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Wiglesworth A, Butts J, Carosella KA, Mirza S, Papke V, Bendezú JJ, Klimes-Dougan B, Cullen KR. Stress system concordance as a predictor of longitudinal patterns of resilience in adolescence. Dev Psychopathol 2023; 35:2384-2401. [PMID: 37434505 PMCID: PMC10784418 DOI: 10.1017/s0954579423000731] [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] [Indexed: 07/13/2023]
Abstract
Resilience promotes positive adaptation to challenges and may facilitate recovery for adolescents experiencing psychopathology. This work examined concordance across the experience, expression, and physiological response to stress as a protective factor that may predict longitudinal patterns of psychopathology and well-being that mark resilience. Adolescents aged 14-17 at recruitment (oversampled for histories of non-suicidal self-injury; NSSI) were part of a three-wave (T1, T2, T3) longitudinal study. Multi-trajectory modeling produced four distinct profiles of stress experience, expression, and physiology at T1 (High-High-High, Low-Low-Low, High-Low-Moderate, and High-High-Low, respectively). Linear mixed-effect regressions modeled whether the profiles predicted depressive symptoms, suicide ideation, NSSI engagement, positive affect, satisfaction with life, and self-worth over time. Broadly, concordant stress response profiles (Low-Low-Low, High-High-High) were associated with resilient-like patterns of psychopathology and well-being over time. Adolescents with a concordant High-High-High stress response profile showed a trend of greater reduction in depressive symptoms (B = 0.71, p = 0.052), as well as increased global self-worth (B = -0.88, p = 0.055), from T2 to T3 compared to the discordant High-High-Low profile. Concordance across multi-level stress responses may be protective and promote future resilience, whereas blunted physiological responses in the presence of high perceived and expressed stress may indicate poorer outcomes over time.
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Affiliation(s)
| | - Jessica Butts
- Public Health, Division of Biostatistics, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | | | - Salahudeen Mirza
- Psychology, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Victoria Papke
- Psychology, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | | | | | - Kathryn R Cullen
- Psychiatry and Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN, USA
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Bini J. The historical progression of positron emission tomography research in neuroendocrinology. Front Neuroendocrinol 2023; 70:101081. [PMID: 37423505 PMCID: PMC10530506 DOI: 10.1016/j.yfrne.2023.101081] [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: 01/31/2023] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 07/11/2023]
Abstract
The rapid and continual development of a number of radiopharmaceuticals targeting different receptor, enzyme and small molecule systems has fostered Positron Emission Tomography (PET) imaging of endocrine system actions in vivo in the human brain for several decades. PET radioligands have been developed to measure changes that are regulated by hormone action (e.g., glucose metabolism, cerebral blood flow, dopamine receptors) and actions within endocrine organs or glands such as steroids (e.g., glucocorticoids receptors), hormones (e.g., estrogen, insulin), and enzymes (e.g., aromatase). This systematic review is targeted to the neuroendocrinology community that may be interested in learning about positron emission tomography (PET) imaging for use in their research. Covering neuroendocrine PET research over the past half century, researchers and clinicians will be able to answer the question of where future research may benefit from the strengths of PET imaging.
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Affiliation(s)
- Jason Bini
- Yale PET Center, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States.
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Gbyl K, Lindberg U, Wiberg Larsson HB, Rostrup E, Videbech P. Cerebral perfusion is related to antidepressant effect and cognitive side effects of Electroconvulsive Therapy. Brain Stimul 2022; 15:1486-1494. [PMID: 36332891 DOI: 10.1016/j.brs.2022.10.007] [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: 08/24/2022] [Revised: 10/11/2022] [Accepted: 10/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The mechanisms underlying the antidepressant effect and cognitive side effects of Electroconvulsive Therapy (ECT) remain elusive. The measurement of cerebral perfusion provides an insight into brain physiology. OBJECTIVE We investigated ECT-related perfusion changes in depressed patients and tested whether these changes correlate with clinical effects. METHODS A sample of 22 in-patients was examined at three time points: 1) within two days before, 2) within one week after, and 3) six months after an ECT series. Cerebral perfusion was quantified using arterial spin labeling magnetic resonance imaging. The primary regions of interest were the bilateral dorsolateral prefrontal cortices (DL-PFC) and hippocampi. The depression severity was assessed by the six-item Hamilton Depression Rating Scale, and cognitive performance by the Screen for Cognitive Impairment in Psychiatry. A linear mixed model and partial correlation were used for statistical analyses. RESULTS Following an ECT series, perfusion decreased in the right (-6.0%, p = .01) and left DL-PFC (-5.6%, p = .001). Perfusion increased in the left hippocampus (4.8%, p = .03), while on the right side the increase was insignificant (2.3%, p = .23). A larger perfusion reduction in the right DL-PFC correlated with a better antidepressant effect, and a larger perfusion increase in the right hippocampus with worse cognitive impairment. CONCLUSION ECT-induced attenuation of prefrontal activity may be related to clinical improvement, whereas a hippocampal process triggered by the treatment is likely associated with cognitive side effects.
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Affiliation(s)
- Krzysztof Gbyl
- Center for Neuropsychiatric Depression Research (CNDR), Mental Health Center Glostrup, Glostrup, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Ulrich Lindberg
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Bo Wiberg Larsson
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Egill Rostrup
- Center for Neuropsychiatric Schizophrenia Research, Mental Health Center Glostrup, Denmark
| | - Poul Videbech
- Center for Neuropsychiatric Depression Research (CNDR), Mental Health Center Glostrup, Glostrup, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Pollak C, Maier HB, Moschny N, Jahn K, Bleich S, Frieling H, Neyazi A. Epinephrine levels decrease in responders after electroconvulsive therapy. J Neural Transm (Vienna) 2021; 128:1917-1921. [PMID: 34554316 PMCID: PMC8571228 DOI: 10.1007/s00702-021-02420-1] [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] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/16/2021] [Indexed: 11/29/2022]
Abstract
We examined potential changes in catecholamine plasma levels and cortisol serum levels in 29 patients with treatment-resistant Major Depressive Disorder (MDD) during a course of electroconvulsive therapy (ECT). Blood samples were taken at three different time points: directly before (T1) and 15 min after (T2) the first ECT, and directly before the last one (T3). Patients responding to ECT had a significant decrease of the intraindividual epinephrine plasma level when both first time points (Δ T1-T2) were compared (χ2 (1) = 10.05, p = 0.002). This finding encourages further investigation in the understanding of the catecholamine-metabolism including its release and uptake in patients with treatment-resistant MDD receiving ECT.
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Affiliation(s)
- Christoph Pollak
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Hannah Benedictine Maier
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Nicole Moschny
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Kirsten Jahn
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.,Laboratory for Molecular Neuroscience, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.,Laboratory for Molecular Neuroscience, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Helge Frieling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.,Laboratory for Molecular Neuroscience, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Alexandra Neyazi
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Gyger L, Regen F, Ramponi C, Marquis R, Mall JF, Swierkosz-Lenart K, von Gunten A, Toni N, Kherif F, Heuser I, Draganski B. Gradient of electro-convulsive therapy's antidepressant effects along the longitudinal hippocampal axis. Transl Psychiatry 2021; 11:191. [PMID: 33782387 PMCID: PMC8007583 DOI: 10.1038/s41398-021-01310-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 02/12/2021] [Accepted: 03/02/2021] [Indexed: 12/17/2022] Open
Abstract
Despite decades of successful treatment of therapy-resistant depression and major scientific advances in the field, our knowledge about electro-convulsive therapy's (ECT) mechanisms of action is still scarce. Building on strong empirical evidence for ECT-induced hippocampus anatomy changes, we sought to test the hypothesis that ECT has a differential impact along the hippocampus longitudinal axis. We acquired behavioural and brain anatomy magnetic resonance imaging (MRI) data in patients with depressive episode undergoing ECT (n = 9) or pharmacotherapy (n = 24) and healthy controls (n = 30) at two time points 3 months apart. Using whole-brain voxel-based statistical parametric mapping and topographic analysis focused on the hippocampus, we observed ECT-induced gradient of grey matter volume increase along the hippocampal longitudinal axis with predominant impact on its anterior portion. Clinical outcome measures showed strong correlations with both baseline volume and rate of ECT-induced change exclusively for the anterior, but not posterior hippocampus. We interpret our findings confined to the anterior hippocampus and amygdala as additional evidence of the regional specific impact of ECT that unfolds its beneficial effect on depression via the "limbic" system. Main limitations of the study are patients' polypharmacy, heterogeneity of psychiatric diagnosis, and long-time interval between scans.
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Affiliation(s)
- Lucien Gyger
- LREN, Dept. of clinical neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Francesca Regen
- Department of Psychiatry, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Cristina Ramponi
- LREN, Dept. of clinical neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Renaud Marquis
- EEG and Epilepsy Unit, Department of Clinical Neuroscience, University Hospital of Geneva and Faculty of Medicine, Geneva, Switzerland
| | - Jean-Frederic Mall
- Old Age Psychiatry service, Department of Psychiatry, Lausanne University Hospital (CHUV), and University of Lausanne, Lausanne, Switzerland
| | - Kevin Swierkosz-Lenart
- Old Age Psychiatry service, Department of Psychiatry, Lausanne University Hospital (CHUV), and University of Lausanne, Lausanne, Switzerland
| | - Armin von Gunten
- Old Age Psychiatry service, Department of Psychiatry, Lausanne University Hospital (CHUV), and University of Lausanne, Lausanne, Switzerland
| | - Nicolas Toni
- Centre for Psychiatric Neurosciences, Department of Psychiatry, Lausanne University Hospital (CHUV) and Lausanne University, Lausanne, Switzerland
| | - Ferath Kherif
- LREN, Dept. of clinical neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Isabella Heuser
- Department of Psychiatry, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Bogdan Draganski
- LREN, Dept. of clinical neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
- Neurology Department, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
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Gbyl K, Rostrup E, Raghava JM, Andersen C, Rosenberg R, Larsson HBW, Videbech P. Volume of hippocampal subregions and clinical improvement following electroconvulsive therapy in patients with depression. Prog Neuropsychopharmacol Biol Psychiatry 2021; 104:110048. [PMID: 32730916 DOI: 10.1016/j.pnpbp.2020.110048] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/08/2020] [Accepted: 07/21/2020] [Indexed: 12/14/2022]
Abstract
It is thought that the hippocampal neurogenesis is an important mediator of the antidepressant effect of electroconvulsive therapy (ECT). However, most previous studies failed to demonstrate the relationship between the increase in the hippocampal volume and the antidepressant effect. We reinvestigated this relationship by looking at distinct hippocampal subregions and applying repeated measures correlation. Using a 3 Tesla MRI-scanner, we scanned 22 severely depressed in-patients at three time points: before the ECT series, after the series, and at six-month follow-up. The depression severity was assessed by the 17-item Hamilton Rating Scale for Depression (HAMD-17). The hippocampus was segmented into subregions using Freesurfer software. The dentate gyrus (DG) was the primary region of interest (ROI), due to the role of this region in neurogenesis. The other major hippocampal subregions were the secondary ROIs (n = 20). The general linear mixed model and the repeated measures correlation were used for statistical analyses. Immediately after the ECT series, a significant volume increase was present in the right DG (Cohen's d = 1.7) and the left DG (Cohen's d = 1.5), as well as 15 out of 20 secondary ROIs. The clinical improvement, i.e., the decrease in HAMD-17 score, was correlated to the increase in the right DG volume (rrm = -0.77, df = 20, p < .001), and the left DG volume (rrm = -0.75, df = 20, p < .001). Similar correlations were observed in 14 out of 20 secondary ROIs. Thus, ECT induces an increase not only in the volume of the DG, but also in the volume of other major hippocampal subregions. The volumetric increases may reflect a neurobiological process that may be related to the ECT's antidepressant effect. Further investigation of the relationship between hippocampal subregions and the antidepressant effect is warranted. A statistical approach taking the repeated measurements into account should be preferred in the analyses.
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Affiliation(s)
- Krzysztof Gbyl
- Center for Neuropsychiatric Depression Research, Mental Health Center Glostrup, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Science, The University of Copenhagen, Copenhagen, Denmark.
| | - Egill Rostrup
- Center for Neuropsychiatric Schizophrenia Research, and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Center Glostrup, Glostrup, Denmark
| | - Jayachandra Mitta Raghava
- Center for Neuropsychiatric Schizophrenia Research, and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Center Glostrup, Glostrup, Denmark; Functional Imaging Unit, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Glostrup, Glostrup, Denmark
| | | | | | - Henrik Bo Wiberg Larsson
- Functional Imaging Unit, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Glostrup, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Science, The University of Copenhagen, Copenhagen, Denmark
| | - Poul Videbech
- Center for Neuropsychiatric Depression Research, Mental Health Center Glostrup, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Science, The University of Copenhagen, Copenhagen, Denmark
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Low Circulating Levels of GR, FKBP5, and SGK1 in Medicated Patients With Depression Are Not Altered by Electroconvulsive Therapy. J ECT 2020; 36:137-143. [PMID: 31725056 DOI: 10.1097/yct.0000000000000633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Hypothalamic-pituitary-adrenal axis dysregulation is frequently observed in patients with depression, with increased levels of the glucocorticoid (GC) cortisol commonly reported. Hypothalamic-pituitary-adrenal axis dysregulation may be a consequence of impaired feedback inhibition due to GC receptor (GR) impairments or dysfunction, termed "glucocorticoid resistance." Here, our objective was to assess mRNA levels of GC-related markers (GR, FKBP5, serum glucocorticoid kinase 1 [SGK1]) in patients with depression versus controls and in patient samples after electroconvulsive therapy (ECT). We also examined the relationship between these GC-related markers and 24-item Hamilton Depression Rating Scale (HAM-D24) scores to assess the utility of using them as biological markers for depression or the therapeutic response to ECT. METHODS GR, FKBP5, and SGK1 mRNA levels were examined in whole blood samples from 88 medicated patients with depression pre-/post-ECT and 63 controls using quantitative real-time polymerase chain reaction. Exploratory subgroup correlational analyses were performed to determine the relationship between GR, FKBP5, and SGK1 and 24-item Hamilton Depression Rating Scale scores. RESULTS GR, FKBP5, and SGK1 mRNA levels were significantly lower in medicated patients with depression compared with controls (P < 0.001, P = 0.03, P < 0.001, respectively), but ECT did not alter their levels (all P > 0.05). There was no relationship between GR, FKBP5, or SGK1 and 24-item Hamilton Depression Rating Scale scores. CONCLUSIONS GR, FKBP5, and SGK1 do not seem to be involved in the peripheral molecular response to ECT and do not represent useful biomarkers for predicting the therapeutic response to ECT in a real-world clinical setting.
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Mindt S, Neumaier M, Hoyer C, Sartorius A, Kranaster L. Cytokine-mediated cellular immune activation in electroconvulsive therapy: A CSF study in patients with treatment-resistant depression. World J Biol Psychiatry 2020; 21:139-147. [PMID: 31081432 DOI: 10.1080/15622975.2019.1618494] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objectives: Evidence points towards an important relationship between the antidepressant effects of electroconvulsive therapy (ECT) and the modulation of the immune system. To further elucidate this interplay, we performed a study on the effects of the antidepressant treatment by ECT on 25 cytokines in patients with depression.Methods: We measured 25 different cytokines (interleukin (IL)-1β, IL-1RA, Il-2, IL-2R, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12 (p40/p70), IL-13, IL-15, IL-17, tumor necrosis factor-α, interferon (IFN)-α, IFN-γ, granulocyte-macrophage colony-stimulating factor, macrophage inflammatory protein (MIP)-1α, MIP-1β, IFN-γ-induced protein 10 (IP-10), monokine induced by IFN-γ, Eotaxin, Rantes and monocyte chemoattractant protein 1) in the cerebrospinal fluid (CSF) and blood of 12 patients with a severe and treatment-resistant depressive episode before and after a course of ECT.Results: CSF levels of IP-10, IL-5 and IL-8 were elevated after ECT and more ECT sessions were associated with the differences of CSF levels before and after ECT of IFN-γ, IL-2RA, Rantes, IL-6 and IL-1β. Responders and/or remitters had a decrease of CSF levels of IL-17, MIP-1α, Rantes and IL-2R during ECT. CSF IP-10 levels increased less during ECT in patients who had a remission.Conclusions: Although the sample size was small, we found different effects of the ECT treatment per se and of the antidepressant action induced by ECT in CSF and blood.
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Affiliation(s)
- Sonani Mindt
- Faculty of Medicine Mannheim, Institute for Clinical Chemistry, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Neumaier
- Faculty of Medicine Mannheim, Institute for Clinical Chemistry, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Carolin Hoyer
- Department of Neurology, University Medical Centre Mannheim, Mannheim, Germany
| | - Alexander Sartorius
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Laura Kranaster
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Ryan KM, Allers KA, McLoughlin DM, Harkin A. Tryptophan metabolite concentrations in depressed patients before and after electroconvulsive therapy. Brain Behav Immun 2020; 83:153-162. [PMID: 31606477 DOI: 10.1016/j.bbi.2019.10.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 09/30/2019] [Accepted: 10/03/2019] [Indexed: 01/09/2023] Open
Abstract
Tryptophan and kynurenine pathway (KP) metabolites are implicated in the pathophysiology of depression. We aimed to investigate their plasma concentrations in medicated patients with depression (n = 94) compared to age- and sex-matched healthy controls (n = 57), and in patients with depression after electroconvulsive therapy (ECT) in a real-world clinical setting, taking account of co-variables including ECT modality and heterogenous psychopathology. Depression severity was assessed using the Hamilton Depression Rating Scale (HAM-D24). Tryptophan (TRP) and kynurenine (KYN) metabolite concentrations [anthranilic acid (AA), 3-hydroxyanthranilic acid (3HAA), picolinic acid (PA), kynurenic acid (KYNA), and xanthurenic acid (XA)] and KYNA/KYN and KYNA/quinolinic acid (QUIN) ratios were lower in patients compared to controls. For the total group there was no significant change in KP metabolites post-ECT or correlations with mood ratings. However, improvements in mood score were correlated with increased KYN, 3-hydroxykynurenine (3HK), 3HAA, QUIN, and KYN/TRP in a subgroup of unipolar depressed patients. Additionally, in remitters baseline KYN, 3HK, and QUIN were associated with baseline HAM-D24 scores, and changes in 3HK and 3HAA concentrations post-ECT correlated with improvement in mood. KYN, KYNA, AA, 3HK, XA, PA, and QUIN were increased in a smaller 3-month follow-up group (n = 19) compared to pre-ECT concentrations. Overall, the results indicate that ECT mobilizes the KP, where a moderate association between selected metabolites and treatment response in unipolar depressed patients is evident.
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Affiliation(s)
- Karen M Ryan
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland; Department of Psychiatry, St. Patrick's University Hospital, Trinity College Dublin, Dublin, Ireland
| | - Kelly A Allers
- Central Nervous System Disease Research, Boehringer Ingelheim Pharma GmbH + Co. KG, Birkendorferstrabe 65, Biberach a.d. Riss, Germany
| | - Declan M McLoughlin
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland; Department of Psychiatry, St. Patrick's University Hospital, Trinity College Dublin, Dublin, Ireland
| | - Andrew Harkin
- Neuropsychopharmacology Research Group, School of Pharmacy and Pharmaceutical Sciences & Trinity College Institute of Neuroscience, Trinity College, Dublin, Ireland.
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Kobayashi Y, Segi-Nishida E. Search for factors contributing to resistance to the electroconvulsive seizure treatment model using adrenocorticotrophic hormone-treated mice. Pharmacol Biochem Behav 2019; 186:172767. [PMID: 31491434 DOI: 10.1016/j.pbb.2019.172767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/02/2019] [Accepted: 09/02/2019] [Indexed: 12/20/2022]
Abstract
Approximately one third of patients with depression remain treatment resistant with existing antidepressants, suggesting that the currently-available antidepressants cannot induce appropriate responses in the brains of all patients. Long-term exposure to adrenocorticotrophic hormone (ACTH) has been proposed as a model that mimics at least some aspects of clinical treatment-resistant depression in rodents. The purpose of this study was to explore potential causes of antidepressant treatment resistance using the chronic ACTH-treated mouse model. We subjected ACTH-treated mice to a rodent model of electroconvulsive therapy, i.e., electroconvulsive seizure (ECS), which induces various molecular and cellular changes, including in gene expression and adult neurogenesis in the hippocampus. First, behavioral effect of repeated ECS in the forced swim test (FST) was examined. In our experimental setting, ACTH-treated mice showed resistance to the antidepressant-like effect of ECS in the FST. We then examined which cellular and molecular changes induced by ECS were attenuated by ACTH administration. Chronic ACTH treatment suppressed the increase of gene expression such as of Bdnf, Npy, and Drd1 induced by ECS in the hippocampus. In contrast, there was no difference in ECS-induced promotion of the early neurogenetic process in the hippocampus between ACTH-treated and control mice. Our results suggest the possibility that impaired neuromodulation and monoamine signaling in the hippocampus are among the factors contributing to antidepressant treatment resistance.
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Affiliation(s)
- Yurika Kobayashi
- Department of Biological Science and Technology, Faculty of Industrial Science and Technology, Tokyo University of Science, Japan
| | - Eri Segi-Nishida
- Department of Biological Science and Technology, Faculty of Industrial Science and Technology, Tokyo University of Science, Japan.
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Peripheral blood GILZ mRNA levels in depression and following electroconvulsive therapy. Psychoneuroendocrinology 2019; 101:304-310. [PMID: 30602137 DOI: 10.1016/j.psyneuen.2018.12.234] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 12/20/2018] [Accepted: 12/22/2018] [Indexed: 12/12/2022]
Abstract
Dysregulation of the hypothalamic-pituitary-adrenocortical (HPA)-axis is commonly observed in patients with depression. The delayed feedback system that mediates inhibition of HPA-axis activation is regulated by glucocorticoid receptors (GRs) found in stress-responsive areas of the brain. Glucocorticoid-induced leucine zipper (GILZ) is a key molecule in glucocorticoid biology and is thought to mediate the downstream anti-inflammatory effects of GRs. Previous reports suggest that GILZ levels are altered in the blood and brains of patients with, and animal models of, depression. However, no study has yet investigated the effects of antidepressant treatment on GILZ. Therefore, our aim was to examine peripheral blood GILZ mRNA levels in patients with depression (n = 88) compared to age- and sex-matched healthy controls (n = 63), and in patients with depression following treatment with a course of electroconvulsive therapy (ECT). We also assessed the relationship between GILZ and mood and clinical outcomes following ECT. GILZ mRNA levels were assessed using qRT-PCR. GILZ levels were found to be significantly lower in patients with depression compared to controls (p < 0.002), and ECT further decreased GILZ levels (p = 0.05). Both of these results survived adjustment for potential covariates. However, we found no association between GILZ and mood scores. Overall, these results suggest that GILZ is involved in the pathophysiology of depression and the peripheral molecular response to ECT.
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Herzog DP, Wegener G, Lieb K, Müller MB, Treccani G. Decoding the Mechanism of Action of Rapid-Acting Antidepressant Treatment Strategies: Does Gender Matter? Int J Mol Sci 2019; 20:ijms20040949. [PMID: 30813226 PMCID: PMC6412361 DOI: 10.3390/ijms20040949] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/15/2019] [Accepted: 02/19/2019] [Indexed: 12/19/2022] Open
Abstract
Gender differences play a pivotal role in the pathophysiology and treatment of major depressive disorder. This is strongly supported by a mean 2:1 female-male ratio of depression consistently observed throughout studies in developed nations. Considering the urgent need to tailor individualized treatment strategies to fight depression more efficiently, a more precise understanding of gender-specific aspects in the pathophysiology and treatment of depressive disorders is fundamental. However, current treatment guidelines almost entirely neglect gender as a potentially relevant factor. Similarly, the vast majority of animal experiments analysing antidepressant treatment in rodent models exclusively uses male animals and does not consider gender-specific effects. Based on the growing interest in innovative and rapid-acting treatment approaches in depression, such as the administration of ketamine, its metabolites or electroconvulsive therapy, this review article summarizes the evidence supporting the importance of gender in modulating response to rapid acting antidepressant treatment. We provide an overview on the current state of knowledge and propose a framework for rodent experiments to ultimately decode gender-dependent differences in molecular and behavioural mechanisms involved in shaping treatment response.
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Affiliation(s)
- David P Herzog
- Department of Psychiatry and Psychotherapy, Johannes Gutenberg University Medical Center Mainz, Untere Zahlbacher Straße 8, 55131 Mainz, Germany.
- Focus Program Translational Neurosciences, Johannes Gutenberg University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany.
| | - Gregers Wegener
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Skovagervej 2, 8240 Risskov, Denmark.
| | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, Johannes Gutenberg University Medical Center Mainz, Untere Zahlbacher Straße 8, 55131 Mainz, Germany.
- Focus Program Translational Neurosciences, Johannes Gutenberg University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany.
| | - Marianne B Müller
- Department of Psychiatry and Psychotherapy, Johannes Gutenberg University Medical Center Mainz, Untere Zahlbacher Straße 8, 55131 Mainz, Germany.
- Focus Program Translational Neurosciences, Johannes Gutenberg University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany.
| | - Giulia Treccani
- Department of Psychiatry and Psychotherapy, Johannes Gutenberg University Medical Center Mainz, Untere Zahlbacher Straße 8, 55131 Mainz, Germany.
- Focus Program Translational Neurosciences, Johannes Gutenberg University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany.
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Skovagervej 2, 8240 Risskov, Denmark.
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Alemu JL, Elberling F, Azam B, Pakkenberg B, Olesen MV. Electroconvulsive treatment prevents chronic restraint stress-induced atrophy of the hippocampal formation-A stereological study. Brain Behav 2019; 9:e01195. [PMID: 30656862 PMCID: PMC6379514 DOI: 10.1002/brb3.1195] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 12/05/2018] [Accepted: 12/09/2018] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Electroconvulsive therapy (ECT) is one of the most efficient treatments of major depressive disorder (MDD), although the underlying neurobiology remains poorly understood. There is evidence that ECT and MDD exert opposing effects on the hippocampal formation with respect to volume and number of neurons. However, there has been a paucity of quantitative data in experimental models of ECT and MDD. METHODS Using design-based stereology, we have measured the effects of a stress-induced depression model (chronic restraint stress, CRS) and ECS on the morphology of the hippocampus by estimating the volume and total number of neurons in the hilus, CA1, and CA2/3, as well as in the entire hippocampus. RESULTS We find that CRS induces a significant decrease in volume exclusively of the hilus and that ECS (CRS + ECS) blocks this reduction. Furthermore, ECS alone does not change the volume or total number of neurons in the entire hippocampus or any hippocampal subdivision in our rat model.
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Affiliation(s)
- Johanne L Alemu
- Research Laboratory for Stereology and Neuroscience, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Frederik Elberling
- Research Laboratory for Stereology and Neuroscience, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Department of Biotechnology and Biomedicine, Disease System Immunology, DTU Bioengineering, Kongens Lyngby, Denmark
| | - Bushra Azam
- Research Laboratory for Stereology and Neuroscience, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Bente Pakkenberg
- Research Laboratory for Stereology and Neuroscience, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel V Olesen
- Research Laboratory for Stereology and Neuroscience, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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14
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Tavares MK, dos Reis S, Platt N, Heinrich IA, Wolin IA, Leal RB, Kaster MP, Rodrigues ALS, Freitas AE. Agmatine potentiates neuroprotective effects of subthreshold concentrations of ketamine via mTOR/S6 kinase signaling pathway. Neurochem Int 2018; 118:275-285. [DOI: 10.1016/j.neuint.2018.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/08/2018] [Accepted: 05/11/2018] [Indexed: 12/24/2022]
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15
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Ahmed E, Tawfik MK, Essawy SS, Ahmed AS, Hermans E. Cysteamine Potentiates the Anti-Depressive Effects of Venlafaxine in Corticosterone-Induced Anxiety/Depression Mouse Model: Effect on Brain-Derived Neurotrophic Factor and Tropomyosin-Related Kinase B. EGYPTIAN JOURNAL OF BASIC AND CLINICAL PHARMACOLOGY 2018. [DOI: 10.11131/2018/101383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Eman Ahmed
- Department of Clinical Pharmacology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
- Neuropharmacology Group, Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Mona K. Tawfik
- Department of Clinical Pharmacology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Soha S. Essawy
- Department of Clinical Pharmacology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Amal S. Ahmed
- Department of Clinical Pathology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Emmanuel Hermans
- Neuropharmacology Group, Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
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16
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Leistner C, Menke A. How to measure glucocorticoid receptor's sensitivity in patients with stress-related psychiatric disorders. Psychoneuroendocrinology 2018; 91:235-260. [PMID: 29449045 DOI: 10.1016/j.psyneuen.2018.01.023] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 12/07/2017] [Accepted: 01/28/2018] [Indexed: 12/31/2022]
Abstract
Stress is a state of derailed homeostasis and a main environmental risk factor for psychiatric diseases. Chronic or uncontrollable stress may lead to a dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, which is a common feature of stress-related psychiatric disorders. One of the key mechanisms underlying a disturbed HPA axis is an impaired function of the glucocorticoid receptor (GR) with an enhanced or reduced feedback sensitivity for glucocorticoids and subsequently altered concentrations of peripheral cortisol. GR function is regulated by a multiprotein complex including the different expression of the hsp90 co-chaperone FK 506 binding protein 51 (FKBP5) that may be genetically determined or acquired in response to stressful stimuli. Specific patterns of a dysregulation of the HPA axis and GR function are found in different stress-related psychiatric entities e.g. major depression, job-related exhaustion or posttraumatic stress disorder. GR challenge tests like the dexamethasone-suppression test (DST), the dexamethasone-corticotropin-releasing hormone (dex-CRH) test or most recently the analysis of the dexamethasone-induced gene expression are employed to sensitively measure HPA axis activity in these disorders. They provide information for a stratification of phenotypic similar but neurobiological diverse psychiatric disorders. In this review we present a synopsis of GR challenge tests with a focus on the application of the DST, the CRH test and the dex-CRH test as well as the dexamethasone-induced gene expression in stress-related psychiatric entities.
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Affiliation(s)
- Carolin Leistner
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Margarete-Hoeppel-Platz 1, Wuerzburg, 97080, Germany
| | - Andreas Menke
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Margarete-Hoeppel-Platz 1, Wuerzburg, 97080, Germany; Comprehensive Heart Failure Center, University Hospital of Wuerzburg, Am Schwarzenberg 15, Wuerzburg, 97080, Germany.
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17
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Maynard KR, Hobbs JW, Rajpurohit SK, Martinowich K. Electroconvulsive seizures influence dendritic spine morphology and BDNF expression in a neuroendocrine model of depression. Brain Stimul 2018; 11:856-859. [PMID: 29674117 DOI: 10.1016/j.brs.2018.04.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/30/2018] [Accepted: 04/03/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is a rapid and effective treatment for major depressive disorder. Chronic stress-induced depression causes dendrite atrophy and deficiencies in brain-derived neurotrophic factor (BDNF), which are reversed by anti-depressant drugs. Electroconvulsive seizures (ECS), an animal model of ECT, robustly increase BDNF expression and stimulate dendritic outgrowth. OBJECTIVE The present study aims to understand cellular and molecular plasticity mechanisms contributing to the efficacy of ECS following chronic stress-induced depression. METHODS We quantify Bdnf transcript levels and dendritic spine density and morphology on cortical pyramidal neurons in mice exposed to vehicle or corticosterone and receiving either Sham or ECS treatment. RESULTS ECS rescues corticosterone-induced defects in spine morphology and elevates Bdnf exon 1 and exon 4-containing transcripts in cortex. CONCLUSIONS Dendritic spine remodeling and induction of activity-induced BDNF in the cortex represent important cellular and molecular plasticity mechanisms underlying the efficacy of ECS for treatment of chronic stress-induced depression.
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Affiliation(s)
- Kristen R Maynard
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, 21205, United States
| | - John W Hobbs
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, 21205, United States
| | - Sumita K Rajpurohit
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, 21205, United States
| | - Keri Martinowich
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, 21205, United States; Departments of Neuroscience, Psychiatry and Behavioral Sciences, Johns Hopkins Medical School, Baltimore, MD, 21205, United States.
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18
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Emerging role of amyloid beta in stress response: Implication for depression and diabetes. Eur J Pharmacol 2017; 817:22-29. [DOI: 10.1016/j.ejphar.2017.08.031] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 12/11/2022]
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19
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Yrondi A, Sporer M, Péran P, Schmitt L, Arbus C, Sauvaget A. Electroconvulsive therapy, depression, the immune system and inflammation: A systematic review. Brain Stimul 2017; 11:29-51. [PMID: 29111078 DOI: 10.1016/j.brs.2017.10.013] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/13/2017] [Accepted: 10/15/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The management and treatment of major depressive disorder are major public health challenges, the lifetime prevalence of this illness being 4.4%-20% in the general population. Major depressive disorder and treatment resistant depression appear to be, in part, related to a dysfunction of the immune response. Among the treatments for depression ECT occupies an important place. The underlying cerebral mechanisms of ECT remain unclear. OBJECTIVES/HYPOTHESIS The aim of this review is to survey the potential actions of ECT on the immuno-inflammatory cascade activated during depression. METHODS A systematic search of the literature was carried out, using the bibliographic search engines PubMed and Embase. The search covered articles published up until october 2017. The following MESH terms were used: Electroconvulsive therapy AND (inflammation OR immune OR immunology). RESULTS Our review shows that there is an acute immuno-inflammatory response immediately following an ECT session. There is an acute stress reaction. Studies show an increase in the plasma levels of cortisol and of interleukins 1 and 6. However, at the end of the course of treatment, ECT produces, in the long term, a fall in the plasma level of cortisol, a reduction in the levels of TNF alpha and interleukin 6. LIMITATIONS One of the limitations of this review is that a large number of studies are relatively old, with small sample sizes and methodological bias. CONCLUSION Advances in knowledge of the immuno-inflammatory component of depression seem to be paving the way towards models to explain the mechanism of action of ECT.
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Affiliation(s)
- Antoine Yrondi
- Psychiatric Department, CHU Toulouse-Purpan, 330 Avenue de Grande Bretagne, 31059 Toulouse, France; Toulouse NeuroImaging Center, ToNIC, University of Toulouse, Inserm, UPS, France.
| | - Marie Sporer
- Psychiatric Department, CHU Toulouse-Purpan, 330 Avenue de Grande Bretagne, 31059 Toulouse, France
| | - Patrice Péran
- Toulouse NeuroImaging Center, ToNIC, University of Toulouse, Inserm, UPS, France
| | - Laurent Schmitt
- Psychiatric Department, CHU Toulouse-Purpan, 330 Avenue de Grande Bretagne, 31059 Toulouse, France
| | - Christophe Arbus
- Psychiatric Department, CHU Toulouse-Purpan, 330 Avenue de Grande Bretagne, 31059 Toulouse, France; Toulouse NeuroImaging Center, ToNIC, University of Toulouse, Inserm, UPS, France
| | - Anne Sauvaget
- CHU Nantes, Addictology and Liaison Psychiatry Department, Neuromodulation Unit in Psychiatry, Nantes, France
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20
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Jiang J, Wang J, Li C. Potential Mechanisms Underlying the Therapeutic Effects of Electroconvulsive Therapy. Neurosci Bull 2017; 33:339-347. [PMID: 28032314 PMCID: PMC5567510 DOI: 10.1007/s12264-016-0094-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 11/23/2016] [Indexed: 01/01/2023] Open
Abstract
In spite of the extensive application of electroconvulsive therapy (ECT), how it works remains unclear. So far, researchers have made great efforts in figuring out the mechanisms underlying the effect of ECT treatment via determining the levels of neurotransmitters and cytokines and using genetic and epigenetic tools, as well as structural and functional neuroimaging. To help address this question and provide implications for future research, relevant clinical trials and animal experiments are reviewed.
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Affiliation(s)
- Jiangling Jiang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Ministry of Education, Shanghai Jiao Tong University, Shanghai, 200030, China
- Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Chunbo Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China.
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Ministry of Education, Shanghai Jiao Tong University, Shanghai, 200030, China.
- Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, 200030, China.
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21
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El Arfani A, Parthoens J, Demuyser T, Servaes S, De Coninck M, De Deyn PP, Van Dam D, Wyckhuys T, Baeken C, Smolders I, Staelens S. Accelerated high-frequency repetitive transcranial magnetic stimulation enhances motor activity in rats. Neuroscience 2017; 347:103-110. [DOI: 10.1016/j.neuroscience.2017.01.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 01/23/2017] [Accepted: 01/27/2017] [Indexed: 01/21/2023]
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22
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Chau DT, Fogelman P, Nordanskog P, Drevets WC, Hamilton JP. Distinct Neural-Functional Effects of Treatments With Selective Serotonin Reuptake Inhibitors, Electroconvulsive Therapy, and Transcranial Magnetic Stimulation and Their Relations to Regional Brain Function in Major Depression: A Meta-analysis. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2017; 2:318-326. [PMID: 29560920 DOI: 10.1016/j.bpsc.2017.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/19/2017] [Accepted: 01/19/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Functional neuroimaging studies have examined the neural substrates of treatments for major depressive disorder (MDD). Low sample size and methodological heterogeneity, however, undermine the generalizability of findings from individual studies. We conducted a meta-analysis to identify reliable neural changes resulting from different modes of treatment for MDD and compared them with each other and with reliable neural functional abnormalities observed in depressed versus control samples. METHODS We conducted a meta-analysis of studies reporting changes in brain activity (e.g., as indexed by positron emission tomography) following treatments with selective serotonin reuptake inhibitors (SSRIs), electroconvulsive therapy (ECT), or transcranial magnetic stimulation. Additionally, we examined the statistical reliability of overlap among thresholded meta-analytic SSRI, ECT, and transcranial magnetic stimulation maps as well as a map of abnormal neural function in MDD. RESULTS Our meta-analysis revealed that 1) SSRIs decrease activity in the anterior insula, 2) ECT decreases activity in central nodes of the default mode network, 3) transcranial magnetic stimulation does not result in reliable neural changes, and 4) regional effects of these modes of treatment do not significantly overlap with each other or with regions showing reliable functional abnormality in MDD. CONCLUSIONS SSRIs and ECT produce neurally distinct effects relative to each other and to the functional abnormalities implicated in depression. These treatments therefore may exert antidepressant effects by diminishing neural functions not implicated in depression but that nonetheless impact mood. We discuss how the distinct neural changes resulting from SSRIs and ECT can account for both treatment effects and side effects from these therapies as well as how to individualize these treatments.
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Affiliation(s)
- David T Chau
- Laureate Institute for Brain Research, Tulsa, Oklahoma
| | | | - Pia Nordanskog
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Wayne C Drevets
- Laureate Institute for Brain Research, Tulsa, Oklahoma; Janssen Research & Development, Janssen Pharmaceuticals of Johnson & Johnson, Titusville, New Jersey
| | - J Paul Hamilton
- Laureate Institute for Brain Research, Tulsa, Oklahoma; Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
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Argyelan M, Lencz T, Kaliora S, Sarpal DK, Weissman N, Kingsley PB, Malhotra AK, Petrides G. Subgenual cingulate cortical activity predicts the efficacy of electroconvulsive therapy. Transl Psychiatry 2016; 6:e789. [PMID: 27115120 PMCID: PMC4872412 DOI: 10.1038/tp.2016.54] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 01/25/2016] [Accepted: 02/28/2016] [Indexed: 12/12/2022] Open
Abstract
Electroconvulsive therapy (ECT) is the most effective treatment for depression, yet its mechanism of action is unknown. Our goal was to investigate the neurobiological underpinnings of ECT response using longitudinally collected resting-state functional magnetic resonance imaging (rs-fMRI) in 16 patients with treatment-resistant depression and 10 healthy controls. Patients received bifrontal ECT 3 times a week under general anesthesia. We acquired rs-fMRI at three time points: at baseline, after the 1st ECT administration and after the course of the ECT treatment; depression was assessed with the Hamilton Depression Rating Scale (HAM-D). The primary measure derived from rs-fMRI was fractional amplitude of low frequency fluctuation (fALFF), which provides an unbiased voxel-wise estimation of brain activity. We also conducted seed-based functional connectivity analysis based on our primary findings. We compared treatment-related changes in HAM-D scores with pre- and post-treatment fALFF and connectivity measures. Subcallosal cingulate cortex (SCC) demonstrated higher BOLD signal fluctuations (fALFF) at baseline in depressed patients, and SCC fALFF decreased over the course of treatment. The baseline level of fALFF of SCC predicted response to ECT. In addition, connectivity of SCC with bilateral hippocampus, bilateral temporal pole, and ventromedial prefrontal cortex was significantly reduced over the course of treatment. These results suggest that the antidepressant effect of ECT may be mediated by downregulation of SCC activity and connectivity. SCC function may serve as an important biomarker of target engagement in the development of novel therapies for depression that is resistant to treatment with standard medications.
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Affiliation(s)
- M Argyelan
- Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA,Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA,Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, 75-59 263rd Street, Glen Oaks, NY 11004, USA. E-mail:
| | - T Lencz
- Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA,Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA,Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - S Kaliora
- Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA,Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
| | - D K Sarpal
- Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA,Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
| | - N Weissman
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
| | - P B Kingsley
- Department of Radiology, North Shore University Hospital, Northwell Health, Manhasset, NY, USA
| | - A K Malhotra
- Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA,Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA,Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - G Petrides
- Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA,Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA,Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, NY, USA
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Ota M, Noda T, Sato N, Okazaki M, Ishikawa M, Hattori K, Hori H, Sasayama D, Teraishi T, Sone D, Kunugi H. Effect of electroconvulsive therapy on gray matter volume in major depressive disorder. J Affect Disord 2015; 186:186-91. [PMID: 26247910 DOI: 10.1016/j.jad.2015.06.051] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 06/28/2015] [Accepted: 06/29/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Although the clinical efficacy of electroconvulsive therapy (ECT) is well established, the underlying mechanisms of action remain elusive. The aim of this study was to elucidate structural changes of the brain following ECT in patients with major depressive disorder (MDD). METHOD Fifteen patients with MDD underwent magnetic resonance imaging scanning before and after ECT. Their gray matter volumes were compared between pre- and post-ECT. RESULTS There were significant volume increases after ECT in the bilateral medial temporal cortices, inferior temporal cortices, and right anterior cingulate. Further, the increase ratio was correlated with the clinical improvement measured by the Hamilton Depression Rating scale. LIMITATION All subjects were treated with antidepressants that could have a neurotoxic or neuroprotective effect on the brain. CONCLUSIONS We found that there were significant increases of gray matter volume in medial temporal lobes following ECT, suggesting that a neurotrophic effect of ECT could play a role in its therapeutic effect.
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Affiliation(s)
- Miho Ota
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8502, Japan.
| | - Takamasa Noda
- Department of Psychiatry, National Center Hospital of Neurology and Psychiatry, 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan
| | - Noriko Sato
- Department of Radiology, National Center Hospital of Neurology and Psychiatry, 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan
| | - Mitsutoshi Okazaki
- Department of Psychiatry, National Center Hospital of Neurology and Psychiatry, 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan
| | - Masatoshi Ishikawa
- Department of Psychiatry, National Center Hospital of Neurology and Psychiatry, 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan
| | - Kotaro Hattori
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8502, Japan
| | - Hiroaki Hori
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8502, Japan
| | - Daimei Sasayama
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8502, Japan
| | - Toshiya Teraishi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8502, Japan
| | - Daichi Sone
- Department of Radiology, National Center Hospital of Neurology and Psychiatry, 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan
| | - Hiroshi Kunugi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8502, Japan
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25
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Schloesser RJ, Orvoen S, Jimenez DV, Hardy NF, Maynard KR, Sukumar M, Manji HK, Gardier AM, David DJ, Martinowich K. Antidepressant-like Effects of Electroconvulsive Seizures Require Adult Neurogenesis in a Neuroendocrine Model of Depression. Brain Stimul 2015; 8:862-7. [PMID: 26138027 DOI: 10.1016/j.brs.2015.05.011] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 05/05/2015] [Accepted: 05/31/2015] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Neurogenesis continues throughout life in the hippocampal dentate gyrus. Chronic treatment with monoaminergic antidepressant drugs stimulates hippocampal neurogenesis, and new neurons are required for some antidepressant-like behaviors. Electroconvulsive seizures (ECS), a laboratory model of electroconvulsive therapy (ECT), robustly stimulate hippocampal neurogenesis. HYPOTHESIS ECS requires newborn neurons to improve behavioral deficits in a mouse neuroendocrine model of depression. METHODS We utilized immunohistochemistry for doublecortin (DCX), a marker of migrating neuroblasts, to assess the impact of Sham or ECS treatments (1 treatment per day, 7 treatments over 15 days) on hippocampal neurogenesis in animals receiving 6 weeks of either vehicle or chronic corticosterone (CORT) treatment in the drinking water. We conducted tests of anxiety- and depressive-like behavior to investigate the ability of ECS to reverse CORT-induced behavioral deficits. We also determined whether adult neurons are required for the effects of ECS. For these studies we utilized a pharmacogenetic model (hGFAPtk) to conditionally ablate adult born neurons. We then evaluated behavioral indices of depression after Sham or ECS treatments in CORT-treated wild-type animals and CORT-treated animals lacking neurogenesis. RESULTS ECS is able to rescue CORT-induced behavioral deficits in indices of anxiety- and depressive-like behavior. ECS increases both the number and dendritic complexity of adult-born migrating neuroblasts. The ability of ECS to promote antidepressant-like behavior is blocked in mice lacking adult neurogenesis. CONCLUSION ECS ameliorates a number of anxiety- and depressive-like behaviors caused by chronic exposure to CORT. ECS requires intact hippocampal neurogenesis for its efficacy in these behavioral indices.
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Affiliation(s)
- Robert J Schloesser
- University of Maryland School of Medicine, Department of Psychiatry, Baltimore, MD, USA; Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, USA
| | - Sophie Orvoen
- Université Paris Sud, INSERM UMR S 1178, Faculté de Pharmacie, Châtenay-Malabry, France
| | - Dennisse V Jimenez
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, USA
| | - Nicholas F Hardy
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, USA
| | - Kristen R Maynard
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, USA
| | - Mahima Sukumar
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, USA
| | - Husseini K Manji
- Global Therapeutic Area Head, Neuroscience, Janssen Research & Development, Titusville, NJ, USA
| | - Alain M Gardier
- Université Paris Sud, INSERM UMR S 1178, Faculté de Pharmacie, Châtenay-Malabry, France
| | - Denis J David
- Université Paris Sud, INSERM UMR S 1178, Faculté de Pharmacie, Châtenay-Malabry, France
| | - Keri Martinowich
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, USA; Departments of Psychiatry and Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Abbott CC, Gallegos P, Rediske N, Lemke NT, Quinn DK. A review of longitudinal electroconvulsive therapy: neuroimaging investigations. J Geriatr Psychiatry Neurol 2014; 27:33-46. [PMID: 24381234 PMCID: PMC6624835 DOI: 10.1177/0891988713516542] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Electroconvulsive therapy (ECT) is the most effective treatment for a depressive episode but the mechanism of action and neural correlates of response are poorly understood. Different theories have suggested that anticonvulsant properties or neurotrophic effects are related to the unique mechanism of action of ECT. This review assessed longitudinal imaging investigations (both structural and functional) associated with ECT response published from 2002 to August 2013. We identified 26 investigations that used a variety of different imaging modalities and data analysis methods. Despite these methodological differences, we summarized the major findings of each investigation and identified common patterns that exist across multiple investigations. The ECT response is associated with decreased frontal perfusion, metabolism, and functional connectivity and increased volume and neuronal chemical metabolites. The general collective of longitudinal neuroimaging investigations support both the anticonvulsant and the neurotrophic effects of ECT. We propose a conceptual framework that integrates these seemingly contradictory hypotheses.
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Affiliation(s)
- Christopher C. Abbott
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Patrick Gallegos
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Nathan Rediske
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Nicholas T. Lemke
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Davin K. Quinn
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA
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Leukocyte Gene Expression in Patients with Medication Refractory Depression before and after Treatment with ECT or Isoflurane Anesthesia: A Pilot Study. DEPRESSION RESEARCH AND TREATMENT 2014; 2014:582380. [PMID: 24826212 PMCID: PMC4009159 DOI: 10.1155/2014/582380] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 03/22/2014] [Indexed: 12/16/2022]
Abstract
Objective. To evaluate leukocyte gene expression for 9 selected genes (mRNAs) as biological markers in patients with medication refractory depression before and after treatment with ECT or isoflurane anesthesia (ISO). Methods. In a substudy of a nonrandomized open-label trial comparing effects of ECT to ISO therapy, blood samples were obtained before and after treatment from 22 patients with refractory depression, and leukocyte mRNA was assessed by quantitative PCR. Patients' mRNAs were also compared to 17 healthy controls. Results. Relative to controls, patients before treatment showed significantly higher IL10 and DBI and lower ADRA2A and ASIC3 mRNA (P < 0.025). Both ECT and ISO induced significant decreases after treatment in 4 genes: IL10, NR3C1, DRD4, and Sult1A1. After treatment, patients' DBI, ASIC3, and ADRA2A mRNA remained dysregulated. Conclusion. Significant differences from controls and/or significant changes after ECT or ISO treatment were observed for 7 of the 9 mRNAs studied. Decreased expression of 4 genes after effective treatment with either ECT or ISO suggests possible overlap of underlying mechanisms. Three genes showing dysregulation before and after treatment may be trait-like biomarkers of medication refractory depression. Gene expression for these patients has the potential to facilitate diagnosis, clarify pathophysiology, and identify potential biomarkers for treatment effects.
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Fosse R, Read J. Electroconvulsive Treatment: Hypotheses about Mechanisms of Action. Front Psychiatry 2013; 4:94. [PMID: 23986724 PMCID: PMC3753611 DOI: 10.3389/fpsyt.2013.00094] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 08/10/2013] [Indexed: 12/11/2022] Open
Abstract
No consensus has been reached on the mode of action of electroconvulsive treatment (ECT). We suggest that two features may aid in the delineation of the involved mechanisms. First, when effective, ECT would be likely to affect brain functions that are typically altered in its primary recipient group, people with severe depression. Central among these are the frontal and temporal lobes, the hypothalamus-pituitary-adrenal (HPA) stress axis, and the mesocorticolimbic dopamine system. Second, the involved mechanisms should be affected for a time period that matches the average endurance of clinical effects, which is indicated to be several days to a few weeks. To identify effects upon frontal and temporal lobe functioning we reviewed human studies using EEG, PET, SPECT, and fMRI. Effects upon the HPA axis and the dopamine system were assessed by reviewing both human and animal studies. The EEG studies indicate that ECT decelerates neural activity in the frontal and temporal lobes (increased delta and theta wave activity) for weeks to months. Comparable findings are reported from PET and SPECT studies, with reduced cerebral blood flow (functional deactivation) for weeks to months after treatment. The EEG deceleration and functional deactivation following ECT are statistically associated with reduced depression scores. FMRI studies indicate that ECT flattens the pattern of activation and deactivation that is associated with cognitive task performance and alters cortical functional connectivity in the ultra slow frequency range. A common finding from human and animal studies is that ECT acutely activates both the HPA axis and the dopamine system. In considering this evidence, we hypothesize that ECT affects the brain in a similar manner as severe stress or brain trauma which activates the HPA axis and the dopamine system and may compromise frontotemporal functions.
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Affiliation(s)
- Roar Fosse
- Division of Mental Health and Addiction, Vestre Viken State Hospital Trust, Lier, Norway
| | - John Read
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
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Reininghaus EZ, Reininghaus B, Ille R, Fitz W, Lassnig RM, Ebner C, Annamaria P, Hofmann P, Kapfhammer HP, Reingard A, Fazekas F, Ropele S, Enzinger C. Clinical effects of electroconvulsive therapy in severe depression and concomitant changes in cerebral glucose metabolism--an exploratory study. J Affect Disord 2013; 146:290-4. [PMID: 23122530 DOI: 10.1016/j.jad.2012.07.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 07/23/2012] [Accepted: 07/23/2012] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is an effective mode of treatment--especially for severe depression and for depression refractory to pharmacotherapy, nevertheless the mode of action of ECT is far from being fully understood. This study assessed the effects of a series of ECT in depressive subjects on cerebral glucose metabolism measured by FDG-PET scans pre- and post-therapy in thus far the largest group of 12 patients. METHODS Our analysis included careful repeated evaluation of clinical changes in mood and behaviour by standardised questionnaires, which allowed testing for a potential correlation between clinical and cerebral metabolic changes. PET scanning was done within a predefined time window and we used predefined ROIs with counts normalized to the pons activity. RESULTS We observed few changes in cerebral glucose metabolism over time. There was a marginal increase in the left temporal and a trend for a decrease in left frontobasal areas subsequent to treatment in our sample. FDG uptake patterns remained remarkably stable in all the other predefined ROIs pre- and post-treatment. There were no significant correlations between changes in relative metabolic rates and changes in depression scores and parameters derived from neurocognitive testing. CONCLUSIONS Our study thus cannot support the view that FDG-PET can assess the functional brain changes that are likely to occur subsequent to ECT in such a scenario, but this may be related to limited sensitivity given the sample size. Future studies thus might wish to challenge this notion in larger patient samples to clarify this issue.
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Affiliation(s)
- Eva Z Reininghaus
- Department of Psychiatry, Medical University of Graz, Auenbruggerplatz 31, A 8036 Graz, Austria.
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Suwa T, Namiki C, Takaya S, Oshita A, Ishizu K, Fukuyama H, Suga H, Murai T. Corticolimbic balance shift of regional glucose metabolism in depressed patients treated with ECT. J Affect Disord 2012; 136:1039-46. [PMID: 22209122 DOI: 10.1016/j.jad.2011.11.040] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Accepted: 11/27/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although the clinical efficacy of electroconvulsive therapy (ECT) has been well established in patients with pharmacotherapy-resistant depression, the physiological mechanism and changes in regional cerebral function after ECT are unclear. METHODS We recruited 16 depressed patients who underwent ECT, and 11 healthy controls. The change in cerebral glucose metabolism was evaluated before and after a series of ECT using [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET). RESULTS Before ECT, the patient group showed significant hypometabolism in the superior frontal gyrus, and hypermetabolism in the inferior temporal gyri compared with healthy controls, and these abnormalities remained after ECT. Comparisons between pre- and post-ECT metabolic activity revealed decreased regional metabolism in the frontotemporal neocortical areas after ECT, while increased metabolism was found in the right medial temporal structures including amygdala and pons. In addition, a decrease in glucose metabolism in the fronto-temporo-parietal regions correlated with an increase in glucose metabolism in the right medial temporal regions across subjects. LIMITATIONS There was considerable variability in the interval between the last ECT and FDG-PET scan. Depressed subjects were maintained on medication. The subjects included both major depressive disorder and bipolar disorder patients, as well as both ECT responders and non-responders. CONCLUSION Depression refractory to pharmacotherapy might have functional deficits in specific circumscribed frontal and temporal structures. ECT resolves the clinical symptoms without largely affecting these brain metabolic abnormalities. In contrast, ECT shifts the balance of corticolimbic function, which might explain how ECT ameliorates symptoms of depression in patients.
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Affiliation(s)
- Taro Suwa
- Department of Neuropsychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is one of the most effective treatments for severe major depressive disorder. However, after acute-phase treatment and initial remission, relapse rates are significant. Strategies to prolong remission include continuation phase ECT, pharmacotherapy, psychotherapy, or their combinations. This systematic review synthesizes extant data regarding the combined use of psychotherapy with ECT for the treatment of patients with severe major depressive disorder and offers the hypothesis that augmenting ECT with depression-specific psychotherapy represents a promising strategy for future investigation. METHODS The authors performed 2 independent searches in PsychInfo (1806-2009) and MEDLINE (1948-2009) using combinations of the following search terms: Electroconvulsive Therapy (including ECT, ECT therapy, electroshock therapy, EST, and shock therapy) and Psychotherapy (including cognitive behavioral, interpersonal, group, psychodynamic, psychoanalytic, individual, eclectic, and supportive). We included in this review a total of 6 articles (English language) that mentioned ECT and psychotherapy in the abstract and provided a case report, series, or clinical trial. We examined the articles for data related to ECT and psychotherapy treatment characteristics, cohort characteristics, and therapeutic outcome. RESULTS Although research over the past 7 decades documenting the combined use of ECT and psychotherapy is limited, the available evidence suggests that testing this combination has promise and may confer additional, positive functional outcomes. CONCLUSIONS Significant methodological variability in ECT and psychotherapy procedures, heterogeneous patient cohorts, and inconsistent outcome measures prevent strong conclusions; however, existing research supports the need for future investigations of combined ECT and psychotherapy in well-designed, controlled clinical studies. Depression-specific psychotherapy approaches may need special adaptations in view of the cognitive effects of ECT.
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Vukadin M, Birkenhäger TK, Wierdsma AI, Groenland THN, van den Broek WW. Post-dexamethasone cortisol as a predictor for the efficacy of electroconvulsive therapy in depressed inpatients. J Psychiatr Res 2011; 45:1165-9. [PMID: 21481419 DOI: 10.1016/j.jpsychires.2011.03.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 02/23/2011] [Accepted: 03/20/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although several variables have been studied as a possible predictor for the efficacy of ECT, results regarding hypercortisolism have been inconsistent. This prospective study evaluates the relation between pre-treatment cortisol levels and the efficacy of ECT in a population of drug-free inpatients with severe major depression. METHODS At the inpatient depression unit, 18 patients meeting the DSM-IV criteria for depressive disorder, and with scores of at least 18 on the 17-item Hamilton Rating Scale for Depression (HAM-D), were treated with bilateral ECT twice weekly. The HAM-D evaluated depression severity and was performed within 3 days prior to ECT, weekly during the course of ECT, and within 3 days after the last treatment. The outcome criterion was defined a priori as the change on the HAM-D score. Salivary cortisol was assessed within 3 days prior to ECT at two time points, followed by 0.5 mg dexamethasone ingestion. The following day, salivary cortisol was again assessed at two time points. The generalized linear model was used to assess the relation between salivary cortisol levels and reduction in HAM-D score as continuous variables. RESULTS Higher levels of salivary cortisol at 9 AM after 0.5 mg dexamethasone ingestion are associated with a greater reduction in HAM-D score (B = -0.279, 95% CI: -0.557 to -0.01, s.e. = 0.13, p = 0.049; R square = 0.23; adjusted R square = 0.13). CONCLUSION This study suggests that higher levels of post-dexamethasone salivary cortisol at 9 AM are predictive of ECT efficacy.
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Affiliation(s)
- Miljana Vukadin
- Department of Psychiatry, Erasmus Medical Center, PO Box 2040, 3000CA Rotterdam, The Netherlands
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Abstract
INTRODUCTION Glucocorticoids and the stress hormone system have been implicated in the pathophysiology of depression and in the mechanism of action of antidepressant response. Many studies have investigated this system in an effort to predict response to antidepressant treatment. The purpose of this review is to evaluate the evidence for using glucocorticoid-related measures for personalized treatment of depression. METHODS We conducted a MEDLINE search from 1966 through 2010 and examined English-language studies reporting on the use of endocrine challenge tests and genetic polymorphisms in genes regulating the stress hormone system as predictors of antidepressant response. RESULTS While measures of glucocorticoid levels using endocrine tests, as well polymorphisms in genes regulating the stress hormone system, show associations with response to antidepressant treatment, these measures will need to be combined with other variables, including clinical information and other biological measures, to realize the goal of highly predictive and clinically relevant biomarkers. DISCUSSION The glucocorticoid system is potentially of great use in predicting antidepressant response. New combinations of biomarkers including these measures should be tested to develop clinically relevant predictors.
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Affiliation(s)
- Sonja Horstmann
- Max Planck Institute of Psychiatry-RG Molecular Genetics of Affective Disorders, Munich, Germany
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Bolwig TG. How does electroconvulsive therapy work? Theories on its mechanism. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2011; 56:13-8. [PMID: 21324238 DOI: 10.1177/070674371105600104] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This article reviews 3 current theories of electroconvulsive therapy (ECT). One theory points to generalized seizures as essential for the therapeutic efficacy of ECT. Another theory highlights the normalization of neuroendocrine dysfunction in melancholic depression as a result of ECT. A third theory is based on recent findings of increased hippocampal neurogenesis and synaptogenesis in experimental animals given electroconvulsive seizures. Presently, the endocrine theory has the strongest foundation to explain the working mechanism of ECT.
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Affiliation(s)
- Tom G Bolwig
- Department of Psychiatry, Copenhagen University Hospital, 9 Blegdamsvej, Copenhagen, Denmark.
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Increase in hippocampal volume after electroconvulsive therapy in patients with depression: a volumetric magnetic resonance imaging study. J ECT 2010; 26:62-7. [PMID: 20190603 DOI: 10.1097/yct.0b013e3181a95da8] [Citation(s) in RCA: 144] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Major depression has traditionally been regarded as a neurochemical disease, but findings of a decreased hippocampal volume in patients with depression have turned the pathophysiological focus toward impairments in structural plasticity. The mechanisms of action of the most effective antidepressive treatment, electroconvulsive therapy (ECT), still remains elusive, but recent animal research has provided evidence for a cell proliferative effect in the hippocampus. The aim of this prospective study was to determine if hippocampal volume changes after ECT in patients with depression. METHODS Twelve patients with depression and ongoing antidepressive pharmacological treatment were investigated with clinical ratings and 3 T magnetic resonance imaging within 1 week before and after the ECT series. Each hippocampus was manually outlined on coronal slices, and the volume was calculated. RESULTS The left as well as the right hippocampal volume increased significantly after ECT. CONCLUSIONS The hippocampal volume increases after ECT, supporting the hypothesis that hippocampus may play a central role in the treatment of depression.
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Abstract
The concept of inducing convulsions, mainly through chemical means, to promote mental wellness has existed since the 16th century. In 1938, Italian scientists first applied electrically induced therapeutic seizures. Although electroconvulsive therapy (ECT) is employed in the treatment of several psychiatric disorders, it is most frequently used today to treat severe depressive episodes and remains the most effective treatment available for those disorders. Despite this, ECT continues to be the most stigmatized treatment available in psychiatry, resulting in restrictions on and reduced accessibility to a helpful and potentially life-saving treatment. The psychiatric and psychosocial ramifications of this stigmatization may include the exacerbation of the increasingly serious, global health problem of major depressive disorders as well as serious consequences for individual patients who may not be offered, or may refuse, a potentially beneficial treatment. The goal of this first article in this two-part series is to provide an overview of ECT's historical development and discuss the current state of knowledge about ECT, including technical aspects of delivery, patient selection, its side-effect profile, and factors that may contribute to underuse of ECT.
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Affiliation(s)
- Nancy A Payne
- Silver School of Social Work, New York University (NYU), USA.
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Wachtel LE, Contrucci-Kuhn SA, Griffin M, Thompson A, Dhossche DM, Reti IM. ECT for self-injury in an autistic boy. Eur Child Adolesc Psychiatry 2009; 18:458-63. [PMID: 19198918 DOI: 10.1007/s00787-009-0754-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Accepted: 01/09/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Self-injurious behavior presents a significant challenge in autism, and first-line psychopharmacological and behavioral interventions have limited efficacy in some patients. These intractable cases may be responsive to electroconvulsive therapy. CLINICAL PICTURE This article presents an eight-year-old boy with autism, mental retardation, prominent mood lability and a five-year history of extreme self-injurious behavior towards his head, averaging 109 self-injurious attempts hourly. The patient was at high risk for serious head trauma, and required usage of bilateral arm restraints and protective equipment (i.e., padding on shoulders, arms, and legs). All areas of daily functioning were profoundly impacted by dangerous self-injury. TREATMENT Fifteen bilateral ECT treatments resulted in excellent mood stabilization and reduction of self-injury to 19 attempts hourly, and maintenance ECT was pursued. The patient was able to return to developmentally-appropriate educational and social activities. CONCLUSION ECT should be considered in the treatment algorithm of refractory cases of severe self-injury in autism.
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Affiliation(s)
- Lee E Wachtel
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA.
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Electroconvulsive stimulations normalizes stress-induced changes in the glucocorticoid receptor and behaviour. Behav Brain Res 2009; 196:71-7. [DOI: 10.1016/j.bbr.2008.07.037] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Revised: 07/14/2008] [Accepted: 07/17/2008] [Indexed: 11/20/2022]
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Binder EB, Künzel HE, Nickel T, Kern N, Pfennig A, Majer M, Uhr M, Ising M, Holsboer F. HPA-axis regulation at in-patient admission is associated with antidepressant therapy outcome in male but not in female depressed patients. Psychoneuroendocrinology 2009; 34:99-109. [PMID: 18829172 DOI: 10.1016/j.psyneuen.2008.08.018] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Revised: 08/13/2008] [Accepted: 08/20/2008] [Indexed: 11/15/2022]
Abstract
A concatenation of data implicates a hyperactivity of the hypothalamus pituitary adrenal (HPA)-axis in the pathogenesis of depression and its normalization as a necessary predecessor of clinical response to antidepressant drugs. In addition, regulation of the HPA-axis has been shown to be dependent on sex hormones. We therefore investigated gender differences in HPA-axis regulation in depression and its normalization during remission of clinical symptoms. We used the combined dexamethasone suppression/CRH stimulation (Dex-CRH) test to evaluate the degree of HPA-axis dysregulation in 194 in-patients with unipolar depression from the Munich Antidepressant Response Signature (MARS) study at both admission and discharge. The Hamilton Depression (HAM-D) Rating Scale was used to monitor clinical response to antidepressant treatment. For both genders, we observed a normalization of HPA-axis dysregulation in remitters but not in non-remitters, both after 5 weeks of treatment and at discharge. The pattern of HPA-axis normalization with remission of depressive symptoms, however, showed gender-specific differences. In male patients, remission after 5 weeks of in-patient treatment was associated with a significantly higher cortisol response in the Dex-CRH test at admission. In female patients, 5-week remitters and non-remitters had a comparable cortisol response at admission. Cortisol response at admission was not correlated with gonadal steroid levels at this time point and the results were similar for pre-menopausal women vs. post-menopausal women. Gender-associated biological characteristics, likely independent of circulating gonadal steroids, thus seem to influence HPA-axis regulation in depression. In male patients, a single measure of HPA-axis dysregulation at admission may serve as a predictor of response to antidepressant treatment in addition to the previously reported repeated measure of the Dex-CRH test.
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Affiliation(s)
- E B Binder
- Max-Planck Institute of Psychiatry, Kraepelinstrasse 2-10, D80804 Munich, Germany.
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Abstract
Clinical studies have demonstrated an impairment of glucocorticoid receptor (GR)-mediated negative feedback on the hypothalamus-pituitary-adrenal (HPA) axis in patients with major depression (GR resistance), and its resolution by antidepressant treatment. Accordingly, reduced GR function has also been demonstrated in vitro, in peripheral tissues of depressed patients, as shown by reduced sensitivity to the effects of glucocorticoids on immune and metabolic functions. We and others have shown that antidepressants in vitro are able to modulate GR mRNA expression, GR protein level and GR function. This paper reviews the in vitro studies that have examined the effect of antidepressants on GR expression, number and function in human and animal cell lines, and the possible molecular mechanisms underlying these effects. Antidepressants are shown to both increase and decrease GR function in vitro, based on different experimental conditions. Specifically, increased GR function is likely to be mediated by an increased intracellular concentration of glucocorticoids, while decreased GR function seems to be the consequence of GR downregulation. We suggest that the study of the effects of antidepressants on glucocorticoid function might help clarify the therapeutic action of these drugs.
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Affiliation(s)
- Livia A Carvalho
- Section and Laboratory of Stress, Psychiatry and Immunology, Division of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK.
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Tanke MAC, Bosker FJ, Gladkevich AV, Medema HM, den Boer JA, Korf J. Lymphocyte glucocorticoid receptor resistance and depressive symptoms severity: a preliminary report. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32:1298-301. [PMID: 18502552 DOI: 10.1016/j.pnpbp.2008.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Revised: 04/02/2008] [Accepted: 04/02/2008] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Assessment of the temporal interrelationship of neuropsychiatric parameters requires technologies allowing frequent biological measurements. We propose glucocorticoid receptor (GR) function of lymphocytes to assess the temporal relationship between glucocorticoid resistance and the course of major depressive disorder. METHOD Dexamethasone suppression of lymphocyte proliferation was in vitro assessed via 5-bromo-2' deoxyuridine (BrdU) incorporation in DNA. Optimal conditions were determined using blood of healthy volunteers. Thereafter the relation between depression severity (Hamilton Depression Rating Scale, HDRS, scores), lymphocyte proliferation and morning cortisol levels in blood was studied in thirteen depressed patients, mostly with a history of treatment resistance. RESULTS Recovery from depression was not directly associated with changes in lymphocyte glucocorticoid resistance. However, a negative correlation was observed between HDRS and BrdU incorporation and a positive correlation between morning cortisol and BrdU incorporation. No significant correlation was found between cortisol and HDRS. Regression analyses showed that HDRS was related to both suppression of BrdU incorporation (beta -0.508, p<0.001) and cortisol levels (beta 0.364, p=0.001) in a highly significant model (F2,60=14,244, p<0.001) Except for one case, such relation could not be found within patients. CONCLUSION Our preliminary results suggest a mutual relation between lymphocyte GR function, morning cortisol levels and MDD symptom severity. A direct relation between glucocorticoids resistance and recovery may not exist, but glucocorticoid resistance might attenuate or prevent recovery. It is clear that additional studies using larger and more homogenous groups of MDD patients are required to support our findings.
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Affiliation(s)
- M A C Tanke
- University Center of Psychiatry, University Medical Center of Groningen, University of Groningen, The Netherlands
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Martin EI, Nemeroff CB. The Role of Corticotropin-releasing Factor in the Pathophysiology of Depression: Implications for Antidepressant Mechanisms of Action. Psychiatr Ann 2008. [DOI: 10.3928/00485713-20080401-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Schmidt EZ, Reininghaus B, Enzinger C, Ebner C, Hofmann P, Kapfhammer HP. Changes in brain metabolism after ECT-positron emission tomography in the assessment of changes in glucose metabolism subsequent to electroconvulsive therapy--lessons, limitations and future applications. J Affect Disord 2008; 106:203-8. [PMID: 17662472 DOI: 10.1016/j.jad.2007.06.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Revised: 06/19/2007] [Accepted: 06/20/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) has been used as an effective treatment option in severe and treatment resistant cases of depression for decades. However the mode of action of ECT is still not fully understood. Advances in neuroimaging created new possibilities to understand the functional changes of the human brain. METHODS Literature review of studies assessing possible changes in cerebral glucose metabolism pre- and post-ECT by PET, identified by PubMed. RESULTS Studies were limited by small sample size, inhomogeneous study population with uni- and bipolar depressive patients and methodological inconsistencies. Despite considerable variance, reduction in glucose metabolism after ECT in bilateral anterior and posterior frontal areas represented the most consistent findings. CONCLUSIONS Future research into this issue should include larger and more consistent cohorts of patients. Assessing clinical improvement of depression after ECT should allow to correlate changes in brain glucose metabolism with functional scores. Follow up PET scans after six or twelve months should be performed to test if changes in brain metabolism are persistent.
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Affiliation(s)
- E Z Schmidt
- Department of Psychiatry, Medical University Graz, Auenbruggerplatz 31, 8036 Graz, Austria.
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Fink M, Rush AJ, Knapp R, Rasmussen K, Mueller M, Rummans TA, O'Connor K, Husain M, Biggs M, Bailine S, Kellner CH. DSM melancholic features are unreliable predictors of ECT response: a CORE publication. J ECT 2007; 23:139-46. [PMID: 17804986 DOI: 10.1097/yct.0b013e3180337344] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the relationship between baseline melancholic features with outcomes in patients with major depressive disorder referred for electroconvulsive therapy (ECT). METHOD In a multihospital (Consortium for Research in ECT) collaborative ECT study, SCID-1 interviews were obtained at study entry. Ratings of the 24-item Hamilton Rating Scale for Depression were obtained thrice weekly during the course of ECT, once during a subsequent treatment-free week, and periodically during 6-month continuation treatment with either bitemporal ECT or nortriptyline plus lithium (continuation pharmacotherapy). RESULTS The evaluable sample was severely ill with a mean 24-item Hamilton Rating Scale for Depression score of 35.2 (+/-6.9). Of 489 patients, 63.6% (311) met DSM-IV criteria for melancholic features. During acute ECT, 62.1% of those with melancholic features remitted, as compared with 78.7% for those without melancholic features (P = 0.002). During medication continuation treatment (continuation pharmacotherapy), relapse rates were higher for those with melancholic features than for those without these features. Conversely, with continuation ECT, the rate of relapse was lower for those with, compared with those without, melancholic features. CONCLUSIONS Ascertaining melancholic features by SCID-1 criteria does not identify depressed patients more likely to respond to ECT as had been anticipated from the literature. Melancholic features were associated with poorer treatment outcomes in acute ECT. Those with melancholic features were less likely to relapse with continuation ECT, but those with melancholic features were more likely to relapse with continuation pharmacotherapy. The limitations of the DSM-IV criteria for melancholia are discussed.
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Affiliation(s)
- Max Fink
- Zucker Hillside Hospital, North Shore-Long Island Jewish Health Systems, Glen Oaks, NY, USA.
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Ising M, Horstmann S, Kloiber S, Lucae S, Binder EB, Kern N, Künzel HE, Pfennig A, Uhr M, Holsboer F. Combined dexamethasone/corticotropin releasing hormone test predicts treatment response in major depression - a potential biomarker? Biol Psychiatry 2007; 62:47-54. [PMID: 17123470 DOI: 10.1016/j.biopsych.2006.07.039] [Citation(s) in RCA: 247] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Revised: 07/25/2006] [Accepted: 07/27/2006] [Indexed: 01/30/2023]
Abstract
BACKGROUND Exaggerated corticotropin (ACTH) and cortisol response to the combined dexamethasone (DEX)/corticotropin releasing hormone (CRH) test, indicating impaired regulation of the hypothalamus-pituitary-adrenocortical (HPA) system, is frequently observed in depression. In the present study, we examined whether change in HPA system function during the first weeks of hospitalization predicts response to antidepressant treatment in major depression and thus constitutes a potential biomarker. METHODS We conducted the DEX/CRH test in 50 inpatients suffering from severe major depression, once after study inclusion and a second time 2 to 3 weeks later while under continuous antidepressant treatment. RESULTS We found increased ACTH and cortisol responses to the first DEX/CRH test compared with healthy control subjects. In the second DEX/CRH test 2 to 3 weeks later, 36 of the 50 patients showed an attenuated cortisol response, while 14 patients did not display improvement or exhibited even aggravation of the altered HPA system function. Improved HPA system regulation in the second DEX/CRH test was associated with beneficial treatment response after 5 weeks and a higher remission rate at the end of hospitalization. CONCLUSIONS The results suggest that change in HPA system regulation assessed with repeated DEX/CRH tests is a potential biomarker that may predict clinical outcome at follow-up. There is consensus that the drug development process could be improved, once reliable biomarkers become available that help to allow a judgement regarding the efficacy of a novel drug candidate. The combined DEX/CRH test seems to be a promising candidate for such a biomarker.
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Affiliation(s)
- Marcus Ising
- Max Planck Institute of Psychiatry, Munich, Germany.
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Suzuki K, Awata S, Oyama Y, Fujiyama M, Takano T, Sugawara A, Matsuoka H. Agitated depression successfully treated with electroconvulsive therapy combined with steroid cover in a patient with Addison's disease. Prog Neuropsychopharmacol Biol Psychiatry 2007; 31:956-8. [PMID: 17324493 DOI: 10.1016/j.pnpbp.2007.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2006] [Revised: 01/12/2007] [Accepted: 01/14/2007] [Indexed: 12/01/2022]
Abstract
We report the case of a 70-year-old man with Addison's disease who developed severe agitated depression resulting in life-threatening medical conditions. The depression was treated safely with electroconvulsive therapy (ECT) combined with steroid cover. Administration of steroid cover just before each ECT session may increase safety of the ECT procedure in psychiatric patients with Addison's disease.
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Affiliation(s)
- Kazumasa Suzuki
- Department of Psychiatry, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
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Jokinen J, Carlborg A, Mårtensson B, Forslund K, Nordström AL, Nordström P. DST non-suppression predicts suicide after attempted suicide. Psychiatry Res 2007; 150:297-303. [PMID: 17316825 DOI: 10.1016/j.psychres.2006.12.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Revised: 11/28/2006] [Accepted: 12/04/2006] [Indexed: 11/22/2022]
Abstract
Most prospective studies of HPA axis have found that non-suppressors in the dexamethasone suppression test (DST) are more likely to commit suicide during the follow-up. Attempted suicide is a strong clinical predictor of suicide. The aim of this study was to assess the predictive value of DST for suicide in a group of depressed inpatients with and without an index suicide attempt. Historical cohort of 382 psychiatric inpatients with mood disorder admitted to the department of Psychiatry at the Karolinska University Hospital between 1980 and 2000 were submitted to the DST and followed up for causes of death. During the follow-up (mean 18 years), 36 suicides (9.4%) occurred, 20 of these were non-suppressors and 16 were suppressors. There was no statistically significant difference in suicide risk between the suppressors and non-suppressors for the sample as a whole. An index suicide attempt predicted suicide. In suicide attempters with mood disorder, the non-suppressor status was significantly associated with suicide indicating that HPA axis hyperactivity is a risk factor for suicide in this group. The dexamethasone suppression test may be a useful predictor within this population.
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Affiliation(s)
- Jussi Jokinen
- Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet Karolinska University Hospital, Solna, SE-171 76 Stockholm, Sweden.
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Abstract
OBJECTIVE To elucidate the relationship between the effects of electroconvulsive therapy (ECT) on hippocampal anatomy and function in the therapy of melancholic depression and preclinical observations of increased neurogenesis in the hippocampus of experimental animals receiving electroconvulsive seizures (ECS). We emphasize the role of hypercortisolaemia in melancholic depression and in experimental hippocampal neurogenesis. METHOD Our statements are based on a variety of studies pointing to i) ECT being superior to all other treatment modalities in the therapy of melancholia, ii) melancholia being associated with hypercortisolaemia and iii) evidence of hippocampal neurogenesis being relevant for understanding both melancholia and ECT. RESULTS The increased neurogenesis found in animal studies shows stronger effect of seizures than of antidepressant drugs. The onset of effect is not only faster but is also sustained. Newborn cells are found to be functional. Suppression of neurogenesis by chronic treatment with corticosterone is associated with depression-like biology and behaviour making comparison with human depression and its response to ECT relevant. CONCLUSION We hypothesize that the superior antimelancholic effect of induced seizures may be understood in the light of the powerful control of neural plasticity exerted by the regulation of the hypothalamic-pituitary-adrenal axis and, perhaps, other regulatory factors.
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Affiliation(s)
- T G Bolwig
- Department of Psychiatry, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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Feier G, Jornada LK, Barichello T, Vitali AM, Bonatto F, Moreira JCF, Dal-Pizzol F, Quevedo J. Long Lasting Effects of Electroconvulsive Seizures on Brain Oxidative Parameters. Neurochem Res 2006; 31:665-70. [PMID: 16770737 DOI: 10.1007/s11064-006-9064-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2006] [Indexed: 10/24/2022]
Abstract
This work was performed in order to determine the level of oxidative damage and antioxidant enzymes activities late after acute and chronic electroconvulsive shock (ECS) in rats. We measured oxidative parameters in hippocampus, cortex, and striatum, at 45, 60, 90 and 120 days after a single or multiple ECS. We demonstrated an increase in lipid peroxidation after multiple ECS in the hippocampus and striatum. This was also the case for protein carbonyls in the single or multiple protocols. In this way, we demonstrated an increase in catalase in cortex in contrast to striatum and hippocampus, were there were decreases sometimes in chronic ECS. The superoxide dismutase activities decrease in different times after single and multiple ECS in the hippocampus. Our findings demonstrated that there is a delayed increase after ECS in oxidative damage and decrease in antioxidant enzymes activities in hippocampus and striatum.
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Affiliation(s)
- Gustavo Feier
- Laboratório de Neurociências, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense, 88806-000 Criciúma, SC, Brazil
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Takano H, Kato M, Inagaki A, Watanabe K, Kashima H. Time course of cerebral blood flow changes following electroconvulsive therapy in depressive patients-measured at 3 time points using single photon emission computed tomography. Keio J Med 2006; 55:153-60. [PMID: 17191070 DOI: 10.2302/kjm.55.153] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Although electroconvulsive therapy (ECT) has been employed for treating depression for more than 60 years, its mechanisms of action are yet unknown. To clarify the ECT effects on brain function, we examined cerebral blood flow (CBF) using single photon emission computed tomography at 3 time points--few days before an ECT course (Pre) and approximately 5 days (Post 1) and 1 month (Post 2) after the last ECT session. Eight depressive patients completed the study. In all the patients, the depressive symptoms improved after the ECT course, and major cognitive impairment was not observed at any time point. At Pre, the regional CBF (rCBF) in the widespread areas in the frontal lobe and limbic regions including cingulate cortex and parahippocampal gyrus was lower in the patients than in the normal controls. At Post 1 and Post 2, the rCBF in the frontal and limbic regions continued to be lower in the patients than in the controls although the successive recovery of decreased rCBF in the frontal region was observed. Regarding the time course among the patients, the rCBF in the right medial frontal region significantly increased (toward normal) at Post 2, not at Post 1. These findings suggest that depressive patients have decreased CBF in the frontal and limbic regions, and the medial frontal region plays a crucial role in ECT and recovery from depression. Further, patients who have undergone ECT treatment for depression should be carefully observed because brain functions continue to change even after a successful ECT course.
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Affiliation(s)
- Harumasa Takano
- Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan.
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