuroimmunology, United States; Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, United States
| | - Susannah J Tye
- Queensland Brain Institute, The University of Queensland, Australia; Department of Psychiatry & Psychology, Mayo Clinic, United States; Department of Psychiatry, University of Minnesota, United States
| | - John O Brooks
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, United States
| | - Benjamin Wade
- Department of Neurology, University of California at Los Angeles, Los Angeles, CA, United States
| | - Eliza Congdon
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, United States
| | - Randall Espinoza
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, United States
| | - Katherine L Narr
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, United States; Department of Neurology, University of California at Los Angeles, Los Angeles, CA, United States
| | - Michael R Irwin
- Cousins Center for Psychoneuroimmunology, United States; Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, United States
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27
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Leaver AM, Vasavada M, Kubicki A, Wade B, Loureiro J, Hellemann G, Joshi SH, Woods RP, Espinoza R, Narr KL. Hippocampal subregions and networks linked with antidepressant response to electroconvulsive therapy. Mol Psychiatry 2021; 26:4288-4299. [PMID: 32029885 PMCID: PMC7415508 DOI: 10.1038/s41380-020-0666-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/11/2019] [Accepted: 01/28/2020] [Indexed: 01/29/2023]
Abstract
Electroconvulsive therapy (ECT) has been repeatedly linked to hippocampal plasticity. However, it remains unclear what role hippocampal plasticity plays in the antidepressant response to ECT. This magnetic resonance imaging (MRI) study tracks changes in separate hippocampal subregions and hippocampal networks in patients with depression (n = 44, 23 female) to determine their relationship, if any, with improvement after ECT. Voxelwise analyses were restricted to the hippocampus, amygdala, and parahippocampal cortex, and applied separately for responders and nonresponders to ECT. In analyses of arterial spin-labeled (ASL) MRI, nonresponders exhibited increased cerebral blood flow (CBF) in bilateral anterior hippocampus, while responders showed CBF increases in right middle and left posterior hippocampus. In analyses of gray matter volume (GMV) using T1-weighted MRI, GMV increased throughout bilateral hippocampus and surrounding tissue in nonresponders, while responders showed increased GMV in right anterior hippocampus only. Using CBF loci as seed regions, BOLD-fMRI data from healthy controls (n = 36, 19 female) identified spatially separable neurofunctional networks comprised of different brain regions. In graph theory analyses of these networks, functional connectivity within a hippocampus-thalamus-striatum network decreased only in responders after two treatments and after index. In sum, our results suggest that the location of ECT-related plasticity within the hippocampus may differ according to antidepressant outcome, and that larger amounts of hippocampal plasticity may not be conducive to positive antidepressant response. More focused targeting of hippocampal subregions and/or circuits may be a way to improve ECT outcome.
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Affiliation(s)
- Amber M. Leaver
- Ahmanson-Lovelace Brain Mapping Center, Department of
Neurology, University of California Los Angeles, Los Angeles, CA, 90095,Center for Translational Imaging, Department of Radiology,
Northwestern University, Chicago, IL, 60611,Corresponding Author: Amber M. Leaver Ph.D.,
Address: 737 N Michigan Ave, Suite 1600, Chicago, IL 60611, Phone 312 694 2966,
Fax 310 926 5991,
| | - Megha Vasavada
- Ahmanson-Lovelace Brain Mapping Center, Department of
Neurology, University of California Los Angeles, Los Angeles, CA, 90095
| | - Antoni Kubicki
- Ahmanson-Lovelace Brain Mapping Center, Department of
Neurology, University of California Los Angeles, Los Angeles, CA, 90095
| | - Benjamin Wade
- Ahmanson-Lovelace Brain Mapping Center, Department of
Neurology, University of California Los Angeles, Los Angeles, CA, 90095
| | - Joana Loureiro
- Ahmanson-Lovelace Brain Mapping Center, Department of
Neurology, University of California Los Angeles, Los Angeles, CA, 90095
| | - Gerhard Hellemann
- Department of Psychiatry and Biobehavioral Sciences,
University of California Los Angeles, Los Angeles, CA, 90095
| | - Shantanu H. Joshi
- Ahmanson-Lovelace Brain Mapping Center, Department of
Neurology, University of California Los Angeles, Los Angeles, CA, 90095
| | - Roger P. Woods
- Ahmanson-Lovelace Brain Mapping Center, Department of
Neurology, University of California Los Angeles, Los Angeles, CA, 90095,Department of Psychiatry and Biobehavioral Sciences,
University of California Los Angeles, Los Angeles, CA, 90095
| | - Randall Espinoza
- Department of Psychiatry and Biobehavioral Sciences,
University of California Los Angeles, Los Angeles, CA, 90095
| | - Katherine L. Narr
- Ahmanson-Lovelace Brain Mapping Center, Department of
Neurology, University of California Los Angeles, Los Angeles, CA, 90095,Department of Psychiatry and Biobehavioral Sciences,
University of California Los Angeles, Los Angeles, CA, 90095
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28
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Jeong H, Lee YJ, Kim N, Jeon S, Jun JY, Yoo SY, Lee SH, Lee J, Kim SJ. Increased medial prefrontal cortical thickness and resilience to traumatic experiences in North Korean refugees. Sci Rep 2021; 11:14910. [PMID: 34290327 PMCID: PMC8295347 DOI: 10.1038/s41598-021-94452-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 07/12/2021] [Indexed: 11/09/2022] Open
Abstract
Little is known regarding structural brain changes in traumatized refugees and the association with psychopathology. In the present study, the cortical thickness in North Korean refugees and the association with psychological symptoms were explored. North Korean refugees with lifetime post-traumatic stress disorder (PTSD group, n = 27), trauma-exposed North Korean refugees without lifetime PTSD (trauma-exposed control (TEC) group, n = 23), and healthy South Korean controls without traumatic experiences (HC group, n = 51) completed questionnaires assessing depression, anxiety, somatization, and PTSD symptoms. The cortical thickness was measured by magnetic resonance imaging (MRI) using FreeSurfer. Age- and sex-adjusted cortical thickness of the right medial prefrontal cortex (mPFC) was greater in the TEC group than in the HC group. However, significant differences were not observed between the PTSD and HC groups. Increased right mPFC thickness was significantly correlated with less anxiety and somatization after controlling for age and sex in the TEC group, but not in the PTSD or HC groups. North Korean refugees who did not develop PTSD after trauma showed increased right mPFC thickness, which was associated with less severe psychiatric symptoms. These findings indicate that increased mPFC thickness might have helped to reduce PTSD and psychiatric symptoms after trauma, and likely reflects resilience achieved by potentially enhancing emotional regulation in the mPFC.
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Affiliation(s)
- Hyunwoo Jeong
- Geumsan-Gun Public Health Center, Geumsan, Republic of Korea
| | - Yu Jin Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Nambeom Kim
- Neuroscience Research Institute, Gachon University, Incheon, Republic of Korea
| | - Sehyun Jeon
- Department of Psychiatry, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jin Yong Jun
- Department of Psychiatry, Seoul National Hospital, Seoul, Republic of Korea
| | - So Young Yoo
- Department of Psychiatry, National Medical Center, Seoul, Republic of Korea
| | - So Hee Lee
- Department of Psychiatry, National Medical Center, Seoul, Republic of Korea
| | - Jooyoung Lee
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Seog Ju Kim
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea.
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29
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Takamiya A, Bouckaert F, Laroy M, Blommaert J, Radwan A, Khatoun A, Deng ZD, Mc Laughlin M, Van Paesschen W, De Winter FL, Van den Stock J, Sunaert S, Sienaert P, Vandenbulcke M, Emsell L. Biophysical mechanisms of electroconvulsive therapy-induced volume expansion in the medial temporal lobe: A longitudinal in vivo human imaging study. Brain Stimul 2021; 14:1038-1047. [PMID: 34182182 PMCID: PMC8474653 DOI: 10.1016/j.brs.2021.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/23/2021] [Accepted: 06/23/2021] [Indexed: 01/22/2023] Open
Abstract
Background: Electroconvulsive therapy (ECT) applies electric currents to the brain to induce seizures for therapeutic purposes. ECT increases gray matter (GM) volume, predominantly in the medial temporal lobe (MTL). The contribution of induced seizures to this volume change remains unclear. Methods: T1-weighted structural MRI was acquired from thirty patients with late-life depression (mean age 72.5 ± 7.9 years, 19 female), before and one week after one course of right unilateral ECT. Whole brain voxel-/deformation-/surface-based morphometry analyses were conducted to identify tissue-specific (GM, white matter: WM), and cerebrospinal fluid (CSF) and cerebral morphometry changes following ECT. Whole-brain voxel-wise electric field (EF) strength was estimated to investigate the association of EF distribution and regional brain volume change. The association between percentage volume change in the right MTL and ECT-related parameters (seizure duration, EF, and number of ECT sessions) was investigated using multiple regression. Results: ECT induced widespread GM volume expansion with corresponding contraction in adjacent CSF compartments, and limited WM change. The regional EF was strongly correlated with the distance from the electrodes, but not with regional volume change. The largest volume expansion was identified in the right MTL, and this was correlated with the total seizure duration. Conclusions: Right unilateral ECT induces widespread, bilateral regional volume expansion and contraction, with the largest change in the right MTL. This dynamic volume change cannot be explained by the effect of electrical stimulation alone and is related to the cumulative effect of ECT-induced seizures.
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Affiliation(s)
- Akihiro Takamiya
- KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry, Leuven, Belgium; Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Filip Bouckaert
- KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry, Leuven, Belgium; Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium
| | - Maarten Laroy
- KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry, Leuven, Belgium
| | - Jeroen Blommaert
- KU Leuven, Department of Oncology, Gynaecological Oncology, Leuven, Belgium
| | - Ahmed Radwan
- KU Leuven, Department of Imaging & Pathology, Translational MRI, Leuven, Belgium
| | - Ahmad Khatoun
- KU Leuven, Leuven Brain Institute, Department of Neurosciences, Research Group Experimental Oto-rhino-laryngology, Leuven, Belgium
| | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Myles Mc Laughlin
- KU Leuven, Leuven Brain Institute, Department of Neurosciences, Research Group Experimental Oto-rhino-laryngology, Leuven, Belgium
| | - Wim Van Paesschen
- KU Leuven, Leuven Brain Institute, Department of Neurosciences, Research Group Experimental Neurology, Leuven, Belgium
| | - François-Laurent De Winter
- KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry, Leuven, Belgium; Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium
| | - Jan Van den Stock
- KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry, Leuven, Belgium; Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium
| | - Stefan Sunaert
- KU Leuven, Department of Imaging & Pathology, Translational MRI, Leuven, Belgium; Department of Radiology, University Hospitals Leuven (UZ Leuven), Leuven, Belgium
| | - Pascal Sienaert
- Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center, KU Leuven, Kortenberg, Belgium
| | - Mathieu Vandenbulcke
- KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry, Leuven, Belgium; Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium
| | - Louise Emsell
- KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry, Leuven, Belgium; Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium; KU Leuven, Department of Imaging & Pathology, Translational MRI, Leuven, Belgium.
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30
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Gryglewski G, Lanzenberger R, Silberbauer LR, Pacher D, Kasper S, Rupprecht R, Frey R, Baldinger-Melich P. Meta-analysis of brain structural changes after electroconvulsive therapy in depression. Brain Stimul 2021; 14:927-937. [PMID: 34119669 DOI: 10.1016/j.brs.2021.05.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 04/30/2021] [Accepted: 05/19/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Increases in the volume of the amygdala and hippocampus after electroconvulsive therapy (ECT) are among the most robust effects known to the brain-imaging field. Recent advances in the segmentation of substructures of these regions allow for novel insights on the relationship between brain structure and clinical outcomes of ECT. OBJECTIVE We aimed to provide a comprehensive synthesis of evidence available on changes in brain structure after ECT, including recently published data on hippocampal subfields. METHODS A meta-analysis of published studies was carried out using random-effects models of standardized mean change of regional brain volumes measured with longitudinal magnetic resonance imaging of depressive patients before and after a series of ECT. RESULTS Data from 21 studies (543 depressed patients) were analysed, including 6 studies (118 patients) on hippocampal subfields. Meta-analyses could be carried out for seven brain regions for which data from at least three published studies was available. We observed increases in left and right hippocampi, amygdalae, cornua ammonis (CA) 1, CA 2/3, dentate gyri (DG) and subicula with standardized mean change scores ranging between 0.34 and 1.15. The model did not reveal significant volume increases in the caudate. Meta-regression indicated a negative relationship between the reported increases in the DG and relative symptom improvement (-0.27 (SE: 0.09) per 10%). CONCLUSIONS ECT is accompanied by significant volume increases in the bilateral hippocampus and amygdala that are not associated with treatment outcome. Among hippocampal subfields, the most robust volume increases after ECT were measured in the dentate gyrus. The indicated negative correlation of this effect with antidepressant efficacy warrants replication in data of individual patients.
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Affiliation(s)
- Gregor Gryglewski
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Austria
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Austria
| | - Leo R Silberbauer
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Austria
| | - Daniel Pacher
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Austria
| | - Siegfried Kasper
- Center for Brain Research, Medical University of Vienna, Austria
| | - Rainer Rupprecht
- Department of Psychiatry and Psychotherapy, University of Regensburg, Germany
| | - Richard Frey
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Austria
| | - Pia Baldinger-Melich
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Austria.
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31
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Ge R, Gregory E, Wang J, Ainsworth N, Jian W, Yang C, Wang G, Vila-Rodriguez F. Magnetic seizure therapy is associated with functional and structural brain changes in MDD: Therapeutic versus side effect correlates. J Affect Disord 2021; 286:40-48. [PMID: 33676262 DOI: 10.1016/j.jad.2021.02.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/27/2020] [Accepted: 02/18/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Magnetic Seizure therapy (MST) is an effective treatment for major depressive disorder (MDD) but its mechanism of action is not fully understood. The present study sought to characterize neuroimaging correlates of response and side effects of MST in a MDD cohort. METHODS Fifteen severe MDD patients underwent a six-day course of MST treatment to the vertex. Before and after treatment, participants received rs-fMRI and structural MRI scans as well as assessments of depressive symptoms and neuropsychological functioning. 10 healthy volunteers received functional and structural MRI scans at similar time intervals. RESULTS MST treatment was associated with increased functional connectivity between the subgenual anterior cingulate cortex (sgACC) and the parietal cortex, which positively correlated with clinical improvement. In contrast, greater decrease in functional connectivity between the right anterior hippocampus and the prefrontal cortex was correlated with lesser clinical and cognitive improvements. Changes in gray matter volume were evident in the bilateral parietal cortex, but were not associated with treatment outcomes. LIMITATIONS The sample size was small and results warrant replication. CONCLUSIONS This is the first quantitative fMRI study to investigate the neural correlates of MST treatment for MDD patients. While preliminary, these findings suggest that the modulation of sgACC activity is integral to the antidepressant mechanisms of MST. In contrast, changes in the hippocampus were not associated with symptom improvement, and appeared to contribute instead to side effects. Future studies in larger samples are warranted and explore the effect of e-electric field and correlates of response.
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Affiliation(s)
- Ruiyang Ge
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada
| | - Elizabeth Gregory
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada
| | - Jian Wang
- Department of psychiatry, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Nicholas Ainsworth
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada
| | - Wei Jian
- The National Clinical Research Centre for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, School of Mental Health, Beijing 100088, China
| | - Chunlin Yang
- The National Clinical Research Centre for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, School of Mental Health, Beijing 100088, China
| | - Gang Wang
- The National Clinical Research Centre for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, School of Mental Health, Beijing 100088, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100069, China.
| | - Fidel Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada.
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32
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Lai CH. Fronto-limbic neuroimaging biomarkers for diagnosis and prediction of treatment responses in major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2021; 107:110234. [PMID: 33370569 DOI: 10.1016/j.pnpbp.2020.110234] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 12/02/2020] [Accepted: 12/21/2020] [Indexed: 12/23/2022]
Abstract
The neuroimaging is an important tool for understanding the biomarkers and predicting treatment responses in major depressive disorder (MDD). The potential biomarkers and prediction of treatment response in MDD will be addressed in the review article. The brain regions of cognitive control and emotion regulation, such as the frontal and limbic regions, might represent the potential targets for MDD biomarkers. The potential targets of frontal lobes might include anterior cingulate cortex (ACC), dorsolateral prefrontal cortex (DLPFC) and orbitofrontal cortex (OFC). For the limbic system, hippocampus and amygdala might be the potentially promising targets for MDD. The potential targets of fronto-limbic regions have been found in the studies of several major neuroimaging modalities, such as the magnetic resonance imaging, near-infrared spectroscopy, electroencephalography, positron emission tomography, and single-photon emission computed tomography. Additional regions, such as brainstem and midbrain, might also play a part in the MDD biomarkers. For the prediction of treatment response, the gray matter volumes, white matter tracts, functional representations and receptor bindings of ACC, DLPFC, OFC, amygdala, and hippocampus might play a role in the prediction of antidepressant responses in MDD. For the response prediction of psychotherapies, the fronto-limbic, reward regions, and insula will be the potential targets. For the repetitive transcranial magnetic stimulation, the DLPFC, ACC, limbic, and visuospatial regions might represent the predictive targets for treatment. The neuroimaging targets of MDD might be focused in the fronto-limbic regions. However, the neuroimaging targets for the prediction of treatment responses might be inconclusive and beyond the fronto-limbic regions.
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Affiliation(s)
- Chien-Han Lai
- Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan; PhD Psychiatry & Neuroscience Clinic, Taoyuan, Taiwan.
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33
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Seymour J. Commentary and Update on the Contribution of the GABA Hypothesis to Understanding the Mechanism of Action of Electroconvulsive Therapy. J ECT 2021; 37:4-9. [PMID: 32826706 DOI: 10.1097/yct.0000000000000711] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Jeremy Seymour
- From the Cherry Tree Court, Tickhill Road Site, Balby Doncaster DN4 8QN, United Kingdom
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34
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Temporal trajectory of brain tissue property changes induced by electroconvulsive therapy. Neuroimage 2021; 232:117895. [PMID: 33617994 DOI: 10.1016/j.neuroimage.2021.117895] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/31/2020] [Accepted: 02/16/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND After more than eight decades of electroconvulsive therapy (ECT) for pharmaco-resistant depression, the mechanisms governing its anti-depressant effects remain poorly understood. Computational anatomy studies using longitudinal T1-weighted magnetic resonance imaging (MRI) data have demonstrated ECT effects on hippocampus volume and cortical thickness, but they lack the interpretational specificity about underlying neurobiological processes. METHODS We sought to fill in the gap of knowledge by acquiring quantitative MRI indicative for brain's myelin, iron and tissue water content at multiple time-points before, during and after ECT treatment. We adapted established tools for longitudinal spatial registration of MRI data to the relaxometry-based multi-parameter maps aiming to preserve the initial total signal amount and introduced a dedicated multivariate analytical framework. RESULTS The whole-brain voxel-based analysis based on a multivariate general linear model showed that there is no brain tissue oedema contributing to the predicted ECT-induced hippocampus volume increase neither in the short, nor in the long-term observations. Improvements in depression symptom severity over time were associated with changes in both volume estimates and brain tissue properties expanding beyond mesial temporal lobe structures to anterior cingulate cortex, precuneus and striatum. CONCLUSION The obtained results stemming from multi-contrast MRI quantitative data provided a fingerprint of ECT-induced brain tissue changes over time that are contrasted against the background of established morphometry findings. The introduced data processing and statistical testing algorithms provided a reliable analytical framework for longitudinal multi-parameter brain maps. The results, particularly the evidence of lack of ECT impact on brain tissue water, should be considered preliminary considering the small sample size of the study.
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35
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Wu P, Zhang A, Sun N, Lei L, Liu P, Wang Y, Li H, Yang C, Zhang K. Cortical Thickness Predicts Response Following 2 Weeks of SSRI Regimen in First-Episode, Drug-Naive Major Depressive Disorder: An MRI Study. Front Psychiatry 2021; 12:751756. [PMID: 35273524 PMCID: PMC8902047 DOI: 10.3389/fpsyt.2021.751756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 12/23/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Major depression disorder (MDD) is a harmful disorder, and the pathological mechanism remains unclear. The primary pharmacotherapy regimen for MDD is selective serotonin reuptake inhibitors (SSRIs), but fewer than 40% of patients with MDD are in remission following initial treatment. Neuroimaging biomarkers of treatment efficacy can be used to guide personalized treatment in MDD. This study aims to determine if cortical thickness can be used as a predictor for SSRIs. METHODS A total of 126 first-episode, drug-naive MDD patients (MDDs) and 71 healthy controls (HCs) were enrolled in our study. Demographic data were collected according to the self-made case report form (CRF) at the baseline of all subjects. Magnetic resonance imaging (MRI) scanning was performed for all the participants at baseline, and all imaging was processed using the DPABISurf software. All MDDs were treated with SSRIs, and symptoms were assessed at both the baseline and 2 weeks using the 17-item Hamilton Rating Scale (HAMD-17). According to HAMD-17 total score improvement from baseline to the end of 2 weeks, the MDDs were divided into the non-responder group (defined as ≤ 20% HAMD-17 reduction) and responder group (defined as ≥50% HAMD-17 reduction). The receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of MDDs' and HCs' cortical thickness for MDD. Correlation analysis was performed for the responder group and the non-responder group separately to identify the relationship between cortical thickness and SSRI treatment efficacy. To analyze whether cortical thickness was sufficient to differentiate responders and non-responders at baseline, we used ROC curve analysis. RESULTS Significant decreases were found in the cortical thickness of the right supplementary motor area (SMA) in MDDs at the baseline (corrected by the Monte Carlo permutation correction, cluster-wise significant threshold at p < 0.025 and vertex-wise threshold at p = 0.001), area under the curve (AUC) = 0.732 [95% confidence interval (CI) = 0.233-0.399]. In the responder group, the cortical thickness of the right SMA was significantly thinner than in the non-responder group at baseline. There was a negative correlation (r = -0.373, p = 0.044) between the cortical thickness of SMA (0 weeks) and HAMD-17 reductive rate (2 weeks) in the responder group. The results of ROC curve analyses of the responder and non-responder groups were AUC = 0.885 (95% CI = 0.803-0.968), sensitivity = 73.5%, and specificity = 96.6%, and the cutoff value was 0.701. CONCLUSION Lower cortical thickness of the right SMA in MDD patients at the baseline may be a neuroimaging biomarker for MDD diagnosis, and a greater extent of thinner cortical thickness in the right SMA at baseline may predict improved SSRI treatment response. Our study shows the potential of cortical thickness as a possible biomarker that predicts a patient's clinical treatment response to SSRIs in MDD.
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Affiliation(s)
- Peiyi Wu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China.,Department of Psychiatry, Shanxi Medical University, Taiyuan, China
| | - Aixia Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Ning Sun
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China.,Department of Mental Health, Shanxi Medical University, Taiyuan, China
| | - Lei Lei
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China.,Department of Psychiatry, Shanxi Medical University, Taiyuan, China
| | - Penghong Liu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yikun Wang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Hejun Li
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Chunxia Yang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Kerang Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
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36
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Yamasaki S, Aso T, Miyata J, Sugihara G, Hazama M, Nemoto K, Yoshihara Y, Matsumoto Y, Okada T, Togashi K, Murai T, Takahashi H, Suwa T. Early and late effects of electroconvulsive therapy associated with different temporal lobe structures. Transl Psychiatry 2020; 10:344. [PMID: 33051437 PMCID: PMC7553938 DOI: 10.1038/s41398-020-01025-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 08/14/2020] [Accepted: 09/03/2020] [Indexed: 12/31/2022] Open
Abstract
Recent studies examining electroconvulsive therapy (ECT) have reported that early sessions can induce rapid antidepressant and antipsychotic effects, and the early termination of ECT was reported to increase the risk of relapse. We hypothesized that different neural mechanisms associated with the therapeutic effects of ECT may be involved in the different responses observed during the early and late periods of ECT treatment. We investigated whether these antidepressant and antipsychotic effects were associated with temporally and spatially different regional gray matter volume (GMV) changes during ECT. Fourteen patients with major depressive disorder, with or without psychotic features, underwent 3-Tesla structural magnetic resonance imaging scans before (time point [Tp] 1), after the fifth or sixth ECT session (Tp2), and after ECT completion (Tp3). We investigated the regions in which GMV changed between Tp1 and Tp2, Tp2 and Tp3, and Tp1 and Tp3 using voxel-based morphometry. In addition, we investigated the association between regional GMV changes and improvement in depressive or psychotic symptoms. GMV increase in the left superior and inferior temporal gyrus during Tp1-Tp2 was associated with improvement in psychotic symptoms (P < 0.025). GMV increase in the left hippocampus was associated with improvement of depressive symptoms in Tp2-Tp3 (P < 0.05). Our findings suggest that different temporal lobe structures are associated with early antipsychotic and late antidepressant effects of ECT.
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Affiliation(s)
- Shimpei Yamasaki
- grid.258799.80000 0004 0372 2033Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshihiko Aso
- grid.258799.80000 0004 0372 2033Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan ,Laboratory for Brain Connectomics Imaging, RIKEN Center for Biosystems Dynamics Research, Kobe, Japan ,grid.258799.80000 0004 0372 2033Human Brain Research Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Jun Miyata
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Genichi Sugihara
- grid.258799.80000 0004 0372 2033Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan ,grid.265073.50000 0001 1014 9130Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaaki Hazama
- grid.258799.80000 0004 0372 2033Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kiyotaka Nemoto
- grid.20515.330000 0001 2369 4728Department of Psychiatry, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yujiro Yoshihara
- grid.258799.80000 0004 0372 2033Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan ,grid.258799.80000 0004 0372 2033Human Brain Research Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yukiko Matsumoto
- grid.258799.80000 0004 0372 2033Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomohisa Okada
- grid.258799.80000 0004 0372 2033Human Brain Research Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kaori Togashi
- grid.258799.80000 0004 0372 2033Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshiya Murai
- grid.258799.80000 0004 0372 2033Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hidehiko Takahashi
- grid.258799.80000 0004 0372 2033Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan ,grid.265073.50000 0001 1014 9130Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taro Suwa
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
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37
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Kruse JL, Olmstead R, Hellemann G, Wade B, Jiang J, Vasavada MM, Brooks JO, Congdon E, Espinoza R, Narr KL, Irwin MR. Inflammation and depression treatment response to electroconvulsive therapy: Sex-specific role of interleukin-8. Brain Behav Immun 2020; 89:59-66. [PMID: 32479994 PMCID: PMC7572496 DOI: 10.1016/j.bbi.2020.05.069] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/15/2020] [Accepted: 05/26/2020] [Indexed: 12/12/2022] Open
Abstract
Females suffer from depression at twice the rate of males and have differential neural and emotional responses to inflammation. However, sex-specific evaluation of relationships between inflammation and response to depression treatments are lacking. Some data suggest that interleukin(IL)-8 predicts treatment response to antidepressants and has a relationship with depressive symptom severity. This study examines whether IL-8 predicts treatment response to electroconvulsive therapy (ECT), and whether there are sex specific effects. In 40 depressed patients (22 female), plasma levels of IL-8, as well as other markers of inflammation including IL-6, IL-10, tumor necrosis factor (TNF)-α, and C-reactive protein (CRP) were obtained prior to administration of ECT and after completion of the index treatment series. Depression treatment response was defined as ≥ 50% reduction in Hamilton Depression Rating Scale (HAM-D) Score. Baseline levels of IL-8 differed by responder status, depending on sex (group × sex interaction: β = -0.571, p = 0.04), with female responders having lower levels of IL-8 at baseline as compared to female non-responders [t(20) = 2.37, p = 0.03]. Further, IL-8 levels from baseline to end of treatment differed by responder status, depending on sex (group × sex × time interaction: [F(1,36) = 9.48, p = 0.004]), and change in IL-8 from baseline to end of treatment was negatively correlated with percentage change in HAM-D score in females (β = -0.458, p = 0.03), but not in males (β = 0.315, p = 0.20). Other inflammatory markers did not differ in relation to responder status and sex. Further evaluation of sex differences in the relationship between IL-8, depression, and treatment response, across disparate treatment modalities, may inform mechanisms of response and aid in development of personalized medicine strategies.
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Affiliation(s)
- Jennifer L. Kruse
- Cousins Center for Psychoneuroimmunology,Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine
| | - Richard Olmstead
- Cousins Center for Psychoneuroimmunology,Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine
| | - Gerhard Hellemann
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine
| | - Benjamin Wade
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine,Department of Neurology, University of California at Los Angeles, Los Angeles, California
| | - Janina Jiang
- Cousins Center for Psychoneuroimmunology,Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine
| | - Megha M. Vasavada
- Department of Neurology, University of California at Los Angeles, Los Angeles, California
| | - John O. Brooks
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine
| | - Eliza Congdon
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine
| | - Randall Espinoza
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine
| | - Katherine L. Narr
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine,Department of Neurology, University of California at Los Angeles, Los Angeles, California
| | - Michael R. Irwin
- Cousins Center for Psychoneuroimmunology,Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine
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38
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Sackeim HA. The impact of electroconvulsive therapy on brain grey matter volume: What does it mean? Brain Stimul 2020; 13:1226-1231. [DOI: 10.1016/j.brs.2020.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 01/16/2023] Open
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Jolly AJ, Singh SM. Does electroconvulsive therapy cause brain damage: An update. Indian J Psychiatry 2020; 62:339-353. [PMID: 33165343 PMCID: PMC7597699 DOI: 10.4103/psychiatry.indianjpsychiatry_239_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/23/2019] [Accepted: 02/08/2020] [Indexed: 12/31/2022] Open
Abstract
Electroconvulsive therapy (ECT) is an effective modality of treatment for a variety of psychiatric disorders. However, it has always been accused of being a coercive, unethical, and dangerous modality of treatment. The dangerousness of ECT has been mainly attributed to its claimed ability to cause brain damage. This narrative review aims to provide an update of the evidence with regard to whether the practice of ECT is associated with damage to the brain. An accepted definition of brain damage remains elusive. There are also ethical and technical problems in designing studies that look at this question specifically. Thus, even though there are newer technological tools and innovations, any review attempting to answer this question would have to take recourse to indirect methods. These include structural, functional, and metabolic neuroimaging; body fluid biochemical marker studies; and follow-up studies of cognitive impairment and incidence of dementia in people who have received ECT among others. The review of literature and present evidence suggests that ECT has a demonstrable impact on the structure and function of the brain. However, there is a lack of evidence at present to suggest that ECT causes brain damage.
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Affiliation(s)
- Amal Joseph Jolly
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shubh Mohan Singh
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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van Kessel MA, van der Vlugt JJB, Spaans HP, Murre JMJ, Verwijk E. Psychotic depressive subtype and white mater hyperintensities do not predict cognitive side effects in ECT: A systematic review of pretreatment predictors. J Affect Disord 2020; 272:340-347. [PMID: 32553376 DOI: 10.1016/j.jad.2020.03.181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 03/03/2020] [Accepted: 03/29/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Most studies regarding cognitive side-effects following ECT for treating depression report transient forms of cognitive disturbances. However, a growing number of studies also report considerable differences among individual patients. OBJECTIVE The aim of this systematic review was to identify pretreatment patient characteristics for predicting the risk of developing cognitive side-effects following ECT. METHODS Online databases PubMed/Medline, Embase, and PsycINFO were searched for articles published from 2002 through May 2019, using the following relevant search terms: #cognitive deficits AND #Electro Convulsive Therapy. Inclusion and exclusion criteria were applied for full-text inclusion. PRISMA guidelines were used. RESULTS Our initial search yielded 2155 publications; 16 studies were included. A total of 16 possible predictive factors were identified. Two factors, psychotic features and white matter hyperintensities, were conclusively found to not predict cognitive side-effects following ECT; the remaining 14 factors were inconclusive. CONCLUSIONS There is robust evidence that psychotic features and white matter hyperintensities are not predictive of cognitive side-effects following ECT. None of the other 14 factors examined were predictive, however these levels of evidence were weak and therefore inconclusive. Additional studies focusing primarily on pretreatment patient characteristics for predicting cognitive side-effects following ECT are needed, including demographic, clinical, physiological, neurobiological, and genetic factors. Finally, we provide suggestions for future research.
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Affiliation(s)
| | | | | | - Jaap M J Murre
- Department of Psychology, Brain & Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Esmée Verwijk
- Parnassia PG, The Hague, The Netherlands; Department of Psychology, Brain & Cognition, University of Amsterdam, Amsterdam, The Netherlands.; Department of Medical Psychology, Amsterdam University Medical Center, Amsterdam, The Netherlands
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41
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Neuromodulation in Schizophrenia: Relevance of Neuroimaging. Curr Behav Neurosci Rep 2020. [DOI: 10.1007/s40473-020-00209-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Brain functional effects of electroconvulsive therapy during emotional processing in major depressive disorder. Brain Stimul 2020; 13:1051-1058. [PMID: 32388195 DOI: 10.1016/j.brs.2020.03.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/12/2020] [Accepted: 03/30/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In treatment-resistant major depressive disorder (MDD), electroconvulsive therapy (ECT) is a treatment with high efficacy. While knowledge regarding changes in brain structure following ECT is growing, the effects of ECT on brain function during emotional processing are largely unknown. OBJECTIVE We investigated the effects of ECT on the activity of the anterior cingulate cortex (ACC) and amygdala during negative emotional stimuli processing and its association with clinical response. METHODS In this non-randomized longitudinal study, patients with MDD (n = 37) were assessed before and after treatment with ECT. Healthy controls (n = 37) were matched regarding age and gender. Functional magnetic resonance imaging (fMRI) was obtained twice, at baseline and after six weeks using a supraliminal face-matching paradigm. In order to evaluate effects of clinical response, additional post-hoc analyses were performed comparing responders to non-responders. RESULTS After ECT, patients with MDD showed a statistically significant increase in ACC activity during processing of negative emotional stimuli (pFWE = .039). This effect was driven by responders (pFWE = .023), while non-responders showed no increase. Responders also had lower pre-treatment ACC activity compared to non-responders (pFWE = .025). No significant effects in the amygdala could be observed. CONCLUSIONS ECT leads to brain functional changes in the ACC, a relevant region for emotional regulation during processing of negative stimuli. Furthermore, baseline ACC activity might serve as a biomarker for treatment response. Findings are in accordance with recent studies highlighting properties of pre-treatment ACC to be associated with general antidepressive treatment response.
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Schmitgen MM, Kubera KM, Depping MS, Nolte HM, Hirjak D, Hofer S, Hasenkamp JH, Seidl U, Stieltjes B, Maier-Hein KH, Sambataro F, Sartorius A, Thomann PA, Wolf RC. Exploring cortical predictors of clinical response to electroconvulsive therapy in major depression. Eur Arch Psychiatry Clin Neurosci 2020; 270:253-261. [PMID: 31278421 DOI: 10.1007/s00406-019-01033-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 06/15/2019] [Indexed: 12/11/2022]
Abstract
Electroconvulsive therapy (ECT) is a rapid and highly effective treatment option for treatment-resistant major depressive disorder (TRD). The neural mechanisms underlying such beneficial effects are poorly understood. Exploring associations between changes of brain structure and clinical response is crucial for understanding ECT mechanisms of action and relevant for the validation of potential biomarkers that can facilitate the prediction of ECT efficacy. The aim of this explorative study was to identify cortical predictors of clinical response in TRD patients treated with ECT. We longitudinally investigated 12 TRD patients before and after ECT. Twelve matched healthy controls were studied cross sectionally. Demographical, clinical, and structural magnetic resonance imaging data at 3 T and multiple cortical markers derived from surface-based morphometry (SBM) analyses were considered. Multiple regression models were computed to identify predictors of clinical response to ECT, as reflected by Hamilton Depression Rating Scale (HAMD) score changes. Symptom severity differences pre-post-ECT were predicted by models including demographic data, clinical data and SBM of frontal, cingulate, and entorhinal structures. Using all-subsets regression, a model comprising HAMD score at baseline and cortical thickness of the left rostral anterior cingulate gyrus explained most variance in the data (multiple R2 = 0.82). The data suggest that SBM provides powerful measures for identifying biomarkers for ECT response in TRD. Rostral anterior cingulate thickness and HAMD score at baseline showed the greatest predictive power of clinical response, in contrast to cortical complexity, cortical gyrification, or demographical data.
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Affiliation(s)
- Mike M Schmitgen
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Vosstrasse 4, 69115, Heidelberg, Germany
| | - Katharina M Kubera
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Vosstrasse 4, 69115, Heidelberg, Germany
| | - Malte S Depping
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Vosstrasse 4, 69115, Heidelberg, Germany
| | - Henrike M Nolte
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Vosstrasse 4, 69115, Heidelberg, Germany
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Stefan Hofer
- Department of Anesthesiology, Westpfalz-Klinikum GmbH, Kaiserslautern, Germany
| | - Julia H Hasenkamp
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Vosstrasse 4, 69115, Heidelberg, Germany
| | - Ulrich Seidl
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Vosstrasse 4, 69115, Heidelberg, Germany
- Department of Psychiatry and Psychotherapy, SHG-Kliniken, Saarbrücken, Germany
| | - Bram Stieltjes
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Klaus H Maier-Hein
- Division of Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Fabio Sambataro
- Department of Neuroscience, University of Padova, Padua, Italy
| | - Alexander Sartorius
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Philipp A Thomann
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Vosstrasse 4, 69115, Heidelberg, Germany
- Center for Mental Health, Odenwald District Healthcare Center, Erbach, Germany
| | - Robert C Wolf
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Vosstrasse 4, 69115, Heidelberg, Germany.
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Ousdal OT, Argyelan M, Narr KL, Abbott C, Wade B, Vandenbulcke M, Urretavizcaya M, Tendolkar I, Takamiya A, Stek ML, Soriano-Mas C, Redlich R, Paulson OB, Oudega ML, Opel N, Nordanskog P, Kishimoto T, Kampe R, Jorgensen A, Hanson LG, Hamilton JP, Espinoza R, Emsell L, van Eijndhoven P, Dols A, Dannlowski U, Cardoner N, Bouckaert F, Anand A, Bartsch H, Kessler U, Oedegaard KJ, Dale AM, Oltedal L. Brain Changes Induced by Electroconvulsive Therapy Are Broadly Distributed. Biol Psychiatry 2020; 87:451-461. [PMID: 31561859 DOI: 10.1016/j.biopsych.2019.07.010] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/14/2019] [Accepted: 07/15/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is associated with volumetric enlargements of corticolimbic brain regions. However, the pattern of whole-brain structural alterations following ECT remains unresolved. Here, we examined the longitudinal effects of ECT on global and local variations in gray matter, white matter, and ventricle volumes in patients with major depressive disorder as well as predictors of ECT-related clinical response. METHODS Longitudinal magnetic resonance imaging and clinical data from the Global ECT-MRI Research Collaboration (GEMRIC) were used to investigate changes in white matter, gray matter, and ventricle volumes before and after ECT in 328 patients experiencing a major depressive episode. In addition, 95 nondepressed control subjects were scanned twice. We performed a mega-analysis of single subject data from 14 independent GEMRIC sites. RESULTS Volumetric increases occurred in 79 of 84 gray matter regions of interest. In total, the cortical volume increased by mean ± SD of 1.04 ± 1.03% (Cohen's d = 1.01, p < .001) and the subcortical gray matter volume increased by 1.47 ± 1.05% (d = 1.40, p < .001) in patients. The subcortical gray matter increase was negatively associated with total ventricle volume (Spearman's rank correlation ρ = -.44, p < .001), while total white matter volume remained unchanged (d = -0.05, p = .41). The changes were modulated by number of ECTs and mode of electrode placements. However, the gray matter volumetric enlargements were not associated with clinical outcome. CONCLUSIONS The findings suggest that ECT induces gray matter volumetric increases that are broadly distributed. However, gross volumetric increases of specific anatomically defined regions may not serve as feasible biomarkers of clinical response.
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Affiliation(s)
| | - Miklos Argyelan
- Center for Psychiatric Neuroscience at the Feinstein Institute for Medical Research, New York, New York
| | - Katherine L Narr
- Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles
| | - Christopher Abbott
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Benjamin Wade
- Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles
| | - Mathieu Vandenbulcke
- Department of Geriatric Psychiatry, University Psychiatric Center Katholieke Universiteit Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Mikel Urretavizcaya
- Department of Psychiatry, Bellvitge University Hospital-Bellvitge Biomedical Research Institute; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Carlos III Health Institute, Madrid, Spain
| | - Indira Tendolkar
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands; Donders Institute for Brain Cognition and Behavior, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands; Faculty of Medicine and Landschaftsverband Rheinland Clinic for Psychiatry and Psychotherapy, University of Duisburg-Essen, Duisburg-Essen, Germany
| | - Akihiro Takamiya
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Center for Psychiatry and Behavioral Science, Komagino Hospital, Tokyo, Japan
| | - Max L Stek
- Geestelijke GezondheidsZorg inGeest Specialized Mental Health Care, Amsterdam, The Netherlands; Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Carles Soriano-Mas
- Department of Psychiatry, Bellvitge University Hospital-Bellvitge Biomedical Research Institute; Department of Psychobiology and Methodology in Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Carlos III Health Institute, Madrid, Spain
| | - Ronny Redlich
- Department of Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany
| | - Olaf B Paulson
- Neurobiology Research Unit, Department of Neurology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mardien L Oudega
- Geestelijke GezondheidsZorg inGeest Specialized Mental Health Care, Amsterdam, The Netherlands; Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Nils Opel
- Department of Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany; Interdisciplinary Centre for Clinical Research (IZKF), University of Muenster, Muenster, Germany
| | - Pia Nordanskog
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Taishiro Kishimoto
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Robin Kampe
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Anders Jorgensen
- Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark
| | - Lars G Hanson
- Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark; Danish Research Centre for Magnetic Resonance, Center for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Hvidovre, Denmark
| | - J Paul Hamilton
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Randall Espinoza
- Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles
| | - Louise Emsell
- Department of Geriatric Psychiatry, University Psychiatric Center Katholieke Universiteit Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Philip van Eijndhoven
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands; Donders Institute for Brain Cognition and Behavior, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands
| | - Annemieke Dols
- Geestelijke GezondheidsZorg inGeest Specialized Mental Health Care, Amsterdam, The Netherlands; Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Udo Dannlowski
- Department of Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany
| | - Narcis Cardoner
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Carlos III Health Institute, Madrid, Spain; Department of Mental Health, University Hospital Parc Taulí-I3PT, Sabadell, Spain
| | - Filip Bouckaert
- Department of Geriatric Psychiatry, University Psychiatric Center Katholieke Universiteit Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Amit Anand
- Cleveland Clinic, Center for Behavioral Health, Cleveland, Ohio
| | - Hauke Bartsch
- Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California; Department of Radiology, University of California, San Diego, La Jolla, California
| | - Ute Kessler
- Norwegian Centre for Mental Disorders Research, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ketil J Oedegaard
- Norwegian Centre for Mental Disorders Research, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Anders M Dale
- Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California; Department of Radiology, University of California, San Diego, La Jolla, California; Department of Neurosciences, University of California, San Diego, La Jolla, California
| | - Leif Oltedal
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Mulders PCR, Llera A, Beckmann CF, Vandenbulcke M, Stek M, Sienaert P, Redlich R, Petrides G, Oudega ML, Oltedal L, Oedegaard KJ, Narr KL, Magnusson PO, Kessler U, Jorgensen A, Espinoza R, Enneking V, Emsell L, Dols A, Dannlowski U, Bolwig TG, Bartsch H, Argyelan M, Anand A, Abbott CC, van Eijndhoven PFP, Tendolkar I. Structural changes induced by electroconvulsive therapy are associated with clinical outcome. Brain Stimul 2020; 13:696-704. [PMID: 32289700 DOI: 10.1016/j.brs.2020.02.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/30/2020] [Accepted: 02/17/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is the most effective treatment option for major depressive disorder, so understanding whether its clinical effect relates to structural brain changes is vital for current and future antidepressant research. OBJECTIVE To determine whether clinical response to ECT is related to structural volumetric changes in the brain as measured by structural magnetic resonance imaging (MRI) and, if so, which regions are related to this clinical effect. We also determine whether a similar model can be used to identify regions associated with electrode placement (unilateral versus bilateral ECT). METHODS Longitudinal MRI and clinical data (Hamilton Depression Rating Scale) was collected from 10 sites as part of the Global ECT-MRI research collaboration (GEMRIC). From 192 subjects, relative changes in 80 (sub)cortical areas were used as potential features for classifying treatment response. We used recursive feature elimination to extract relevant features, which were subsequently used to train a linear classifier. As a validation, the same was done for electrode placement. We report accuracy as well as the structural coefficients of regions included in the discriminative spatial patterns obtained. RESULTS A pattern of structural changes in cortical midline, striatal and lateral prefrontal areas discriminates responders from non-responders (75% accuracy, p < 0.001) while left-sided mediotemporal changes discriminate unilateral from bilateral electrode placement (81% accuracy, p < 0.001). CONCLUSIONS The identification of a multivariate discriminative pattern shows that structural change is relevant for clinical response to ECT, but this pattern does not include mediotemporal regions that have been the focus of electroconvulsive therapy research so far.
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Affiliation(s)
- Peter C R Mulders
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behavior, Centre for Cognitive Neuroimaging, Nijmegen, the Netherlands.
| | - Alberto Llera
- Donders Institute for Brain, Cognition and Behavior, Centre for Cognitive Neuroimaging, Nijmegen, the Netherlands; Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Christian F Beckmann
- Donders Institute for Brain, Cognition and Behavior, Centre for Cognitive Neuroimaging, Nijmegen, the Netherlands; Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), University of Oxford, Oxford, United Kingdom
| | - Mathieu Vandenbulcke
- Department of Geriatric Psychiatry, University Psychiatric Center (UPC), KU Leuven, Leuven, Belgium
| | - Max Stek
- GGZ InGeest Specialized Mental Health Care, Amsterdam, Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Pascal Sienaert
- Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC) - KU Leuven, Kortenberg, Belgium
| | - Ronny Redlich
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Georgios Petrides
- - Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, USA; Center for Neuroscience, Feinstein Institute for Medical Research, Manhasset, USA; Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry, Hempstead, USA
| | - Mardien Leoniek Oudega
- GGZ InGeest Specialized Mental Health Care, Amsterdam, Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Leif Oltedal
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Ketil J Oedegaard
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Katherine L Narr
- Departments of Neurology Psychiatry, Biobehavioral Sciences, Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Peter O Magnusson
- Lund University, Box 118, SE-221 00, Lund, Sweden; Previous: Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Hvidovre, Denmark
| | - Ute Kessler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Anders Jorgensen
- Psychiatric Center Copenhagen & University of Copenhagen, Copenhagen, Denmark
| | - Randall Espinoza
- Departments of Neurology Psychiatry, Biobehavioral Sciences, Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Verena Enneking
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Louise Emsell
- Department of Geriatric Psychiatry, University Psychiatric Center (UPC), KU Leuven, Leuven, Belgium
| | - Annemieke Dols
- GGZ InGeest Specialized Mental Health Care, Amsterdam, Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Udo Dannlowski
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Tom G Bolwig
- Previous: Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Hvidovre, Denmark
| | - Hauke Bartsch
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway; Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, USA
| | - Miklos Argyelan
- - Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, USA; Center for Neuroscience, Feinstein Institute for Medical Research, Manhasset, USA; Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry, Hempstead, USA
| | - Amit Anand
- Center of Behavioral Health, Cleveland Clinic, Cleveland, OH, USA
| | | | - Philip F P van Eijndhoven
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behavior, Centre for Cognitive Neuroimaging, Nijmegen, the Netherlands
| | - Indira Tendolkar
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behavior, Centre for Cognitive Neuroimaging, Nijmegen, the Netherlands; Department of Psychiatry and Psychotherapy, University Hospital Essen, Essen, Germany
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Nemati S, Abdallah CG. Increased Cortical Thickness in Patients With Major Depressive Disorder Following Antidepressant Treatment. CHRONIC STRESS 2020; 4. [PMID: 31938760 PMCID: PMC6959134 DOI: 10.1177/2470547019899962] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Considering the slow-acting properties of traditional antidepressants, an
important challenge in the field is the identification of early treatment
response biomarkers. Reduced cortical thickness has been reported in
neuroimaging studies of depression. However, little is known whether
antidepressants reverse this abnormality. In this brief report, we
investigated early cortical thickness changes following treatment with
sertraline compared to placebo. Methods Participants (n = 215) with major depressive disorder were randomized to a
selective serotonin reuptake inhibitor, sertraline, or to placebo.
Structural magnetic resonance imaging scans were acquired at baseline and
one week following treatment. Response was defined as at least 50%
improvement in Hamilton rating scale for depression score at week 8. In a
vertex-wise approach, we examined the effects of treatment, response, and
treatment × response. Results Following correction for multiple comparisons, we found a significant effect
of treatment, with widespread increase in cortical thickness following
sertraline compared to placebo. Clusters with increased thickness were found
in the left medial prefrontal cortex, right medial and lateral prefrontal
cortex, and within the right parieto-temporal lobes. There were no
sertraline-induced cortical thinning, and no significant response effects or
treatment × response interactions. Conclusion Our findings suggest that cortical thickness abnormalities may be responsive
to antidepressant treatment. However, a relationship between these early
cortical changes and later treatment response was not demonstrated. Future
studies would be needed to investigate whether those early effects are
maintained at eight weeks and are associated with enhanced response.
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Affiliation(s)
- Samaneh Nemati
- VA National Center for PTSD-Clinical Neuroscience Division, US Department of Veterans Affairs, West Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Chadi G Abdallah
- VA National Center for PTSD-Clinical Neuroscience Division, US Department of Veterans Affairs, West Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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47
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Suh JS, Minuzzi L, Raamana PR, Davis A, Hall GB, Harris J, Hassel S, Zamyadi M, Arnott SR, Alders GL, Sassi RB, Milev R, Lam RW, MacQueen GM, Strother SC, Kennedy SH, Frey BN. An investigation of cortical thickness and antidepressant response in major depressive disorder: A CAN-BIND study report. NEUROIMAGE-CLINICAL 2020; 25:102178. [PMID: 32036277 PMCID: PMC7011077 DOI: 10.1016/j.nicl.2020.102178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/25/2019] [Accepted: 01/10/2020] [Indexed: 11/28/2022]
Abstract
Major depressive disorder (MDD) is considered a highly heterogeneous clinical and neurobiological mental disorder. We employed a novel layered treatment design to investigate whether cortical thickness features at baseline differentiated treatment responders from non-responders after 8 and 16 weeks of a standardized sequential antidepressant treatment. Secondary analyses examined baseline differences between MDD and controls as a replication analysis and longitudinal changes in thickness after 8 weeks of escitalopram treatment. 181 MDD and 95 healthy comparison (HC) participants were studied. After 8 weeks of escitalopram treatment (10-20 mg/d, flexible dosage), responders (>50% decrease in Montgomery-Åsberg Depression Scale score) were continued on escitalopram; non-responders received adjunctive aripiprazole (2-10 mg/d, flexible dosage). MDD participants were classified into subgroups according to their response profiles at weeks 8 and 16. Baseline group differences in cortical thickness were analyzed with FreeSurfer between HC and MDD groups as well as between response groups. Two-stage longitudinal processing was used to investigate 8-week escitalopram treatment-related changes in cortical thickness. Compared to HC, the MDD group exhibited thinner cortex in the left rostral middle frontal cortex [MNI(X,Y,Z=-29,9,54.5,-7.7); CWP=0.0002]. No baseline differences in cortical thickness were observed between responders and non-responders based on week-8 or week-16 response profile. No changes in cortical thickness was observed after 8 weeks of escitalopram monotherapy. In a two-step 16-week sequential clinical trial we found that baseline cortical thickness does not appear to be associated to clinical response to pharmacotherapy at 8 or 16 weeks.
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Affiliation(s)
- Jee Su Suh
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada; Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Luciano Minuzzi
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada; Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Pradeep Reddy Raamana
- Rotman Research Institute, Baycrest Health Sciences; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Andrew Davis
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Geoffrey B Hall
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Jacqueline Harris
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
| | - Stefanie Hassel
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB, Canada
| | - Mojdeh Zamyadi
- Rotman Research Institute, Baycrest Health Sciences; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Stephen R Arnott
- Rotman Research Institute, Baycrest Health Sciences; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Gésine L Alders
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada; Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Roberto B Sassi
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Roumen Milev
- Departments of Psychiatry and Psychology, Queen's University and Providence Care Hospital, Kingston, ON, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Glenda M MacQueen
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB, Canada
| | - Stephen C Strother
- Rotman Research Institute, Baycrest Health Sciences; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Sidney H Kennedy
- Canadian Biomarker Integration Network for Depression, St. Michael's Hospital, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Benicio N Frey
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada; Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
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48
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Enneking V, Leehr EJ, Dannlowski U, Redlich R. Brain structural effects of treatments for depression and biomarkers of response: a systematic review of neuroimaging studies. Psychol Med 2020; 50:187-209. [PMID: 31858931 DOI: 10.1017/s0033291719003660] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Antidepressive pharmacotherapy (AD), electroconvulsive therapy (ECT) and cognitive behavioural therapy (CBT) are effective treatments for major depressive disorder. With our review, we aim to provide a systematic overview of neuroimaging studies that investigate the effects of AD, ECT and CBT on brain grey matter volume (GMV) and biomarkers associated with response. After a systematic database research on PubMed, we included 50 studies using magnetic resonance imaging and investigating (1) changes in GMV, (2) pre-treatment GMV biomarkers associated with response, or (3) the accuracy of predictions of response to AD, ECT or CBT based on baseline GMV data. The strongest evidence for brain structural changes was found for ECT, showing volume increases within the temporal lobe and subcortical structures - such as the hippocampus-amygdala complex, anterior cingulate cortex (ACC) and striatum. For AD, the evidence is heterogeneous as only 4 of 11 studies reported significant changes in GMV. The results are not sufficient in order to draw conclusions about the structural brain effects of CBT. The findings show consistently that higher pre-treatment ACC volume is associated with response to AD, ECT and CBT. An association of higher pre-treatment hippocampal volume and response has only been reported for AD. Machine learning approaches based on pre-treatment whole brain patterns reach accuracies of 64-90% for predictions of AD or ECT response on the individual patient level. The findings underline the potential of brain biomarkers for the implementation in clinical practice as an additive feature within the process of treatment selection.
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Affiliation(s)
- Verena Enneking
- Department of Psychiatry, University of Münster, Münster, Germany
| | | | - Udo Dannlowski
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Ronny Redlich
- Department of Psychiatry, University of Münster, Münster, Germany
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49
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Yrondi A, Nemmi F, Billoux S, Giron A, Sporer M, Taib S, Salles J, Pierre D, Thalamas C, Rigal E, Danet L, Pariente J, Schmitt L, Arbus C, Péran P. Grey Matter changes in treatment-resistant depression during electroconvulsive therapy. J Affect Disord 2019; 258:42-49. [PMID: 31382103 DOI: 10.1016/j.jad.2019.07.075] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/08/2019] [Accepted: 07/29/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION 20-30% of depressed patients experience Treatment Resistant Depression (TRD). Electroconvulsive Therapy (ECT) remains the treatment of choice for TRD. However, the exact mechanism of ECT remains unclear. We aim to assess grey matter changes in patients with TRD undergoing bilateral ECT treatment at different points during and after treatment. METHODS Patients are recruited at the University Hospital of Toulouse. Eligibility criteria include a diagnosis of TRD and an age between 50 and 70 years old. Patients received clinical assessments (Hamilton Depression Rating Scale) and structural scans (MRI) at three points: baseline (within 48 h before the first ECT); V2 (after the first ECT considered effective); and V3 (within 1 week of completing ECT). RESULTS At baseline, controls had significantly higher cortical thickness than patients in the fusiform gyrus, the inferior, middle and superior temporal gyrus, the parahippocampal gyrus and the transverse temporal gyrus (respectively: t(35)=2.7, p = 0.02; t(35)=2.89, p = 0.017; t(35)=3.1, p = 0.015; t(35)=3.6, p = 0.009; t(35)=2.37, p = 0.031; t(35)=2.46, p = 0.03). This difference was no longer significant after ECT. We showed an increase in cortical thickness in superior temporal gyrus between (i) baseline and V3 (t(62)=-3.43 p = 0.009) and (ii) V2 and V3 (t(62)=-3.42 p = 0.009). We showed an increase in hippocampal volume between (i) baseline and V3 (t(62)=-5.23 p < 0.001) and (ii) V2 and V3 (t(62)=-5.3 p < 0.001). CONCLUSION We highlight that there are grey matter changes during ECT treatment in a population with TRD compared to a healthy control population. These changes seem to occur after several rounds of ECT.
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Affiliation(s)
- Antoine Yrondi
- Service de Psychiatrie et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU Toulouse, Hospital Purpan, ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.
| | - Federico Nemmi
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Sophie Billoux
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France; Service de medicine légale, CHU Toulouse, Toulouse, France
| | - Aurélie Giron
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France; Service de Psychiatrie et de Psychologie Médicale, CHU de Toulouse, Hospital Purpan, Toulouse, France
| | - Marie Sporer
- Service de Psychiatrie et de Psychologie Médicale, CHU de Toulouse, Hospital Purpan, Toulouse, France
| | - Simon Taib
- Service de Psychiatrie et de Psychologie Médicale, CHU Toulouse, Hospital Purpan, ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Juliette Salles
- Service de Psychiatrie et de Psychologie Médicale, CHU de Toulouse, Hospital Purpan, Toulouse, France
| | - Damien Pierre
- Service de Psychiatrie et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU Toulouse, Hospital Purpan, Toulouse, France
| | - Claire Thalamas
- CIC 1436, Service de Pharmacologie Clinique, CHU de Toulouse, INSERM, Université de Toulouse, UPS, Toulouse, France
| | - Emilie Rigal
- Department of Neurology, University Hospital of Toulouse, Toulouse, France
| | - Lola Danet
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France; Department of Neurology, University Hospital of Toulouse, Toulouse, France
| | - Jérémie Pariente
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France; Department of Neurology, University Hospital of Toulouse, Toulouse, France
| | - Laurent Schmitt
- Service de Psychiatrie et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU Toulouse, Hospital Purpan, Toulouse, France
| | - Christophe Arbus
- Service de Psychiatrie et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU Toulouse, Hospital Purpan, ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Patrice Péran
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France
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50
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Argyelan M, Oltedal L, Deng ZD, Wade B, Bikson M, Joanlanne A, Sanghani S, Bartsch H, Cano M, Dale AM, Dannlowski U, Dols A, Enneking V, Espinoza R, Kessler U, Narr KL, Oedegaard KJ, Oudega ML, Redlich R, Stek ML, Takamiya A, Emsell L, Bouckaert F, Sienaert P, Pujol J, Tendolkar I, van Eijndhoven P, Petrides G, Malhotra AK, Abbott C. Electric field causes volumetric changes in the human brain. eLife 2019; 8:49115. [PMID: 31644424 PMCID: PMC6874416 DOI: 10.7554/elife.49115] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 10/22/2019] [Indexed: 12/13/2022] Open
Abstract
Recent longitudinal neuroimaging studies in patients with electroconvulsive therapy (ECT) suggest local effects of electric stimulation (lateralized) occur in tandem with global seizure activity (generalized). We used electric field (EF) modeling in 151 ECT treated patients with depression to determine the regional relationships between EF, unbiased longitudinal volume change, and antidepressant response across 85 brain regions. The majority of regional volumes increased significantly, and volumetric changes correlated with regional electric field (t = 3.77, df = 83, r = 0.38, p=0.0003). After controlling for nuisance variables (age, treatment number, and study site), we identified two regions (left amygdala and left hippocampus) with a strong relationship between EF and volume change (FDR corrected p<0.01). However, neither structural volume changes nor electric field was associated with antidepressant response. In summary, we showed that high electrical fields are strongly associated with robust volume changes in a dose-dependent fashion. Electroconvulsive therapy, or ECT for short, can be an effective treatment for severe depression. Many patients who do not respond to medication find that their symptoms improve after ECT. During an ECT session, the patient is placed under general anesthesia and two electrodes are attached to the scalp to produce an electric field that generates currents within the brain. These currents activate neurons and make them fire, causing a seizure, but it remains unclear how this reduces symptoms of depression. For many years, researchers thought that the induced seizure must be key to the beneficial effects of ECT, but recent studies have cast doubt on this idea. They show that increasing the strength of the electric field alters the clinical effects of ECT, without affecting the seizure. This suggests that the benefits of ECT depend on the electric field itself. Argyelan et al. now show that electric fields affect the brain by making a part of the brain known as the gray matter expand. In a large multinational study, 151 patients with severe depression underwent brain scans before and after a course of ECT. The scans revealed that the gray matter of the patients’ brains expanded during the treatment. The patients who experienced the strongest electric fields showed the largest increase in brain volume, and individual brain areas expanded if the electric field within them exceeded a certain threshold. This effect was particularly striking in two areas, the hippocampus and the amygdala. Both of these areas are critical for mood and memory. Further studies are needed to determine why the brain expands after ECT, and how long the effect lasts. Another puzzle is why the improvements in depression that the patients reported after their treatment did not correlate with changes in brain volume. Disentangling the relationships between ECT, brain volume and depression will ultimately help develop more robust treatments for this disabling condition.
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Affiliation(s)
- Miklos Argyelan
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, United States.,Center for Neuroscience, Feinstein Institute for Medical Research, Manhasset, United States.,Department of Psychiatry, Zucker School of Medicine, Hempstead, United States
| | - Leif Oltedal
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Radiology, Haukeland University Hospital, Mohn Medical Imaging and Visualization Centre, Bergen, Norway
| | - Zhi-De Deng
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, United States
| | - Benjamin Wade
- Department of Neurology, Ahmanson-Lovelace Brain Mapping Center, University of California, Los Angeles, Los Angeles, United States
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of the City University of New York, New York, United States
| | - Andrea Joanlanne
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, United States
| | - Sohag Sanghani
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, United States
| | - Hauke Bartsch
- Department of Radiology, Haukeland University Hospital, Mohn Medical Imaging and Visualization Centre, Bergen, Norway.,Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, United States
| | - Marta Cano
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,CIBERSAM, Carlos III Health Institute, Barcelona, Spain
| | - Anders M Dale
- Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, United States.,Department of Radiology, University of California, San Diego, San Diego, United States.,Department of Neurosciences, University of California, San Diego, San Diego, United States
| | - Udo Dannlowski
- Department of Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany
| | - Annemiek Dols
- Department of Psychiatry, Amsterdam UMC, location VUmc, GGZinGeest, Old Age Psychiatry, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Verena Enneking
- Department of Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany
| | - Randall Espinoza
- Department of Neurology, University of California, Los Angeles, Los Angeles, United States.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, United States
| | - Ute Kessler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Katherine L Narr
- Department of Neurology, University of California, Los Angeles, Los Angeles, United States.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, United States
| | - Ketil J Oedegaard
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Mardien L Oudega
- Department of Psychiatry, Amsterdam UMC, location VUmc, GGZinGeest, Old Age Psychiatry, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Ronny Redlich
- Department of Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany
| | - Max L Stek
- Department of Psychiatry, Amsterdam UMC, location VUmc, GGZinGeest, Old Age Psychiatry, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Akihiro Takamiya
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Center for Psychiatry and Behavioral Science, Komagino Hospital, Tokyo, Japan
| | - Louise Emsell
- Department of Geriatric Psychiatry, University Psychiatric Center, KU Leuven, Leuven, Belgium
| | - Filip Bouckaert
- Department of Geriatric Psychiatry, University Psychiatric Center, KU Leuven, Leuven, Belgium.,Academic center for ECT and Neurostimulation (AcCENT), University Psychiatric Center, KU Leuven, Kortenberg, Belgium
| | - Pascal Sienaert
- Academic center for ECT and Neurostimulation (AcCENT), University Psychiatric Center, KU Leuven, Kortenberg, Belgium
| | - Jesus Pujol
- CIBERSAM, Carlos III Health Institute, Barcelona, Spain.,MRI Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain
| | - Indira Tendolkar
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands.,Donders Institute for Brain Cognition and Behavior, Centre for Cognitive Neuroimaging, Nijmegen, Netherlands.,Faculty of Medicine and LVR Clinic for Psychiatry and Psychotherapy, University of Duisburg-Essen, Essen, Germany
| | - Philip van Eijndhoven
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands.,Donders Institute for Brain Cognition and Behavior, Centre for Cognitive Neuroimaging, Nijmegen, Netherlands
| | - Georgios Petrides
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, United States.,Center for Neuroscience, Feinstein Institute for Medical Research, Manhasset, United States.,Department of Psychiatry, Zucker School of Medicine, Hempstead, United States
| | - Anil K Malhotra
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, United States.,Center for Neuroscience, Feinstein Institute for Medical Research, Manhasset, United States.,Department of Psychiatry, Zucker School of Medicine, Hempstead, United States
| | - Christopher Abbott
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, United States
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