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Deng ZD, Argyelan M, Miller J, Jones TR, Upston J, McClintock SM, Abbott CC. On assumptions and key issues in electric field modeling for ECT. Mol Psychiatry 2024:10.1038/s41380-024-02567-9. [PMID: 38671213 DOI: 10.1038/s41380-024-02567-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024]
Affiliation(s)
- Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Miklos Argyelan
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA
- Center for Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA
- Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry, Hempstead, NY, USA
| | - Jeremy Miller
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Thomas R Jones
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Joel Upston
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Shawn M McClintock
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
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2
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Abbott CC, Miller J, Farrar D, Argyelan M, Lloyd M, Squillaci T, Kimbrell B, Ryman S, Jones TR, Upston J, Quinn DK, Peterchev AV, Erhardt E, Datta A, McClintock SM, Deng ZD. Amplitude-determined seizure-threshold, electric field modeling, and electroconvulsive therapy antidepressant and cognitive outcomes. Neuropsychopharmacology 2024; 49:640-648. [PMID: 38212442 PMCID: PMC10876627 DOI: 10.1038/s41386-023-01780-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/06/2023] [Accepted: 11/26/2023] [Indexed: 01/13/2024]
Abstract
Electroconvulsive therapy (ECT) pulse amplitude, which dictates the induced electric field (E-field) magnitude in the brain, is presently fixed at 800 or 900 milliamperes (mA) without clinical or scientific rationale. We have previously demonstrated that increased E-field strength improves ECT's antidepressant effect but worsens cognitive outcomes. Amplitude-determined seizure titration may reduce the E-field variability relative to fixed amplitude ECT. In this investigation, we assessed the relationships among amplitude-determined seizure-threshold (STa), E-field magnitude, and clinical outcomes in older adults (age range 50 to 80 years) with depression. Subjects received brain imaging, depression assessment, and neuropsychological assessment pre-, mid-, and post-ECT. STa was determined during the first treatment with a Soterix Medical 4×1 High Definition ECT Multi-channel Stimulation Interface (Investigation Device Exemption: G200123). Subsequent treatments were completed with right unilateral electrode placement (RUL) and 800 mA. We calculated Ebrain defined as the 90th percentile of E-field magnitude in the whole brain for RUL electrode placement. Twenty-nine subjects were included in the final analyses. Ebrain per unit electrode current, Ebrain/I, was associated with STa. STa was associated with antidepressant outcomes at the mid-ECT assessment and bitemporal electrode placement switch. Ebrain/I was associated with changes in category fluency with a large effect size. The relationship between STa and Ebrain/I extends work from preclinical models and provides a validation step for ECT E-field modeling. ECT with individualized amplitude based on E-field modeling or STa has the potential to enhance neuroscience-based ECT parameter selection and improve clinical outcomes.
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Affiliation(s)
| | - Jeremy Miller
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Danielle Farrar
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Miklos Argyelan
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA
| | - Megan Lloyd
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Taylor Squillaci
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Brian Kimbrell
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Sephira Ryman
- Mind Research Network, Albuquerque, NM, USA
- Department of Neurology, Albuquerque, NM, USA
| | - Thomas R Jones
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Joel Upston
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Davin K Quinn
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Angel V Peterchev
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
| | - Erik Erhardt
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, NM, USA
| | | | - Shawn M McClintock
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Zhi-De Deng
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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3
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Verdijk JPAJ, van de Mortel LA, Ten Doesschate F, Pottkämper JCM, Stuiver S, Bruin WB, Abbott CC, Argyelan M, Ousdal OT, Bartsch H, Narr K, Tendolkar I, Calhoun V, Lukemire J, Guo Y, Oltedal L, van Wingen G, van Waarde JA. Longitudinal resting-state network connectivity changes in electroconvulsive therapy patients compared to healthy controls. Brain Stimul 2024; 17:140-147. [PMID: 38101469 DOI: 10.1016/j.brs.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/28/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is effective for major depressive episodes. Understanding of underlying mechanisms has been increased by examining changes of brain connectivity but studies often do not correct for test-retest variability in healthy controls (HC). In this study, we investigated changes in resting-state networks after ECT in a multicenter study. METHODS Functional resting-state magnetic resonance imaging data, acquired before start and within one week after ECT, from 90 depressed patients were analyzed, as well as longitudinal data of 24 HC. Group-information guided independent component analysis (GIG-ICA) was used to spatially restrict decomposition to twelve canonical resting-state networks. Selected networks of interest were the default mode network (DMN), salience network (SN), and left and right frontoparietal network (LFPN, and RFPN). Whole-brain voxel-wise analyses were used to assess group differences at baseline, group by time interactions, and correlations with treatment effectiveness. In addition, between-network connectivity and within-network strengths were computed. RESULTS Within-network strength of the DMN was lower at baseline in ECT patients which increased after ECT compared to HC, after which no differences were detected. At baseline, ECT patients showed lower whole-brain voxel-wise DMN connectivity in the precuneus. Increase of within-network strength of the LFPN was correlated with treatment effectiveness. We did not find whole-brain voxel-wise or between-network changes. CONCLUSION DMN within-network connectivity normalized after ECT. Within-network increase of the LFPN in ECT patients was correlated with higher treatment effectiveness. In contrast to earlier studies, we found no whole-brain voxel-wise changes, which highlights the necessity to account for test-retest effects.
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Affiliation(s)
- Joey P A J Verdijk
- Rijnstate Hospital, Department of Psychiatry, P.O. Box 9555, 6800 TA Arnhem, the Netherlands; University of Twente, Department of Clinical Neurophysiology, Enschede, the Netherlands.
| | - Laurens A van de Mortel
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Freek Ten Doesschate
- Rijnstate Hospital, Department of Psychiatry, P.O. Box 9555, 6800 TA Arnhem, the Netherlands; Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Julia C M Pottkämper
- Rijnstate Hospital, Department of Psychiatry, P.O. Box 9555, 6800 TA Arnhem, the Netherlands; University of Twente, Department of Clinical Neurophysiology, Enschede, the Netherlands
| | - Sven Stuiver
- Rijnstate Hospital, Department of Psychiatry, P.O. Box 9555, 6800 TA Arnhem, the Netherlands; University of Twente, Department of Clinical Neurophysiology, Enschede, the Netherlands
| | - Willem B Bruin
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Christopher C Abbott
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Miklos Argyelan
- Center for Psychiatric Neuroscience at the Feinstein Institute for Medical Research, New York, NY, USA
| | - Olga T Ousdal
- Department of Biomedicine, University of Bergen, Bergen, Norway; Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Hauke Bartsch
- Department of Computer Science, University of Bergen, Bergen, Norway; Mohn Medical Imaging and Visualization Center, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Katherine Narr
- Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Indira Tendolkar
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, the Netherlands
| | - Vince Calhoun
- Tri-institutional center for Translational Research in Neuroimaging and Data Science (TReNDS) Center, Emory University, USA
| | - Joshua Lukemire
- Emory Center for Biomedical Imaging Statistics, Emory University, USA
| | - Ying Guo
- Emory Center for Biomedical Imaging Statistics, Emory University, USA
| | - Leif Oltedal
- Mohn Medical Imaging and Visualization Center, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Guido van Wingen
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Jeroen A van Waarde
- Rijnstate Hospital, Department of Psychiatry, P.O. Box 9555, 6800 TA Arnhem, the Netherlands
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Belge JB, Mulders P, Van Diermen L, Sienaert P, Sabbe B, Abbott CC, Tendolkar I, Schrijvers D, van Eijndhoven P. Reviewing the neurobiology of electroconvulsive therapy on a micro- meso- and macro-level. Prog Neuropsychopharmacol Biol Psychiatry 2023; 127:110809. [PMID: 37331685 DOI: 10.1016/j.pnpbp.2023.110809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 05/27/2023] [Accepted: 06/07/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) remains the one of the most effective of biological antidepressant interventions. However, the exact neurobiological mechanisms underlying the efficacy of ECT remain unclear. A gap in the literature is the lack of multimodal research that attempts to integrate findings at different biological levels of analysis METHODS: We searched the PubMed database for relevant studies. We review biological studies of ECT in depression on a micro- (molecular), meso- (structural) and macro- (network) level. RESULTS ECT impacts both peripheral and central inflammatory processes, triggers neuroplastic mechanisms and modulates large scale neural network connectivity. CONCLUSIONS Integrating this vast body of existing evidence, we are tempted to speculate that ECT may have neuroplastic effects resulting in the modulation of connectivity between and among specific large-scale networks that are altered in depression. These effects could be mediated by the immunomodulatory properties of the treatment. A better understanding of the complex interactions between the micro-, meso- and macro- level might further specify the mechanisms of action of ECT.
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Affiliation(s)
- Jean-Baptiste Belge
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Psychiatry, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - Peter Mulders
- Department of Psychiatry, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, P.O. Box 9010, 6500 GL Nijmegen, The Netherlands
| | - Linda Van Diermen
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Psychiatric Center Bethanië, Andreas Vesaliuslaan 39, Zoersel 2980, Belgium
| | - Pascal Sienaert
- KU Leuven - University of Leuven, University Psychiatric Center KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), Leuvensesteenweg 517, Kortenberg 3010, Belgium
| | - Bernard Sabbe
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Indira Tendolkar
- Department of Psychiatry, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, P.O. Box 9010, 6500 GL Nijmegen, The Netherlands
| | - Didier Schrijvers
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Psychiatry, University Psychiatric Center Duffel, Stationstraat 22, Duffel 2570, Belgium
| | - Philip van Eijndhoven
- Department of Psychiatry, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, P.O. Box 9010, 6500 GL Nijmegen, The Netherlands
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5
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Argyelan M, Deng ZD, Ousdal OT, Oltedal L, Angulo B, Baradits M, Spitzberg AJ, Kessler U, Sartorius A, Dols A, Narr KL, Espinoza R, van Waarde JA, Tendolkar I, van Eijndhoven P, van Wingen GA, Takamiya A, Kishimoto T, Jorgensen MB, Jorgensen A, Paulson OB, Yrondi A, Péran P, Soriano-Mas C, Cardoner N, Cano M, van Diermen L, Schrijvers D, Belge JB, Emsell L, Bouckaert F, Vandenbulcke M, Kiebs M, Hurlemann R, Mulders PC, Redlich R, Dannlowski U, Kavakbasi E, Kritzer MD, Ellard KK, Camprodon JA, Petrides G, Malhotra AK, Abbott CC. Correction: Electroconvulsive therapy-induced volumetric brain changes converge on a common causal circuit in depression. Mol Psychiatry 2023:10.1038/s41380-023-02358-8. [PMID: 38052984 DOI: 10.1038/s41380-023-02358-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Affiliation(s)
- Miklos Argyelan
- Feinstein Institutes for Medical Research, Institute of Behavioral Science, Manhasset, NY, USA.
- The Zucker Hillside Hospital, Glen Oaks, NY, USA.
| | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Olga Therese Ousdal
- Department of Biomedicine, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Leif Oltedal
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Brian Angulo
- Feinstein Institutes for Medical Research, Institute of Behavioral Science, Manhasset, NY, USA
| | - Mate Baradits
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | | | - Ute Kessler
- Department of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Hungary
| | - Alexander Sartorius
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Annemiek Dols
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Neuroscience, Amsterdam, The Netherlands
| | - Katherine L Narr
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Randall Espinoza
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Indira Tendolkar
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, the Netherlands
| | - Philip van Eijndhoven
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, the Netherlands
| | - Guido A van Wingen
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Akihiro Takamiya
- Department of Neuropsychiatry Keio University School of Medicine, Tokyo, Japan
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Belgium
| | - Taishiro Kishimoto
- Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan
| | - Martin B Jorgensen
- Psychiatric Center Copenhagen and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anders Jorgensen
- Psychiatric Center Copenhagen and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Olaf B Paulson
- Neurobiological Research Unit Rigshospitalet and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Antoine Yrondi
- Service de Psychiatrie et Psychologie Médicale, Centre Expert Dépression Résistante, Fondation Fondamental, CHU Toulouse, ToNIC, Toulouse NeuroImaging Center, Univerité de Toulouse, Inserm, UPS, Toulouse, France
| | - Patrice Péran
- ToNIC, Toulouse NeuroImaging Center, Univeristé de Toulouse, Inserm, UPS, Toulouse, France
| | - Carles Soriano-Mas
- Department of Social Psychology and Quantitative Psychology, Universitat de Barcelona-UB, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, Barcelona, Spain
- CIBERSAM, Carlos III Health Institute, Madrid, Spain
| | - Narcis Cardoner
- CIBERSAM, Carlos III Health Institute, Madrid, Spain
- Sant Pau Mental Health Research Group, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, School of Medicine Bellaterra, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Cano
- CIBERSAM, Carlos III Health Institute, Madrid, Spain
- Sant Pau Mental Health Research Group, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Linda van Diermen
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Psychiatric Center Bethanie, Andreas Vesaliuslaan 39, 2980, Zoersel, Belgium
| | - Didier Schrijvers
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- University Psychiatric Center Duffel, Stationstraat 22, Duffel, 2570, Belgium
| | - Jean-Baptiste Belge
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Psychiatry, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Louise Emsell
- Geriatric Psychiatry, University Psychiatric Center-KU Leuven, Leuven, Belgium
| | - Filip Bouckaert
- Geriatric Psychiatry, University Psychiatric Center-KU Leuven, Leuven, Belgium
| | | | - Maximilian Kiebs
- School of Medicine & Health Sciences University Hospital Oldenburg, Oldenburg, Germany
- Department of Psychiatry and Psychotherapy University Hospital Bonn, Bonn, Germany
| | - René Hurlemann
- School of Medicine & Health Sciences University Hospital Oldenburg, Oldenburg, Germany
| | - Peter Cr Mulders
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, the Netherlands
| | - Ronny Redlich
- Department of Psychology, University of Halle, Halle, Germany
- German Center for Mental Health (DZPG), Site Jena-Magdeburg-Halle, Halle, Germany
| | - Udo Dannlowski
- Department of Translational Psychiatry, University of Muenster, Muenster, Germany
| | - Erhan Kavakbasi
- Department of Mental Health, University of Muenster, Muenster, Germany
| | - Michael D Kritzer
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristen K Ellard
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joan A Camprodon
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Anil K Malhotra
- Feinstein Institutes for Medical Research, Institute of Behavioral Science, Manhasset, NY, USA
- The Zucker Hillside Hospital, Glen Oaks, NY, USA
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6
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Argyelan M, Deng ZD, Ousdal OT, Oltedal L, Angulo B, Baradits M, Spitzberg AJ, Kessler U, Sartorius A, Dols A, Narr KL, Espinoza R, van Waarde JA, Tendolkar I, van Eijndhoven P, van Wingen GA, Takamiya A, Kishimoto T, Jorgensen MB, Jorgensen A, Paulson OB, Yrondi A, Péran P, Soriano-Mas C, Cardoner N, Cano M, van Diermen L, Schrijvers D, Belge JB, Emsell L, Bouckaert F, Vandenbulcke M, Kiebs M, Hurlemann R, Mulders PC, Redlich R, Dannlowski U, Kavakbasi E, Kritzer MD, Ellard KK, Camprodon JA, Petrides G, Malhotra AK, Abbott CC. Electroconvulsive therapy-induced volumetric brain changes converge on a common causal circuit in depression. Mol Psychiatry 2023:10.1038/s41380-023-02318-2. [PMID: 37985787 DOI: 10.1038/s41380-023-02318-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/23/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023]
Abstract
Neurostimulation is a mainstream treatment option for major depression. Neuromodulation techniques apply repetitive magnetic or electrical stimulation to some neural target but significantly differ in their invasiveness, spatial selectivity, mechanism of action, and efficacy. Despite these differences, recent analyses of transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS)-treated individuals converged on a common neural network that might have a causal role in treatment response. We set out to investigate if the neuronal underpinnings of electroconvulsive therapy (ECT) are similarly associated with this causal depression network (CDN). Our aim here is to provide a comprehensive analysis in three cohorts of patients segregated by electrode placement (N = 246 with right unilateral, 79 with bitemporal, and 61 with mixed) who underwent ECT. We conducted a data-driven, unsupervised multivariate neuroimaging analysis Principal Component Analysis (PCA) of the cortical and subcortical volume changes and electric field (EF) distribution to explore changes within the CDN associated with antidepressant outcomes. Despite the different treatment modalities (ECT vs TMS and DBS) and methodological approaches (structural vs functional networks), we found a highly similar pattern of change within the CDN in the three cohorts of patients (spatial similarity across 85 regions: r = 0.65, 0.58, 0.40, df = 83). Most importantly, the expression of this pattern correlated with clinical outcomes (t = -2.35, p = 0.019). This evidence further supports that treatment interventions converge on a CDN in depression. Optimizing modulation of this network could serve to improve the outcome of neurostimulation in depression.
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Affiliation(s)
- Miklos Argyelan
- Feinstein Institutes for Medical Research, Institute of Behavioral Science, Manhasset, NY, USA.
- The Zucker Hillside Hospital, Glen Oaks, NY, USA.
| | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Olga Therese Ousdal
- Department of Biomedicine, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Leif Oltedal
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Brian Angulo
- Feinstein Institutes for Medical Research, Institute of Behavioral Science, Manhasset, NY, USA
| | - Mate Baradits
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | | | - Ute Kessler
- Department of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Hungary
| | - Alexander Sartorius
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Annemiek Dols
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Neuroscience, Amsterdam, The Netherlands
| | - Katherine L Narr
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Randall Espinoza
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Indira Tendolkar
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, the Netherlands
| | - Philip van Eijndhoven
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, the Netherlands
| | - Guido A van Wingen
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Akihiro Takamiya
- Department of Neuropsychiatry Keio University School of Medicine, Tokyo, Japan
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Belgium
| | - Taishiro Kishimoto
- Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan
| | - Martin B Jorgensen
- Psychiatric Center Copenhagen and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anders Jorgensen
- Psychiatric Center Copenhagen and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Olaf B Paulson
- Neurobiological Research Unit Rigshospitalet and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Antoine Yrondi
- Service de Psychiatrie et Psychologie Médicale, Centre Expert Dépression Résistante, Fondation Fondamental, CHU Toulouse, ToNIC, Toulouse NeuroImaging Center, Univerité de Toulouse, Inserm, UPS, Toulouse, France
| | - Patrice Péran
- ToNIC, Toulouse NeuroImaging Center, Univeristé de Toulouse, Inserm, UPS, Toulouse, France
| | - Carles Soriano-Mas
- Department of Social Psychology and Quantitative Psychology, Universitat de Barcelona-UB, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, Barcelona, Spain
- CIBERSAM, Carlos III Health Institute, Madrid, Spain
| | - Narcis Cardoner
- CIBERSAM, Carlos III Health Institute, Madrid, Spain
- Sant Pau Mental Health Research Group, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, School of Medicine Bellaterra, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Cano
- CIBERSAM, Carlos III Health Institute, Madrid, Spain
- Sant Pau Mental Health Research Group, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Linda van Diermen
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Psychiatric Center Bethanie, Andreas Vesaliuslaan 39, 2980, Zoersel, Belgium
| | - Didier Schrijvers
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- University Psychiatric Center Duffel, Stationstraat 22, Duffel, 2570, Belgium
| | - Jean-Baptiste Belge
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Psychiatry, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Louise Emsell
- Geriatric Psychiatry, University Psychiatric Center-KU Leuven, Leuven, Belgium
| | - Filip Bouckaert
- Geriatric Psychiatry, University Psychiatric Center-KU Leuven, Leuven, Belgium
| | | | - Maximilian Kiebs
- School of Medicine & Health Sciences University Hospital Oldenburg, Oldenburg, Germany
- Department of Psychiatry and Psychotherapy University Hospital Bonn, Bonn, Germany
| | - René Hurlemann
- School of Medicine & Health Sciences University Hospital Oldenburg, Oldenburg, Germany
| | - Peter Cr Mulders
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, the Netherlands
| | - Ronny Redlich
- Department of Psychology, University of Halle, Halle, Germany
- German Center for Mental Health (DZPG), Site Jena-Magdeburg-Halle, Halle, Germany
| | - Udo Dannlowski
- Department of Translational Psychiatry, University of Muenster, Muenster, Germany
| | - Erhan Kavakbasi
- Department of Mental Health, University of Muenster, Muenster, Germany
| | - Michael D Kritzer
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristen K Ellard
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joan A Camprodon
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Anil K Malhotra
- Feinstein Institutes for Medical Research, Institute of Behavioral Science, Manhasset, NY, USA
- The Zucker Hillside Hospital, Glen Oaks, NY, USA
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Quinn DK, Upston J, Jones TR, Gibson BC, Olmstead TA, Yang J, Price AM, Bowers-Wu DH, Durham E, Hazlewood S, Farrar DC, Miller J, Lloyd MO, Garcia CA, Ojeda CJ, Hager BW, Vakhtin AA, Abbott CC. Electric field distribution predicts efficacy of accelerated intermittent theta burst stimulation for late-life depression. Front Psychiatry 2023; 14:1215093. [PMID: 37593449 PMCID: PMC10427506 DOI: 10.3389/fpsyt.2023.1215093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/13/2023] [Indexed: 08/19/2023] Open
Abstract
Introduction Repetitive transcranial magnetic stimulation (rTMS) is a promising intervention for late-life depression (LLD) but may have lower rates of response and remission owing to age-related brain changes. In particular, rTMS induced electric field strength may be attenuated by cortical atrophy in the prefrontal cortex. To identify clinical characteristics and treatment parameters associated with response, we undertook a pilot study of accelerated fMRI-guided intermittent theta burst stimulation (iTBS) to the right dorsolateral prefrontal cortex in 25 adults aged 50 or greater diagnosed with LLD and qualifying to receive clinical rTMS. Methods Participants underwent baseline behavioral assessment, cognitive testing, and structural and functional MRI to generate individualized targets and perform electric field modeling. Forty-five sessions of iTBS were delivered over 9 days (1800 pulses per session, 50-min inter-session interval). Assessments and testing were repeated after 15 sessions (Visit 2) and 45 sessions (Visit 3). Primary outcome measure was the change in depressive symptoms on the Inventory of Depressive Symptomatology-30-Clinician (IDS-C-30) from Visit 1 to Visit 3. Results Overall there was a significant improvement in IDS score with the treatment (Visit 1: 38.6; Visit 2: 31.0; Visit 3: 21.3; mean improvement 45.5%) with 13/25 (52%) achieving response and 5/25 (20%) achieving remission (IDS-C-30 < 12). Electric field strength and antidepressant effect were positively correlated in a subregion of the ventrolateral prefrontal cortex (VLPFC) (Brodmann area 47) and negatively correlated in the posterior dorsolateral prefrontal cortex (DLPFC). Conclusion Response and remission rates were lower than in recently published trials of accelerated fMRI-guided iTBS to the left DLPFC. These results suggest that sufficient electric field strength in VLPFC may be a contributor to effective rTMS, and that modeling to optimize electric field strength in this area may improve response and remission rates. Further studies are needed to clarify the relationship of induced electric field strength with antidepressant effects of rTMS for LLD.
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Affiliation(s)
- Davin K. Quinn
- Department of Psychiatry and Behavioral Sciences, UNM, Albuquerque, NM, United States
| | - Joel Upston
- Department of Psychiatry and Behavioral Sciences, UNM, Albuquerque, NM, United States
| | - Thomas R. Jones
- Department of Psychiatry and Behavioral Sciences, UNM, Albuquerque, NM, United States
| | - Benjamin C. Gibson
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - Tessa A. Olmstead
- Department of Psychiatry and Behavioral Sciences, UNM, Albuquerque, NM, United States
| | - Justine Yang
- Department of Psychiatry and Behavioral Sciences, UNM, Albuquerque, NM, United States
| | | | - Dorothy H. Bowers-Wu
- Department of Psychiatry and Behavioral Sciences, UNM, Albuquerque, NM, United States
| | - Erick Durham
- Department of Psychiatry, Texas Tech University, El Paso, TX, United States
| | - Shawn Hazlewood
- Department of Psychiatry and Behavioral Sciences, UNM, Albuquerque, NM, United States
| | - Danielle C. Farrar
- Department of Psychiatry and Behavioral Sciences, UNM, Albuquerque, NM, United States
| | - Jeremy Miller
- Department of Psychiatry and Behavioral Sciences, UNM, Albuquerque, NM, United States
| | - Megan O. Lloyd
- Department of Psychiatry and Behavioral Sciences, UNM, Albuquerque, NM, United States
| | - Crystal A. Garcia
- Department of Psychiatry and Behavioral Sciences, UNM, Albuquerque, NM, United States
| | - Cesar J. Ojeda
- Department of Psychiatry and Behavioral Sciences, UNM, Albuquerque, NM, United States
| | - Brant W. Hager
- Department of Psychiatry and Behavioral Sciences, UNM, Albuquerque, NM, United States
| | | | - Christopher C. Abbott
- Department of Psychiatry and Behavioral Sciences, UNM, Albuquerque, NM, United States
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8
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Ten Doesschate F, Bruin W, Zeidman P, Abbott CC, Argyelan M, Dols A, Emsell L, van Eijndhoven PFP, van Exel E, Mulders PCR, Narr K, Tendolkar I, Rhebergen D, Sienaert P, Vandenbulcke M, Verdijk J, van Verseveld M, Bartsch H, Oltedal L, van Waarde JA, van Wingen GA. Effective resting-state connectivity in severe unipolar depression before and after electroconvulsive therapy. Brain Stimul 2023; 16:1128-1134. [PMID: 37517467 DOI: 10.1016/j.brs.2023.07.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/06/2023] [Accepted: 07/27/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is one of the most effective treatments for severe depressive disorders. A recent multi-center study found no consistent changes in correlation-based (undirected) resting-state connectivity after ECT. Effective (directed) connectivity may provide more insight into the working mechanism of ECT. OBJECTIVE We investigated whether there are consistent changes in effective resting-state connectivity. METHODS This multi-center study included data from 189 patients suffering from severe unipolar depression and 59 healthy control participants. Longitudinal data were available for 81 patients and 24 healthy controls. We used dynamic causal modeling for resting-state functional magnetic resonance imaging to determine effective connectivity in the default mode, salience and central executive networks before and after a course of ECT. Bayesian general linear models were used to examine differences in baseline and longitudinal effective connectivity effects associated with ECT and its effectiveness. RESULTS Compared to controls, depressed patients showed many differences in effective connectivity at baseline, which varied according to the presence of psychotic features and later treatment outcome. Additionally, effective connectivity changed after ECT, which was related to ECT effectiveness. Notably, treatment effectiveness was associated with decreasing and increasing effective connectivity from the posterior default mode network to the left and right insula, respectively. No effects were found using correlation-based (undirected) connectivity. CONCLUSIONS A beneficial response to ECT may depend on how brain regions influence each other in networks important for emotion and cognition. These findings further elucidate the working mechanisms of ECT and may provide directions for future non-invasive brain stimulation research.
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Affiliation(s)
- Freek Ten Doesschate
- Department of Psychiatry, Rijnstate Hospital, Arnhem, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands.
| | - Willem Bruin
- Amsterdam UMC Location University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Peter Zeidman
- Wellcome Centre for Human Neuroimaging, 12 Queen Square, London, WC1N 3AR, UK
| | - Christopher C Abbott
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Miklos Argyelan
- Center for Psychiatric Neuroscience at the Feinstein Institute for Medical Research, New York, NY, USA
| | - Annemieke Dols
- GGZ inGeest Specialized Mental Health Care, Department of Old Age Psychiatry, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, the Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, the Netherlands
| | - Louise Emsell
- Katholieke Universiteit Leuven, University Psychiatric Center Katholieke Universiteit Leuven, Leuven, Belgium
| | - Philip F P van Eijndhoven
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, the Netherlands; Department of Psychiatry, Radboud University Medical Centre, Huispost 961, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Eric van Exel
- GGZ inGeest Specialized Mental Health Care, Department of Old Age Psychiatry, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, the Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, the Netherlands
| | - Peter C R Mulders
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, the Netherlands; Department of Psychiatry, Radboud University Medical Centre, Huispost 961, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Katherine Narr
- Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Indira Tendolkar
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, the Netherlands; Department of Psychiatry, Radboud University Medical Centre, Huispost 961, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Didi Rhebergen
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, the Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, the Netherlands
| | - Pascal Sienaert
- Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (Catholic University of Leuven), Leuven, Belgium
| | - Mathieu Vandenbulcke
- Katholieke Universiteit Leuven, University Psychiatric Center Katholieke Universiteit Leuven, Leuven, Belgium
| | - Joey Verdijk
- Department of Psychiatry, Rijnstate Hospital, Arnhem, the Netherlands
| | | | - Hauke Bartsch
- Mohn Medical Imaging and Visualization Center, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Leif Oltedal
- Mohn Medical Imaging and Visualization Center, Department of Radiology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Guido A van Wingen
- Amsterdam UMC Location University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands
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Miller J, Jones T, Upston J, Deng ZD, McClintock SM, Erhardt E, Farrar D, Abbott CC. Electric Field, Ictal Theta Power, and Clinical Outcomes in Electroconvulsive Therapy. Biol Psychiatry Cogn Neurosci Neuroimaging 2023; 8:760-767. [PMID: 36925066 PMCID: PMC10329999 DOI: 10.1016/j.bpsc.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/22/2023] [Accepted: 03/01/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is efficacious for treatment-resistant depression. Treatment-induced cognitive impairment can adversely impact functional outcomes. Our pilot study linked the electric field to ictal theta power from a single suprathreshold treatment and linked ictal theta power to changes in phonemic fluency. In this study, we set out to replicate our findings and expand upon the utility of ictal theta power as a potential cognitive biomarker. METHODS Twenty-seven participants (18 female and 9 male) received right unilateral ECT for treatment-resistant depression. Pre-ECT magnetic resonance imaging and finite element modeling determined the 90th percentile maximum electric field in the brain. Two-lead electroencephalographs were digitally captured across the ECT course, with the earliest suprathreshold treatment used to determine power spectral density. Clinical and cognitive outcomes were assessed pre-, mid-, and post-ECT. We assessed the relationship between the electric field in the brain, ictal theta power, clinical outcome (Inventory of Depressive Symptomatology), and cognitive outcomes (phonemic and semantic fluency) with linear models. RESULTS Ictal theta power in the Fp1 and Fp2 channels was associated with the electric field, antidepressant outcome, and phonemic and semantic fluency. The relationship between ictal theta power and phonemic fluency was strengthened in the longitudinal analysis. The electric field in the brain was directly associated with phonemic and semantic fluency but not with antidepressant outcome. CONCLUSIONS Ictal theta power is a potential cognitive biomarker early on in the ECT course to help guide parameter changes. Larger studies are needed to further assess ictal theta power's role in predicting mood outcome and changes with ECT parameters.
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Affiliation(s)
- Jeremy Miller
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico.
| | - Tom Jones
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Joel Upston
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Zhi-De Deng
- Computational Neurostimulation Research Program, Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Shawn M McClintock
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas
| | - Erik Erhardt
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, New Mexico
| | - Danielle Farrar
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Christopher C Abbott
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico.
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10
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Guillen A, Abbott CC, Deng ZD, Huang Y, Pascoal-Faria P, Truong DQ, Datta A. Impact of modeled field of view in electroconvulsive therapy current flow simulations. Front Psychiatry 2023; 14:1168672. [PMID: 37275969 PMCID: PMC10232815 DOI: 10.3389/fpsyt.2023.1168672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/25/2023] [Indexed: 06/07/2023] Open
Abstract
Background The field of view (FOV) considered in MRI-guided forward models of electroconvulsive therapy (ECT) are, as expected, limited to the MRI volume collected. Therefore, there is variation in model extent considered across simulation efforts. This study examines the impact of FOV on the induced electric field (E-field) due to two common electrode placements: right unilateral (RUL) and bilateral (BL). Methods A full-body dataset was obtained and processed for modeling relevant to ECT physics. Multiple extents were derived by truncating from the head down to four levels: upper head (whole-brain), full head, neck, and torso. All relevant stimulation and focality metrics were determined. The differences in the 99th percentile peak of stimulation strength in the brain between each extent to the full-body (reference) model were considered as the relative error (RE). We also determine the FOV beyond which the difference to a full-body model would be negligible. Results The 2D and 3D spatial plots revealed anticipated results in line with prior efforts. The RE for BL upper head was ~50% reducing to ~2% for the neck FOV. The RE for RUL upper head was ~5% reducing to subpercentage (0.28%) for the full-head FOV. As shown previously, BL was found to stimulate a larger brain volume-but restricted to the upper head and for amplitude up to ~480 mA. To some extent, RUL stimulated a larger volume. The RUL-induced volume was larger even when considering the neural activation threshold corresponding to brief pulse BL if ECT amplitude was >270 mA. This finding is explained by the BL-induced current loss through the inferior regions as more FOV is considered. Our result is a departure from prior efforts and raises questions about the focality metric as defined and/or inter-individual differences. Conclusion Our findings highlight that BL is impacted more than RUL with respect to FOV. It is imperative to collect full-head data at a minimum for any BL simulation and possibly more. Clinical practice resorts to using BL ECT when RUL is unsuccessful. However, the notion that BL is more efficacious on the premise of stimulating more brain volume needs to be revisited.
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Affiliation(s)
- Alexander Guillen
- Research and Development, Soterix Medical, Woodbridge, NJ, United States
| | | | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institute of Health, Bethesda, MD, United States
| | - Yu Huang
- Research and Development, Soterix Medical, Woodbridge, NJ, United States
| | - Paula Pascoal-Faria
- Department of Mathematics ESTG and CDRSP Polytechnic Institute of Leiria, Leiria, Portugal
| | - Dennis Q. Truong
- Research and Development, Soterix Medical, Woodbridge, NJ, United States
| | - Abhishek Datta
- Research and Development, Soterix Medical, Woodbridge, NJ, United States
- City College of New York, New York, NY, United States
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11
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Blanken MAJT, Oudega ML, Hoogendoorn AW, Sonnenberg CS, Rhebergen D, Klumpers UMH, Van Diermen L, Birkenhager T, Schrijvers D, Redlich R, Dannlowski U, Heindel W, Coenjaerts M, Nordanskog P, Oltedal L, Kessler U, Frid LM, Takamiya A, Kishimoto T, Jorgensen MB, Jorgensen A, Bolwig T, Emsell L, Sienaert P, Bouckaert F, Abbott CC, Péran P, Arbus C, Yrondi A, Kiebs M, Philipsen A, van Waarde JA, Prinsen E, van Verseveld M, Van Wingen G, Ten Doesschate F, Camprodon JA, Kritzer M, Barbour T, Argyelan M, Cardoner N, Urretavizcaya M, Soriano-Mas C, Narr KL, Espinoza RT, Prudic J, Rowny S, van Eijndhoven P, Tendolkar I, Dols A. Sex-specifics of ECT outcome. J Affect Disord 2023; 326:243-248. [PMID: 36632848 DOI: 10.1016/j.jad.2022.12.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 12/23/2022] [Accepted: 12/25/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is the most effective treatment for patients with severe major depressive disorder (MDD). Given the known sex differences in MDD, improved knowledge may provide more sex-specific recommendations in clinical guidelines and improve outcome. In the present study we examine sex differences in ECT outcome and its predictors. METHODS Clinical data from 20 independent sites participating in the Global ECT-MRI Research Collaboration (GEMRIC) were obtained for analysis, totaling 500 patients with MDD (58.6 % women) with a mean age of 54.8 years. Severity of depression before and after ECT was assessed with validated depression scales. Remission was defined as a HAM-D score of 7 points or below after ECT. Variables associated with remission were selected based on literature (i.e. depression severity at baseline, age, duration of index episode, and presence of psychotic symptoms). RESULTS Remission rates of ECT were independent of sex, 48.0 % in women and 45.7 % in men (X2(1) = 0.2, p = 0.70). In the logistic regression analyses, a shorter index duration was identified as a sex-specific predictor for ECT outcome in women (X2(1) = 7.05, p = 0.01). The corresponding predictive margins did show overlapping confidence intervals for men and women. CONCLUSION The evidence provided by our study suggests that ECT as a biological treatment for MDD is equally effective in women and men. A shorter duration of index episode was an additional sex- specific predictor for remission in women. Future research should establish whether the confidence intervals for the corresponding predictive margins are overlapping, as we find, or not.
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Affiliation(s)
- M A J T Blanken
- Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam UMC, location Vumc, Amsterdam, the Netherlands.
| | - M L Oudega
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands; Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam UMC, location Vumc, Amsterdam, the Netherlands
| | - A W Hoogendoorn
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands; Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam UMC, location Vumc, Amsterdam, the Netherlands
| | - C S Sonnenberg
- Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; GGZ Parnassia NH, Specialized Mental Health Care, Castricum, the Netherlands
| | - D Rhebergen
- Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam UMC, location Vumc, Amsterdam, the Netherlands; GGZ Centraal, Specialized Mental Health Care, Amersfoort, the Netherlands
| | - U M H Klumpers
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands; Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam UMC, location Vumc, Amsterdam, the Netherlands
| | - L Van Diermen
- Psychiatric Center Bethanië, Andreas Vesaliuslaan 39, 2980 Zoersel, Belgium; Department of Biomedical Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp. Universiteitsplein 1, 2610 Antwerp, Belgium; University Psychiatric Center (UPC) Duffel, Stationsstraat 22c, 2570 Duffel, Belgium
| | - T Birkenhager
- Department of Biomedical Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp. Universiteitsplein 1, 2610 Antwerp, Belgium; Erasmus MC, Rotterdam, the Netherlands
| | - D Schrijvers
- Department of Biomedical Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp. Universiteitsplein 1, 2610 Antwerp, Belgium; University Psychiatric Center (UPC) Duffel, Stationsstraat 22c, 2570 Duffel, Belgium
| | - R Redlich
- Department of Psychology, University of Halle, Germany; Institute for Translational Psychiatry, University of Münster Germany, Germany
| | - U Dannlowski
- Institute for Translational Psychiatry, University of Münster Germany, Germany
| | - W Heindel
- Department of Radiology, University of Münster Germany, Germany
| | - M Coenjaerts
- Division of Medical Psychology, Department of Psychiatry and Psychotherapy, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - P Nordanskog
- Center for Social and Affective Neuroscience (CSAN), Department of Biomedical and Clinical Sciences, Linköping University, Department of Psychiatry, Linköping University Hospital, Sweden
| | - L Oltedal
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - U Kessler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - L M Frid
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - A Takamiya
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan; Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Belgium
| | - T Kishimoto
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan
| | - M B Jorgensen
- Psychiatric Centre Copenhagen and Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - A Jorgensen
- Psychiatric Centre Copenhagen and Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - T Bolwig
- Psychiatric Centre Copenhagen and Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - L Emsell
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Belgium
| | - P Sienaert
- Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center (UPC) - KU Leuven, Kortenberg, Belgium
| | - F Bouckaert
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Belgium
| | - C C Abbott
- University of New Mexico Department of Psychiatry, 87131, United States of America
| | - P Péran
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - C Arbus
- Service de Psychiatrie et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU Toulouse, Hospital Purpan, ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - A Yrondi
- Service de Psychiatrie et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU Toulouse, Hospital Purpan, ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - M Kiebs
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany; Section of Medical Psychology, University of Bonn, Bonn, Germany; School of Medicine & Health Sciences University Hospital Oldenburg at the Karl-Jaspers Clinic, Germany
| | - A Philipsen
- Section of Medical Psychology, University of Bonn, Bonn, Germany
| | | | | | | | - G Van Wingen
- Amsterdam UMC, location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - F Ten Doesschate
- Rijnstate Arnhem, the Netherlands; Amsterdam UMC, location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, the Netherlands
| | - J A Camprodon
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - M Kritzer
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - T Barbour
- Massachusetts General Hospital, United States of America
| | - M Argyelan
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, United States of America
| | - N Cardoner
- Sant Pau Mental Health Research Group, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, School of Medicine Bellaterra, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBERSAM, Carlos III Health Institute, Madrid, Spain
| | - M Urretavizcaya
- CIBERSAM, Carlos III Health Institute, Madrid, Spain; Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, Barcelona, Spain; Department of Clinical Sciences, Bellvitge Campus, Universitat de Barcelona-UB, Barcelona, Spain
| | - C Soriano-Mas
- CIBERSAM, Carlos III Health Institute, Madrid, Spain; Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, Barcelona, Spain; Department of Social Psychology and Quantitative Psychology, Universitat de Barcelona-UB, Barcelona, Spain
| | - K L Narr
- Department of Neurology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, United States of America
| | - R T Espinoza
- Department of Neurology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, United States of America
| | - J Prudic
- Columbia University Irving Medical Center, United States of America
| | - S Rowny
- Columbia University Irving Medical Center, United States of America
| | | | - I Tendolkar
- Radboud University, Nijmegen, the Netherlands
| | - A Dols
- Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam UMC, location Vumc, Amsterdam, the Netherlands; Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
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Qi S, Calhoun VD, Zhang D, Miller J, Deng ZD, Narr KL, Sheline Y, McClintock SM, Jiang R, Yang X, Upston J, Jones T, Sui J, Abbott CC. Correction: Links between electroconvulsive therapy responsive and cognitive impairment multimodal brain networks in late-life major depressive disorder. BMC Med 2023; 21:113. [PMID: 36978111 PMCID: PMC10052797 DOI: 10.1186/s12916-023-02800-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Affiliation(s)
- Shile Qi
- College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, China.
| | - Vince D Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS) Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
| | - Daoqiang Zhang
- College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Jeremy Miller
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics & Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Katherine L Narr
- Departments of Neurology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Yvette Sheline
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Shawn M McClintock
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Rongtao Jiang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Xiao Yang
- Huaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Joel Upston
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Tom Jones
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Jing Sui
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China.
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13
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Fu Z, Abbott CC, Miller J, Deng ZD, McClintock SM, Sendi MSE, Sui J, Calhoun VD. Cerebro-cerebellar functional neuroplasticity mediates the effect of electric field on electroconvulsive therapy outcomes. Transl Psychiatry 2023; 13:43. [PMID: 36746924 PMCID: PMC9902462 DOI: 10.1038/s41398-023-02312-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 02/08/2023] Open
Abstract
Electroconvulsive therapy (ECT) is the most effective treatment for severe depression and works by applying an electric current through the brain. The applied current generates an electric field (E-field) and seizure activity, changing the brain's functional organization. The E-field, which is determined by electrode placement (right unilateral or bitemporal) and pulse amplitude (600, 700, or 800 milliamperes), is associated with the ECT response. However, the neural mechanisms underlying the relationship between E-field, functional brain changes, and clinical outcomes of ECT are not well understood. Here, we investigated the relationships between whole-brain E-field (Ebrain, the 90th percentile of E-field magnitude in the brain), cerebro-cerebellar functional network connectivity (FNC), and clinical outcomes (cognitive performance and depression severity). A fully automated independent component analysis framework determined the FNC between the cerebro-cerebellar networks. We found a linear relationship between Ebrain and cognitive outcomes. The mediation analysis showed that the cerebellum to middle occipital gyrus (MOG)/posterior cingulate cortex (PCC) FNC mediated the effects of Ebrain on cognitive performance. In addition, there is a mediation effect through the cerebellum to parietal lobule FNC between Ebrain and antidepressant outcomes. The pair-wise t-tests further demonstrated that a larger Ebrain was associated with increased FNC between cerebellum and MOG and decreased FNC between cerebellum and PCC, which were linked with decreased cognitive performance. This study implies that an optimal E-field balancing the antidepressant and cognitive outcomes should be considered in relation to cerebro-cerebellar functional neuroplasticity.
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Affiliation(s)
- Zening Fu
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA.
| | | | - Jeremy Miller
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Zhi-De Deng
- Computational Neurostimulation Research Program, Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Shawn M McClintock
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Mohammad S E Sendi
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Jing Sui
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA.
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China.
| | - Vince D Calhoun
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
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14
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Fu Z, Abbott CC, Sui J, Calhoun VD. Predictive signature of static and dynamic functional connectivity for ECT clinical outcomes. Front Pharmacol 2023; 14:1102413. [PMID: 36755955 PMCID: PMC9899999 DOI: 10.3389/fphar.2023.1102413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/11/2023] [Indexed: 01/24/2023] Open
Abstract
Introduction: Electroconvulsive therapy (ECT) remains one of the most effective approaches for treatment-resistant depressive episodes, despite the potential cognitive impairment associated with this treatment. As a potent stimulator of neuroplasticity, ECT might normalize aberrant depression-related brain function via the brain's reconstruction by forming new neural connections. Multiple lines of evidence have demonstrated that functional connectivity (FC) changes are reliable indicators of antidepressant efficacy and cognitive changes from static and dynamic perspectives. However, no previous studies have directly ascertained whether and how different aspects of FC provide complementary information in terms of neuroimaging-based prediction of clinical outcomes. Methods: In this study, we implemented a fully automated independent component analysis framework to an ECT dataset with subjects (n = 50, age = 65.54 ± 8.92) randomized to three treatment amplitudes (600, 700, or 800 milliamperes [mA]). We extracted the static functional network connectivity (sFNC) and dynamic FNC (dFNC) features and employed a partial least square regression to build predictive models for antidepressant outcomes and cognitive changes. Results: We found that both antidepressant outcomes and memory changes can be robustly predicted by the changes in sFNC (permutation test p < 5.0 × 10-3). More interestingly, by adding dFNC information, the model achieved higher accuracy for predicting changes in the Hamilton Depression Rating Scale 24-item (HDRS24, t = 9.6434, p = 1.5 × 10-21). The predictive maps of clinical outcomes show a weakly negative correlation, indicating that the ECT-induced antidepressant outcomes and cognitive changes might be associated with different functional brain neuroplasticity. Discussion: The overall results reveal that dynamic FC is not redundant but reflects mechanisms of ECT that cannot be captured by its static counterpart, especially for the prediction of antidepressant efficacy. Tracking the predictive signatures of static and dynamic FC will help maximize antidepressant outcomes and cognitive safety with individualized ECT dosing.
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Affiliation(s)
- Zening Fu
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia Institute of Technology, Georgia State University, Emory University, Atlanta, GA, United States,*Correspondence: Christopher C. Abbott, ; Zening Fu,
| | - Christopher C. Abbott
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, United States,*Correspondence: Christopher C. Abbott, ; Zening Fu,
| | - Jing Sui
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia Institute of Technology, Georgia State University, Emory University, Atlanta, GA, United States,State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Vince D. Calhoun
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia Institute of Technology, Georgia State University, Emory University, Atlanta, GA, United States,Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
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15
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Qi S, Calhoun VD, Zhang D, Miller J, Deng ZD, Narr KL, Sheline Y, McClintock SM, Jiang R, Yang X, Upston J, Jones T, Sui J, Abbott CC. Links between electroconvulsive therapy responsive and cognitive impairment multimodal brain networks in late-life major depressive disorder. BMC Med 2022; 20:477. [PMID: 36482369 PMCID: PMC9733153 DOI: 10.1186/s12916-022-02678-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although electroconvulsive therapy (ECT) is an effective treatment for depression, ECT cognitive impairment remains a major concern. The neurobiological underpinnings and mechanisms underlying ECT antidepressant and cognitive impairment effects remain unknown. This investigation aims to identify ECT antidepressant-response and cognitive-impairment multimodal brain networks and assesses whether they are associated with the ECT-induced electric field (E-field) with an optimal pulse amplitude estimation. METHODS A single site clinical trial focused on amplitude (600, 700, and 800 mA) included longitudinal multimodal imaging and clinical and cognitive assessments completed before and immediately after the ECT series (n = 54) for late-life depression. Another two independent validation cohorts (n = 84, n = 260) were included. Symptom and cognition were used as references to supervise fMRI and sMRI fusion to identify ECT antidepressant-response and cognitive-impairment multimodal brain networks. Correlations between ECT-induced E-field within these two networks and clinical and cognitive outcomes were calculated. An optimal pulse amplitude was estimated based on E-field within antidepressant-response and cognitive-impairment networks. RESULTS Decreased function in the superior orbitofrontal cortex and caudate accompanied with increased volume in medial temporal cortex showed covarying functional and structural alterations in both antidepressant-response and cognitive-impairment networks. Volume increases in the hippocampal complex and thalamus were antidepressant-response specific, and functional decreases in the amygdala and hippocampal complex were cognitive-impairment specific, which were validated in two independent datasets. The E-field within these two networks showed an inverse relationship with HDRS reduction and cognitive impairment. The optimal E-filed range as [92.7-113.9] V/m was estimated to maximize antidepressant outcomes without compromising cognitive safety. CONCLUSIONS The large degree of overlap between antidepressant-response and cognitive-impairment networks challenges parameter development focused on precise E-field dosing with new electrode placements. The determination of the optimal individualized ECT amplitude within the antidepressant and cognitive networks may improve the treatment benefit-risk ratio. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02999269.
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Affiliation(s)
- Shile Qi
- College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, China.
| | - Vince D Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS) Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
| | - Daoqiang Zhang
- College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Jeremy Miller
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics & Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Katherine L Narr
- Departments of Neurology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Yvette Sheline
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Shawn M McClintock
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Rongtao Jiang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Xiao Yang
- Huaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Joel Upston
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Tom Jones
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Jing Sui
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China.
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McClintock SM, Abbott CC. Five-Year Longitudinal Evidence Supports the Safety and Efficacy of Electroconvulsive Therapy for Older Adults With Major Depressive Disorder. Am J Geriatr Psychiatry 2022; 30:1295-1297. [PMID: 35879214 DOI: 10.1016/j.jagp.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 06/29/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Shawn M McClintock
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center (SMM), Dallas, TX.
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Abstract
OBJECTIVE Electroconvulsive therapy (ECT) remains the benchmark for treatment resistant depression, yet its cognitive adverse effects have a negative impact on treatment. A predictive safety biomarker early in ECT treatment is needed to identify patients at cognitive risk to maximize therapeutic outcomes and minimize adverse effects. We used ictal electroencephalography frequency analysis from suprathreshold treatments to assess the relationships between ECT dose, ictal power across different frequency domains, and cognitive outcomes. METHODS Seventeen subjects with treatment resistant depression received right unilateral ECT. Structural magnetic resonance imaging was obtained pre-ECT for electric field modeling to assess ECT dose. Serial assessments with 24-lead electroencephalography captured ictal activity. Clinical and cognitive assessments were performed before and after ECT. The primary cognitive outcome was the change in Delis Kaplan Executive Function Verbal Fluency Letter Fluency. RESULTS Ictal theta (4-8 Hz) power in the Fp1/Fp2 channels was associated with both whole-brain electric field strength (t(2,12) = 19.5, P = 0.007)/(t(2,10) = 21.85, P = 0.02) and Delis Kaplan Executive Function Verbal Fluency Letter Fluency scores (t(2,12) = -2.05, P = 0.05)/(t(2,10) = -2.20, P = 0.01). Other frequency bands (beta, alpha, delta, and gamma) did not demonstrate this relationship. CONCLUSIONS This pilot data identify ictal theta power as a potential safety biomarker in ECT and is related to the strength of the ECT dose. Ictal theta power could prove to be a convenient and powerful tool for clinicians to identify those patients most susceptible to cognitive impairment early in the treatment series. Additional studies are needed to assess the role of longitudinal changes in ictal theta power throughout the ECT series.
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Affiliation(s)
- Jeremy Miller
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Tom Jones
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Joel Upston
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
- Duke Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Shawn M. McClintock
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
- Duke Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | | | - Davin Quinn
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Christopher C. Abbott
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA
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Miller J, Sowar K, Abbott CC, Christie WA, Carubia BA, Geppert C. Crossing State Lines: Ethical and Clinical Considerations in Treating a Child With Catatonia. J Am Acad Child Adolesc Psychiatry 2022; 61:583-585. [PMID: 35181465 DOI: 10.1016/j.jaac.2022.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/14/2021] [Accepted: 02/08/2022] [Indexed: 10/19/2022]
Abstract
Catatonia is a complex constellation of symptoms presenting with abnormalities in movement and behavior and arises from multiple medical, neurologic, and psychiatric conditions. In recent years, there has been a call to move catatonia from a classifier to a diagnosis of its own in the DSM-5.1,2 Catatonia is often underdiagnosed in the hospital and carries with it substantial morbidity and mortality.3 Malignant catatonia, characterized by autonomic instability, hyperactivity, mutism, and stuporous exhaustion, is a medical emergency requiring intensive care.4 Early diagnosis and treatment are imperative, as untreated malignant catatonia may be fatal in up to 10% to 20% of cases, sometimes only days from onset.5 The combination of lorazepam and electroconvulsive therapy (ECT) is a safe and effective treatment for catatonia in both adults and children, although the body of literature pertaining to children remains limited.6,7 In addition, there are multiple case reports of improvement in catatonia with ECT regardless of etiology.8 However, laws in some US states prohibit ECT's use despite evidence of its effectiveness and safety in children and adolescents.9 Here, we describe a case presentation that was both prolonged and complicated by state laws pertaining to the use of ECT in children and adolescents.
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Affiliation(s)
- Jeremy Miller
- The University of New Mexico School of Medicine, Albuquerque; The University of Colorado School of Medicine, Aurora.
| | - Kristina Sowar
- The University of New Mexico School of Medicine, Albuquerque; The University of Colorado School of Medicine, Aurora
| | - Christopher C Abbott
- The University of New Mexico School of Medicine, Albuquerque; The University of Colorado School of Medicine, Aurora
| | - William A Christie
- The University of New Mexico School of Medicine, Albuquerque; The University of Colorado School of Medicine, Aurora
| | - Beau A Carubia
- The University of New Mexico School of Medicine, Albuquerque; The University of Colorado School of Medicine, Aurora
| | - Cynthia Geppert
- The University of New Mexico School of Medicine, Albuquerque; The University of Colorado School of Medicine, Aurora
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Deng ZD, Argyelan M, Miller J, Quinn DK, Lloyd M, Jones TR, Upston J, Erhardt E, McClintock SM, Abbott CC. Electroconvulsive therapy, electric field, neuroplasticity, and clinical outcomes. Mol Psychiatry 2022; 27:1676-1682. [PMID: 34853404 PMCID: PMC9095458 DOI: 10.1038/s41380-021-01380-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/20/2021] [Accepted: 10/26/2021] [Indexed: 01/08/2023]
Abstract
Electroconvulsive therapy (ECT) remains the gold-standard treatment for patients with depressive episodes, but the underlying mechanisms for antidepressant response and procedure-induced cognitive side effects have yet to be elucidated. Such mechanisms may be complex and involve certain ECT parameters and brain regions. Regarding parameters, the electrode placement (right unilateral or bitemporal) determines the geometric shape of the electric field (E-field), and amplitude determines the E-field magnitude in select brain regions (e.g., hippocampus). Here, we aim to determine the relationships between hippocampal E-field strength, hippocampal neuroplasticity, and antidepressant and cognitive outcomes. We used hippocampal E-fields and volumes generated from a randomized clinical trial that compared right unilateral electrode placement with different pulse amplitudes (600, 700, and 800 mA). Hippocampal E-field strength was variable but increased with each amplitude arm. We demonstrated a linear relationship between right hippocampal E-field and right hippocampal neuroplasticity. Right hippocampal neuroplasticity mediated right hippocampal E-field and antidepressant outcomes. In contrast, right hippocampal E-field was directly related to cognitive outcomes as measured by phonemic fluency. We used receiver operating characteristic curves to determine that the maximal right hippocampal E-field associated with cognitive safety was 112.5 V/m. Right hippocampal E-field strength was related to the whole-brain ratio of E-field strength per unit of stimulation current, but this whole-brain ratio was unrelated to antidepressant or cognitive outcomes. We discuss the implications of optimal hippocampal E-field dosing to maximize antidepressant outcomes and cognitive safety with individualized amplitudes.
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Affiliation(s)
- Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Miklos Argyelan
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA
- Center for Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA
- Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry, Hempstead, NY, USA
| | - Jeremy Miller
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Davin K Quinn
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Megan Lloyd
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Thomas R Jones
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Joel Upston
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Erik Erhardt
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, NM, USA
| | - Shawn M McClintock
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
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20
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Sendi MS, Zendehrouh E, Sui J, Fu Z, Zhi D, Lv L, Ma X, Ke Q, Li X, Wang C, Abbott CC, Turner JA, Miller RL, Calhoun VD. Abnormal Dynamic Functional Network Connectivity Estimated from Default Mode Network Predicts Symptom Severity in Major Depressive Disorder. Brain Connect 2021; 11:838-849. [PMID: 33514278 PMCID: PMC8713570 DOI: 10.1089/brain.2020.0748] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Major depressive disorder (MDD) is a severe mental illness marked by a continuous sense of sadness and a loss of interest. The default mode network (DMN) is a group of brain areas that are more active during rest and deactivate when engaged in task-oriented activities. The DMN of MDD has been found to have aberrant static functional network connectivity (FNC) in recent studies. In this work, we extend previous findings by evaluating dynamic functional network connectivity (dFNC) within the DMN subnodes in MDD. Methods: We analyzed resting-state functional magnetic resonance imaging data of 262 patients with MDD and 277 healthy controls (HCs). We estimated dFNCs for seven subnodes of the DMN, including the anterior cingulate cortex (ACC), posterior cingulate cortex (PCC), and precuneus (PCu), using a sliding window approach, and then clustered the dFNCs into five brain states. Classification of MDD and HC subjects based on state-specific FC was performed using a logistic regression classifier. Transition probabilities between dFNC states were used to identify relationships between symptom severity and dFNC data in MDD patients. Results: By comparing state-specific FNC between HC and MDD, a disrupted connectivity pattern was observed within the DMN. In more detail, we found that the connectivity of ACC is stronger, and the connectivity between PCu and PCC is weaker in individuals with MDD than in those of HC subjects. In addition, MDD showed a higher probability of transitioning from a state with weaker ACC connectivity to a state with stronger ACC connectivity, and this abnormality is associated with symptom severity. This is the first research to look at the dFC of the DMN in MDD with a large sample size. It provides novel evidence of abnormal time-varying DMN configuration in MDD and offers links to symptom severity in MDD subjects. Impact Statement This study is the first attempt that explored the temporal change on default mode network (DMN) connectivity in a relatively large cohort of patients with major depressive disorder (MDD). We also introduced a new hypothesis that explains the inconsistency in DMN functional network connectivity (FNC) comparison between MDD and healthy control based on static FNC in the previous literature. Additionally, our findings suggest that within anterior cingulate cortex connectivity and the connectivity between the precuneus and posterior cingulate cortex are the potential biomarkers for the future intervention of MDD.
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Affiliation(s)
- Mohammad S.E. Sendi
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science: Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, Georgia, USA
| | - Elaheh Zendehrouh
- Department of Computer Science, Georgia State University, Atlanta, Georgia, USA
| | - Jing Sui
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science: Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, Georgia, USA
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- School of Future Technologies, University of Chinese Academy of Sciences, Beijing, China
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Zening Fu
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science: Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, Georgia, USA
| | - Dongmei Zhi
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science: Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, Georgia, USA
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- School of Future Technologies, University of Chinese Academy of Sciences, Beijing, China
| | - Luxian Lv
- Department of Psychiatry, Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
- Henan Key Laboratory of Biological Psychiatry, Xinxiang Medical University, Xinxiang, China
| | - Xiaohong Ma
- Psychiatric Laboratory and Mental Health Center, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, China
- Huaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Qing Ke
- Department of Neurology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xianbin Li
- Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Chuanyue Wang
- Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | | | - Jessica A. Turner
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science: Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, Georgia, USA
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
- Neuroscience Institute, Georgia State University, Atlanta, Georgia, USA
| | - Robyn L. Miller
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science: Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, Georgia, USA
- Department of Computer Science, Georgia State University, Atlanta, Georgia, USA
| | - Vince D. Calhoun
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science: Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, Georgia, USA
- Department of Computer Science, Georgia State University, Atlanta, Georgia, USA
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
- Neuroscience Institute, Georgia State University, Atlanta, Georgia, USA
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21
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Wade BSC, Hellemann G, Espinoza RT, Woods RP, Joshi SH, Redlich R, Dannlowski U, Jorgensen A, Abbott CC, Oltedal L, Narr KL. Accounting for symptom heterogeneity can improve neuroimaging models of antidepressant response after electroconvulsive therapy. Hum Brain Mapp 2021; 42:5322-5333. [PMID: 34390089 PMCID: PMC8519875 DOI: 10.1002/hbm.25620] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/21/2021] [Accepted: 07/29/2021] [Indexed: 12/19/2022] Open
Abstract
Depression symptom heterogeneity limits the identifiability of treatment‐response biomarkers. Whether improvement along dimensions of depressive symptoms relates to separable neural networks remains poorly understood. We build on work describing three latent symptom dimensions within the 17‐item Hamilton Depression Rating Scale (HDRS) and use data‐driven methods to relate multivariate patterns of patient clinical, demographic, and brain structural changes over electroconvulsive therapy (ECT) to dimensional changes in depressive symptoms. We included 110 ECT patients from Global ECT‐MRI Research Collaboration (GEMRIC) sites who underwent structural MRI and HDRS assessments before and after treatment. Cross validated random forest regression models predicted change along symptom dimensions. HDRS symptoms clustered into dimensions of somatic disturbances (SoD), core mood and anhedonia (CMA), and insomnia. The coefficient of determination between predicted and actual changes were 22%, 39%, and 39% (all p < .01) for SoD, CMA, and insomnia, respectively. CMA and insomnia change were predicted more accurately than HDRS‐6 and HDRS‐17 changes (p < .05). Pretreatment symptoms, body‐mass index, and age were important predictors. Important imaging predictors included the right transverse temporal gyrus and left frontal pole for the SoD dimension; right transverse temporal gyrus and right rostral middle frontal gyrus for the CMA dimension; and right superior parietal lobule and left accumbens for the insomnia dimension. Our findings support that recovery along depressive symptom dimensions is predicted more accurately than HDRS total scores and are related to unique and overlapping patterns of clinical and demographic data and volumetric changes in brain regions related to depression and near ECT electrodes.
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Affiliation(s)
- Benjamin S C Wade
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, UCLA, Los Angeles, California, USA
| | - Gerhard Hellemann
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Randall T Espinoza
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Roger P Woods
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, UCLA, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Shantanu H Joshi
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, UCLA, Los Angeles, California, USA
| | - Ronny Redlich
- Institute of Translational Psychiatry, Department of Mental Health, University of Münster, Münster, Germany.,Department of Clinical Psychology, University of Halle, Halle, Germany
| | - Udo Dannlowski
- Institute of Translational Psychiatry, Department of Mental Health, University of Münster, Münster, Germany
| | | | - Christopher C Abbott
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Leif Oltedal
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Katherine L Narr
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, UCLA, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
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22
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Dini H, Sendi MSE, Sui J, Fu Z, Espinoza R, Narr KL, Qi S, Abbott CC, van Rooij SJH, Riva-Posse P, Bruni LE, Mayberg HS, Calhoun VD. Dynamic Functional Connectivity Predicts Treatment Response to Electroconvulsive Therapy in Major Depressive Disorder. Front Hum Neurosci 2021; 15:689488. [PMID: 34295231 PMCID: PMC8291148 DOI: 10.3389/fnhum.2021.689488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/31/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Electroconvulsive therapy (ECT) is one of the most effective treatments for major depressive disorder. Recently, there has been increasing attention to evaluate the effect of ECT on resting-state functional magnetic resonance imaging (rs-fMRI). This study aims to compare rs-fMRI of depressive disorder (DEP) patients with healthy participants, investigate whether pre-ECT dynamic functional network connectivity network (dFNC) estimated from patients rs-fMRI is associated with an eventual ECT outcome, and explore the effect of ECT on brain network states. Method: Resting-state functional magnetic resonance imaging (fMRI) data were collected from 119 patients with depression or depressive disorder (DEP) (76 females), and 61 healthy (HC) participants (34 females), with an age mean of 52.25 (N = 180) years old. The pre-ECT and post-ECT Hamilton Depression Rating Scale (HDRS) were 25.59 ± 6.14 and 11.48 ± 9.07, respectively. Twenty-four independent components from default mode (DMN) and cognitive control network (CCN) were extracted, using group-independent component analysis from pre-ECT and post-ECT rs-fMRI. Then, the sliding window approach was used to estimate the pre-and post-ECT dFNC of each subject. Next, k-means clustering was separately applied to pre-ECT dFNC and post-ECT dFNC to assess three distinct states from each participant. We calculated the amount of time each subject spends in each state, which is called “occupancy rate” or OCR. Next, we compared OCR values between HC and DEP participants. We also calculated the partial correlation between pre-ECT OCRs and HDRS change while controlling for age, gender, and site. Finally, we evaluated the effectiveness of ECT by comparing pre- and post-ECT OCR of DEP and HC participants. Results: The main findings include (1) depressive disorder (DEP) patients had significantly lower OCR values than the HC group in state 2, where connectivity between cognitive control network (CCN) and default mode network (DMN) was relatively higher than other states (corrected p = 0.015), (2) Pre-ECT OCR of state, with more negative connectivity between CCN and DMN components, is linked with the HDRS changes (R = 0.23 corrected p = 0.03). This means that those DEP patients who spent less time in this state showed more HDRS change, and (3) The post-ECT OCR analysis suggested that ECT increased the amount of time DEP patients spent in state 2 (corrected p = 0.03). Conclusion: Our finding suggests that dynamic functional network connectivity (dFNC) features, estimated from CCN and DMN, show promise as a predictive biomarker of the ECT outcome of DEP patients. Also, this study identifies a possible underlying mechanism associated with the ECT effect on DEP patients.
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Affiliation(s)
- Hossein Dini
- Department of Architecture, Design and Media Technology, Aalborg University, Copenhagen, Denmark
| | - Mohammad S E Sendi
- Wallace H. Coulter Department of Biomedical Engineering at Georgia Institute of Technology and Emory University, Atlanta, GA, United States.,Department of Electrical and Computer Engineering at Georgia Institute of Technology, Atlanta, GA, United States.,Tri-Institutional Center for Translational Research in Neuroimaging and Data Science, Georgia Institute of Technology, Georgia State University, Emory University, Atlanta, GA, United States
| | - Jing Sui
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science, Georgia Institute of Technology, Georgia State University, Emory University, Atlanta, GA, United States.,National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Zening Fu
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science, Georgia Institute of Technology, Georgia State University, Emory University, Atlanta, GA, United States
| | - Randall Espinoza
- Departments of Neurology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Katherine L Narr
- Departments of Neurology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Shile Qi
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science, Georgia Institute of Technology, Georgia State University, Emory University, Atlanta, GA, United States
| | - Christopher C Abbott
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, United States
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Patricio Riva-Posse
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Luis Emilio Bruni
- Department of Architecture, Design and Media Technology, Aalborg University, Copenhagen, Denmark
| | - Helen S Mayberg
- Departments of Neurology, Neurosurgery, Psychiatry and Neuroscience, Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Vince D Calhoun
- Wallace H. Coulter Department of Biomedical Engineering at Georgia Institute of Technology and Emory University, Atlanta, GA, United States.,Department of Electrical and Computer Engineering at Georgia Institute of Technology, Atlanta, GA, United States.,Tri-Institutional Center for Translational Research in Neuroimaging and Data Science, Georgia Institute of Technology, Georgia State University, Emory University, Atlanta, GA, United States
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23
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Harrington K, Abbott CC, Quinn D. Psychiatric Presentations of Creutzfeldt-Jakob Disease: A Case Report. J Acad Consult Liaison Psychiatry 2021; 62:248-252. [PMID: 33973526 DOI: 10.1016/j.jaclp.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Kelly Harrington
- Department of Psychiatry, University of New Mexico, Albuquerque, NM
| | | | - Davin Quinn
- Department of Psychiatry, University of New Mexico, Albuquerque, NM.
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24
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Abbott CC, Quinn D, Miller J, Ye E, Iqbal S, Lloyd M, Jones TR, Upston J, De Deng Z, Erhardt E, McClintock SM. Electroconvulsive Therapy Pulse Amplitude and Clinical Outcomes. Am J Geriatr Psychiatry 2021; 29:166-178. [PMID: 32651051 PMCID: PMC7744398 DOI: 10.1016/j.jagp.2020.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Electroconvulsive therapy (ECT) pulse amplitude, which determines the induced electric field magnitude in the brain, is currently set at 800-900 milliamperes (mA) on modern ECT devices without any clinical or scientific rationale. The present study assessed differences in depression and cognitive outcomes for three different pulse amplitudes during an acute ECT series. We hypothesized that the lower amplitudes would maintain the antidepressant efficacy of the standard treatment and reduce the risk of neurocognitive impairment. METHODS This double-blind investigation randomized subjects to three treatment arms: 600, 700, and 800 mA (active comparator). Clinical, cognitive, and imaging assessments were conducted pre-, mid- and post-ECT. Subjects had a diagnosis of major depressive disorder, age range between 50 and 80 years, and met clinical indication for ECT. RESULTS The 700 and 800 mA arms had improvement in depression outcomes relative to the 600 mA arm. The amplitude groups showed no differences in the primary cognitive outcome variable, the Hopkins Verbal Learning Test-Revised (HVLT-R) retention raw score. However, secondary cognitive outcomes such as the Delis Kaplan Executive Function System Letter and Category Fluency measures demonstrated cognitive impairment in the 800 mA arm. DISCUSSION The results demonstrated a dissociation of depression (higher amplitudes better) and cognitive (lower amplitudes better) related outcomes. Future work is warranted to elucidate the relationship between amplitude, electric field, neuroplasticity, and clinical outcomes.
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Affiliation(s)
- Christopher C Abbott
- Department of Psychiatry (CCA, DQ, JM, EY, SI, ML, TRJ, JU), University of New Mexico, Albuquerque, NM.
| | - Davin Quinn
- Department of Psychiatry, University of New Mexico, Albuquerque, NM
| | - Jeremy Miller
- Department of Psychiatry, University of New Mexico, Albuquerque, NM
| | - Enstin Ye
- Department of Psychiatry, University of New Mexico, Albuquerque, NM
| | - Sulaiman Iqbal
- Department of Psychiatry, University of New Mexico, Albuquerque, NM
| | - Megan Lloyd
- Department of Psychiatry, University of New Mexico, Albuquerque, NM
| | - Thomas R Jones
- Department of Psychiatry, University of New Mexico, Albuquerque, NM
| | - Joel Upston
- Department of Psychiatry, University of New Mexico, Albuquerque, NM
| | - Zhi De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD,Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Erik Erhardt
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, NM
| | - Shawn M McClintock
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX,Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
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25
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Erchinger VJ, Ersland L, Aukland SM, Abbott CC, Oltedal L. Magnetic Resonance Spectroscopy in Depressed Subjects Treated With Electroconvulsive Therapy-A Systematic Review of Literature. Front Psychiatry 2021; 12:608857. [PMID: 33841198 PMCID: PMC8027236 DOI: 10.3389/fpsyt.2021.608857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/24/2021] [Indexed: 12/28/2022] Open
Abstract
Electroconvulsive therapy (ECT) is considered to be the most effective acute treatment for otherwise treatment resistant major depressive episodes, and has been used for over 80 years. Still, the underlying mechanism of action is largely unknow. Several studies suggest that ECT affects the cerebral neurotransmitters, such as gamma-aminobutyric acid (GABA) and glutamate. Magnetic resonance spectroscopy (MRS) allows investigators to study neurotransmitters in vivo, and has been used to study neurochemical changes in the brain of patients treated with ECT. Several investigations have been performed on ECT-patients; however, no systematic review has yet summarized these findings. A systematic literature search based on the Prisma guidelines was performed. PubMed (Medline) was used in order to find investigations studying patients that had been treated with ECT and had undergone an MRS examination. A search in the databases Embase, PsycInfo, and Web of Science was also performed, leading to no additional records. A total of 30 records were identified and screened which resulted in 16 original investigations for review. The total number of patients that was included in these studies, ignoring potential overlap of samples in some investigations, was 325. The metabolites reported were N-acetyl aspartate, Choline, Myoinositol, Glutamate and Glutamine, GABA and Creatine. The strongest evidence for neurochemical change related to ECT, was found for N-acetyl aspartate (reduction), which is a marker of neuronal integrity. Increased choline and glutamate following treatment was also commonly reported.
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Affiliation(s)
| | - Lars Ersland
- Department of Clinical Engineering, Haukeland University Hospital, Bergen, Norway.,Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
| | | | - Christopher C Abbott
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Leif Oltedal
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Radiology, Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, Bergen, Norway
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26
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Quinn DK, Jones TR, Upston J, Huff M, Ryman SG, Vakhtin AA, Abbott CC. Right prefrontal intermittent theta-burst stimulation for major depressive disorder: A case series. Brain Stimul 2020; 14:97-99. [PMID: 33242610 DOI: 10.1016/j.brs.2020.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022] Open
Affiliation(s)
- Davin K Quinn
- Department of Psychiatry and Behavioral Sciences, 2600 Marble Avenue NE, University of New Mexico, Albuquerque, NM, 87106, USA.
| | - Thomas R Jones
- Department of Psychiatry and Behavioral Sciences, 2600 Marble Avenue NE, University of New Mexico, Albuquerque, NM, 87106, USA
| | - Joel Upston
- Department of Psychiatry and Behavioral Sciences, 2600 Marble Avenue NE, University of New Mexico, Albuquerque, NM, 87106, USA
| | - Michael Huff
- Department of Psychiatry and Behavioral Sciences, 2600 Marble Avenue NE, University of New Mexico, Albuquerque, NM, 87106, USA
| | - Sephira G Ryman
- Mind Research Network, 1101 Yale Boulevard NE, Albuquerque, NM, 87106, USA
| | - Andrei A Vakhtin
- Mind Research Network, 1101 Yale Boulevard NE, Albuquerque, NM, 87106, USA
| | - Christopher C Abbott
- Department of Psychiatry and Behavioral Sciences, 2600 Marble Avenue NE, University of New Mexico, Albuquerque, NM, 87106, USA
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27
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Erchinger VJ, Miller J, Jones T, Kessler U, Bustillo J, Haavik J, Petrillo J, Ziomek G, Hammar Å, Oedegaard KJ, Calhoun VD, McClintock SM, Ersland L, Oltedal L, Abbott CC. Anterior cingulate gamma-aminobutyric acid concentrations and electroconvulsive therapy. Brain Behav 2020; 10:e01833. [PMID: 32940003 PMCID: PMC7667336 DOI: 10.1002/brb3.1833] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE The anticonvulsant hypothesis posits that ECT's mechanism of action is related to enhancement of endogenous anticonvulsant brain mechanisms. Results of prior studies investigating the role of the inhibitory neurotransmitter gamma-aminobutyric acid ("GABA+", GABA and coedited macromolecules) in the pathophysiology and treatment of depression remain inconclusive. The aim of our study was to investigate treatment-responsive changes of GABA+ in subjects with a depressive episode receiving electroconvulsive therapy (ECT). METHODS In total, 41 depressed subjects (DEP) and 35 healthy controls (HC) were recruited at two independent sites in Norway and the USA. MEGA-PRESS was used for investigation of GABA+ in the anterior cingulate cortex. We assessed longitudinal and cross-sectional differences between DEP and HC, as well as the relationship between GABA+ change and change in depression severity and number of ECTs. We also assessed longitudinal differences in cognitive performance and GABA+ levels. RESULTS Depressive episode did not show a difference in GABA+ relative to HC (t71 = -0.36, p = .72) or in longitudinal analysis (t36 = 0.97, p = .34). Remitters and nonremitters did not show longitudinal (t36 = 1.12, p = .27) or cross-sectional differences in GABA+. GABA+ levels were not related to changes in antidepressant response (t35 = 1.12, p = .27) or treatment number (t36 = 0.05, p = .96). An association between cognitive performance and GABA+ levels was found in DEP that completed cognitive effortful testing (t18 = 2.4, p = .03). CONCLUSION Our results failed to support GABA as a marker for depression and abnormal mood state and provide no support for the anticonvulsant hypothesis of ECT. ECT-induced change in GABA concentrations may be related to change in cognitive function.
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Affiliation(s)
- Vera J Erchinger
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jeremy Miller
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Thomas Jones
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Ute Kessler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Juan Bustillo
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Jan Haavik
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Jonathan Petrillo
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Gregory Ziomek
- Department of Psychiatry, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Åsa Hammar
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Ketil J Oedegaard
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Vince D Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia Tech, Emory, Atlanta, GA, USA
| | - Shawn M McClintock
- Division of Psychology, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Lars Ersland
- Department of Biomedicine, University of Bergen, Bergen, Norway.,Department of Clinical Engineering, Haukeland University Hospital, Bergen, Norway.,Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Leif Oltedal
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Christopher C Abbott
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA
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28
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Zendehrouh E, Sendi MSE, Sui J, Fu Z, Zhi D, Lv L, Ma X, Ke Q, Li X, Wang C, Abbott CC, Turner JA, Miller RL, Calhoun VD. Aberrant Functional Network Connectivity Transition Probability in Major Depressive Disorder. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020:1493-1496. [PMID: 33018274 PMCID: PMC8233065 DOI: 10.1109/embc44109.2020.9175872] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Major depressive disorder (MDD) is a common and serious mental disorder characterized by a persistent negative feeling and tremendous sadness. In recent decades, several studies used functional network connectivity (FNC), estimated from resting state functional magnetic resonance imaging (fMRI), to investigate the biological signature of MDD. However, the majority of them have ignored the temporal change of brain interaction by focusing on static FNC (sFNC). Dynamic functional network connectivity (dFNC) that explores temporal patterns of functional connectivity (FC) might provide additional information to its static counterpart. In the current study, by applying k-means clustering on dFNC of MDD and healthy subjects (HCs), we estimated 5 different states. Next, we use the hidden Markov model as a potential biomarker to differentiate the dFNC pattern of MDD patients from HCs. Comparing MDD and HC subjects' hidden Markov model (HMM) features, we have highlighted the role of transition probabilities between states as potential biomarkers and identified that transition probability from a lightly- connected state to highly connected one reduces as symptom severity increases in MDD subjects.Index Terms- Major depressive disorder, Dynamic functional network connectivity, Machine learning, Resting- state functional magnetic resonance imaging, Hidden Markov model.
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Mulders PCR, Llera A, Beckmann CF, Vandenbulcke M, Stek M, Sienaert P, Redlich R, Petrides G, Oudega ML, Oltedal L, Oedegaard KJ, Narr KL, Magnusson PO, Kessler U, Jorgensen A, Espinoza R, Enneking V, Emsell L, Dols A, Dannlowski U, Bolwig TG, Bartsch H, Argyelan M, Anand A, Abbott CC, van Eijndhoven PFP, Tendolkar I. Structural changes induced by electroconvulsive therapy are associated with clinical outcome. Brain Stimul 2020; 13:696-704. [PMID: 32289700 DOI: 10.1016/j.brs.2020.02.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/30/2020] [Accepted: 02/17/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is the most effective treatment option for major depressive disorder, so understanding whether its clinical effect relates to structural brain changes is vital for current and future antidepressant research. OBJECTIVE To determine whether clinical response to ECT is related to structural volumetric changes in the brain as measured by structural magnetic resonance imaging (MRI) and, if so, which regions are related to this clinical effect. We also determine whether a similar model can be used to identify regions associated with electrode placement (unilateral versus bilateral ECT). METHODS Longitudinal MRI and clinical data (Hamilton Depression Rating Scale) was collected from 10 sites as part of the Global ECT-MRI research collaboration (GEMRIC). From 192 subjects, relative changes in 80 (sub)cortical areas were used as potential features for classifying treatment response. We used recursive feature elimination to extract relevant features, which were subsequently used to train a linear classifier. As a validation, the same was done for electrode placement. We report accuracy as well as the structural coefficients of regions included in the discriminative spatial patterns obtained. RESULTS A pattern of structural changes in cortical midline, striatal and lateral prefrontal areas discriminates responders from non-responders (75% accuracy, p < 0.001) while left-sided mediotemporal changes discriminate unilateral from bilateral electrode placement (81% accuracy, p < 0.001). CONCLUSIONS The identification of a multivariate discriminative pattern shows that structural change is relevant for clinical response to ECT, but this pattern does not include mediotemporal regions that have been the focus of electroconvulsive therapy research so far.
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Affiliation(s)
- Peter C R Mulders
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behavior, Centre for Cognitive Neuroimaging, Nijmegen, the Netherlands.
| | - Alberto Llera
- Donders Institute for Brain, Cognition and Behavior, Centre for Cognitive Neuroimaging, Nijmegen, the Netherlands; Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Christian F Beckmann
- Donders Institute for Brain, Cognition and Behavior, Centre for Cognitive Neuroimaging, Nijmegen, the Netherlands; Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), University of Oxford, Oxford, United Kingdom
| | - Mathieu Vandenbulcke
- Department of Geriatric Psychiatry, University Psychiatric Center (UPC), KU Leuven, Leuven, Belgium
| | - Max Stek
- GGZ InGeest Specialized Mental Health Care, Amsterdam, Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Pascal Sienaert
- Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC) - KU Leuven, Kortenberg, Belgium
| | - Ronny Redlich
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Georgios Petrides
- - Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, USA; Center for Neuroscience, Feinstein Institute for Medical Research, Manhasset, USA; Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry, Hempstead, USA
| | - Mardien Leoniek Oudega
- GGZ InGeest Specialized Mental Health Care, Amsterdam, Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Leif Oltedal
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Ketil J Oedegaard
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Katherine L Narr
- Departments of Neurology Psychiatry, Biobehavioral Sciences, Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Peter O Magnusson
- Lund University, Box 118, SE-221 00, Lund, Sweden; Previous: Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Hvidovre, Denmark
| | - Ute Kessler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Anders Jorgensen
- Psychiatric Center Copenhagen & University of Copenhagen, Copenhagen, Denmark
| | - Randall Espinoza
- Departments of Neurology Psychiatry, Biobehavioral Sciences, Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Verena Enneking
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Louise Emsell
- Department of Geriatric Psychiatry, University Psychiatric Center (UPC), KU Leuven, Leuven, Belgium
| | - Annemieke Dols
- GGZ InGeest Specialized Mental Health Care, Amsterdam, Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Udo Dannlowski
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Tom G Bolwig
- Previous: Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Hvidovre, Denmark
| | - Hauke Bartsch
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway; Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, USA
| | - Miklos Argyelan
- - Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, USA; Center for Neuroscience, Feinstein Institute for Medical Research, Manhasset, USA; Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry, Hempstead, USA
| | - Amit Anand
- Center of Behavioral Health, Cleveland Clinic, Cleveland, OH, USA
| | | | - Philip F P van Eijndhoven
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behavior, Centre for Cognitive Neuroimaging, Nijmegen, the Netherlands
| | - Indira Tendolkar
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behavior, Centre for Cognitive Neuroimaging, Nijmegen, the Netherlands; Department of Psychiatry and Psychotherapy, University Hospital Essen, Essen, Germany
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Qi S, Abbott CC, Narr KL, Jiang R, Upston J, McClintock SM, Espinoza R, Jones T, Zhi D, Sun H, Yang X, Sui J, Calhoun VD. Electroconvulsive therapy treatment responsive multimodal brain networks. Hum Brain Mapp 2020; 41:1775-1785. [PMID: 31904902 PMCID: PMC7267951 DOI: 10.1002/hbm.24910] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/02/2019] [Accepted: 12/16/2019] [Indexed: 02/05/2023] Open
Abstract
Electroconvulsive therapy is regarded as the most effective antidepressant treatment for severe and treatment‐resistant depressive episodes. Despite the efficacy of electroconvulsive therapy, the neurobiological underpinnings and mechanisms underlying electroconvulsive therapy induced antidepressant effects remain unclear. The objective of this investigation was to identify electroconvulsive therapy treatment responsive multimodal biomarkers with the 17‐item Hamilton Depression Rating Scale guided brain structure–function fusion in 118 patients with depressive episodes and 60 healthy controls. Results show that reduced fractional amplitude of low frequency fluctuations in the prefrontal cortex, insula and hippocampus, linked with increased gray matter volume in anterior cingulate, medial temporal cortex, insula, thalamus, caudate and hippocampus represent electroconvulsive therapy responsive covarying functional and structural brain networks. In addition, relative to nonresponders, responder‐specific electroconvulsive therapy related brain networks occur in frontal‐limbic network and are associated with successful therapeutic outcomes. Finally, electroconvulsive therapy responsive brain networks were unrelated to verbal declarative memory. Using a data‐driven, supervised‐learning method, we demonstrated that electroconvulsive therapy produces a remodeling of brain functional and structural covariance that was unique to antidepressant symptom response, but not linked to memory impairment.
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Affiliation(s)
- Shile Qi
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS) [Georgia State University, Georgia Institute of Technology, Emory University], Atlanta, Georgia
| | | | - Katherine L Narr
- Department of Neurology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), California
| | - Rongtao Jiang
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Joel Upston
- Department of Psychiatry, University of New Mexico, Albuquerque, New Mexico
| | - Shawn M McClintock
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Randall Espinoza
- Department of Neurology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), California
| | - Tom Jones
- Department of Psychiatry, University of New Mexico, Albuquerque, New Mexico
| | - Dongmei Zhi
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Hailun Sun
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Xiao Yang
- Huaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Jing Sui
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China.,Chinese Academy of Sciences Center for Excellence in Brain Science, Institute of Automation, Beijing, China
| | - Vince D Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS) [Georgia State University, Georgia Institute of Technology, Emory University], Atlanta, Georgia
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Sun H, Jiang R, Qi S, Narr KL, Wade BS, Upston J, Espinoza R, Jones T, Calhoun VD, Abbott CC, Sui J. Preliminary prediction of individual response to electroconvulsive therapy using whole-brain functional magnetic resonance imaging data. Neuroimage Clin 2019; 26:102080. [PMID: 31735637 PMCID: PMC7229344 DOI: 10.1016/j.nicl.2019.102080] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 11/03/2019] [Accepted: 11/05/2019] [Indexed: 12/12/2022]
Abstract
The negative FC networks achieve predictive accuracy of 76.23% for ECT response. The consensus FCs represent predominately frontal, temporal and subcortical regions. FCs that changed significantly were concentrated in frontal and limbic networks. Longitudinal change overlapped with two FCs compared with FC with predictive power.
Electroconvulsive therapy (ECT) works rapidly and has been widely used to treat depressive disorders (DEP). However, identifying biomarkers predictive of response to ECT remains a priority to individually tailor treatment and understand treatment mechanisms. This study used a connectome-based predictive modeling (CPM) approach in 122 patients with DEP to determine if pre-ECT whole-brain functional connectivity (FC) predicts depressive rating changes and remission status after ECT (47 of 122 total subjects or 38.5% of sample), and whether pre-ECT and longitudinal changes (pre/post-ECT) in regional brain network biomarkers are associated with treatment-related changes in depression ratings. Results show the networks with the best predictive performance of ECT response were negative (anti-correlated) FC networks, which predict the post-ECT depression severity (continuous measure) with a 76.23% accuracy for remission prediction. FC networks with the greatest predictive power were concentrated in the prefrontal and temporal cortices and subcortical nuclei, and include the inferior frontal (IFG), superior frontal (SFG), superior temporal (STG), inferior temporal gyri (ITG), basal ganglia (BG), and thalamus (Tha). Several of these brain regions were also identified as nodes in the FC networks that show significant change pre-/post-ECT, but these networks were not related to treatment response. This study design has limitations regarding the longitudinal design and the absence of a control group that limit the causal inference regarding mechanism of post-treatment status. Though predictive biomarkers remained below the threshold of those recommended for potential translation, the analysis methods and results demonstrate the promise and generalizability of biomarkers for advancing personalized treatment strategies.
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Affiliation(s)
- Hailun Sun
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China
| | - Rongtao Jiang
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China
| | - Shile Qi
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, and Emory University, Atlanta, GA, USA
| | - Katherine L Narr
- Departments of Neurology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), CA, USA
| | - Benjamin Sc Wade
- Departments of Neurology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), CA, USA
| | - Joel Upston
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Randall Espinoza
- Departments of Neurology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), CA, USA
| | - Tom Jones
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Vince D Calhoun
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, and Emory University, Atlanta, GA, USA
| | | | - Jing Sui
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China; Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, and Emory University, Atlanta, GA, USA; Chinese Academy of Sciences Center for Excellence in Brain Science, Institute of Automation, Beijing, China.
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Abbott CC, Miller J, Lloyd M, Tohen M. Electroconvulsive therapy electrode placement for bipolar state-related targeted engagement. Int J Bipolar Disord 2019; 7:11. [PMID: 31053985 PMCID: PMC6499851 DOI: 10.1186/s40345-019-0146-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/19/2019] [Indexed: 02/06/2023] Open
Abstract
Background Electroconvulsive therapy (ECT) is an effective treatment for all bipolar states. However, ECT remains underutilized, likely stemming from stigma and the risk of neurocognitive impairment. Neuroimaging research has identified state-specific areas of aberrant brain activity that may serve as targets for therapeutic brain stimulation. Electrode placement determines the geometry of the electric field and can be either non-focal (bitemporal) or more focal (right unilateral or bifrontal). Previous research has shown that electrode placement can impact clinical and cognitive outcomes independent of seizure activity. This review critically examines the evidence that focal (unilateral or bifrontal) electrode placements target specific aberrant circuitry in specific bipolar states to optimize clinical outcomes. We hypothesize that optimal target engagement for a bipolar state will be associated with equivalent efficacy relative to bitemporal non-focal stimulation with less neurocognitive impairment. Methods We performed a literature search in the PubMed database. Inclusion criteria included prospective, longitudinal investigations during the ECT series with specific electrode placements within a bipolar state from 2000 to 2018. Results We identified investigations that met our inclusion criteria with bipolar mania (n = 6), depression (n = 6), mixed (n = 3) and catatonia (n = 1) states. These studies included clinical outcomes and several included cognitive outcomes, which were discussed separately. Conclusions While the heterogeneity of the studies makes comparisons difficult, important patterns included the reduced cognitive side effects, faster rate of response, and equivalent efficacy rates of the focal electrode placements (right unilateral and bifrontal) when compared to non-focal (bitemporal) placement. Further avenues for research include more robust cognitive assessments to separate procedure-related and state-related impairment. In addition, future studies could investigate novel electrode configurations with more specific target engagement for different bipolar states.
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Affiliation(s)
- Christopher C Abbott
- Department of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, University of New Mexico School of Medicine, Albuquerque, NM, 87131, USA.
| | - Jeremy Miller
- Department of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, University of New Mexico School of Medicine, Albuquerque, NM, 87131, USA
| | - Megan Lloyd
- Department of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, University of New Mexico School of Medicine, Albuquerque, NM, 87131, USA
| | - Mauricio Tohen
- Department of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, University of New Mexico School of Medicine, Albuquerque, NM, 87131, USA
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Wilcox CE, Abbott CC, Calhoun VD. Alterations in resting-state functional connectivity in substance use disorders and treatment implications. Prog Neuropsychopharmacol Biol Psychiatry 2019; 91:79-93. [PMID: 29953936 PMCID: PMC6309756 DOI: 10.1016/j.pnpbp.2018.06.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 06/18/2018] [Accepted: 06/23/2018] [Indexed: 02/06/2023]
Abstract
Substance use disorders (SUD) are diseases of the brain, characterized by aberrant functioning in the neural circuitry of the brain. Resting state functional connectivity (rsFC) can illuminate these functional changes by measuring the temporal coherence of low-frequency fluctuations of the blood oxygenation level-dependent magnetic resonance imaging signal in contiguous or non-contiguous regions of the brain. Because this data is easy to obtain and analyze, and therefore fairly inexpensive, it holds promise for defining biological treatment targets in SUD, which could help maximize the efficacy of existing clinical interventions and develop new ones. In an effort to identify the most likely "treatment targets" obtainable with rsFC we summarize existing research in SUD focused on 1) the relationships between rsFC and functionality within important psychological domains which are believed to underlie relapse vulnerability 2) changes in rsFC from satiety to deprived or abstinent states 3) baseline rsFC correlates of treatment outcome and 4) changes in rsFC induced by treatment interventions which improve clinical outcomes and reduce relapse risk. Converging evidence indicates that likely "treatment target" candidates, emerging consistently in all four sections, are reduced connectivity within executive control network (ECN) and between ECN and salience network (SN). Other potential treatment targets also show promise, but the literature is sparse and more research is needed. Future research directions include data-driven prediction analyses and rsFC analyses with longitudinal datasets that incorporate time since last use into analysis to account for drug withdrawal. Once the most reliable biological markers are identified, they can be used for treatment matching, during preliminary testing of new pharmacological compounds to establish clinical potential ("target engagement") prior to carrying out costly clinical trials, and for generating hypotheses for medication repurposing.
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McClintock SM, Kallioniemi E, Martin DM, Kim JU, Weisenbach SL, Abbott CC. A Critical Review and Synthesis of Clinical and Neurocognitive Effects of Noninvasive Neuromodulation Antidepressant Therapies. Focus (Am Psychiatr Publ) 2019; 17:18-29. [PMID: 31975955 PMCID: PMC6493152 DOI: 10.1176/appi.focus.20180031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
There is a plethora of current and emerging antidepressant therapies in the psychiatric armamentarium for the treatment of major depressive disorder. Noninvasive neuromodulation therapies are one such therapeutic category; they typically involve the transcranial application of electrical or magnetic stimulation to modulate cortical and subcortical brain activity. Although electroconvulsive therapy (ECT) has been used since the 1930s, with the prevalence of major depressive disorder and treatment-resistant depression (TRD), the past three decades have seen a proliferation of noninvasive neuromodulation antidepressant therapeutic development. The purpose of this critical review was to synthesize information regarding the clinical effects, neurocognitive effects, and possible mechanisms of action of noninvasive neuromodulation therapies, including ECT, transcranial magnetic stimulation, magnetic seizure therapy, and transcranial direct current stimulation. Considerable research has provided substantial information regarding their antidepressant and neurocognitive effects, but their mechanisms of action remain unknown. Although the four therapies vary in how they modulate neurocircuitry and their resultant antidepressant and neurocognitive effects, they are nonetheless useful for patients with acute and chronic major depressive disorder and TRD. Continued research is warranted to inform dosimetry, algorithm for administration, and integration among the noninvasive neuromodulation therapies and with other antidepressant strategies to continue to maximize their safety and antidepressant benefit.
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Affiliation(s)
- Shawn M McClintock
- Neurocognitive Research Laboratory, Department of Psychiatry, University of Texas (UT) Southwestern Medical Center, Dallas, Texas (McClintock, Kallioniemi, Martin); Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (McClintock); Black Dog Institute, Sydney, Australia, and School of Psychiatry, University of New South Wales, Sydney (Martin); Department of Psychiatry, University of Utah School of Medicine, Salt Lake City (Kim, Weisenbach); VA Salt Lake City, Mental Health Program (Weisenbach); Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque (Abbott)
| | - Elisa Kallioniemi
- Neurocognitive Research Laboratory, Department of Psychiatry, University of Texas (UT) Southwestern Medical Center, Dallas, Texas (McClintock, Kallioniemi, Martin); Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (McClintock); Black Dog Institute, Sydney, Australia, and School of Psychiatry, University of New South Wales, Sydney (Martin); Department of Psychiatry, University of Utah School of Medicine, Salt Lake City (Kim, Weisenbach); VA Salt Lake City, Mental Health Program (Weisenbach); Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque (Abbott)
| | - Donel M Martin
- Neurocognitive Research Laboratory, Department of Psychiatry, University of Texas (UT) Southwestern Medical Center, Dallas, Texas (McClintock, Kallioniemi, Martin); Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (McClintock); Black Dog Institute, Sydney, Australia, and School of Psychiatry, University of New South Wales, Sydney (Martin); Department of Psychiatry, University of Utah School of Medicine, Salt Lake City (Kim, Weisenbach); VA Salt Lake City, Mental Health Program (Weisenbach); Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque (Abbott)
| | - Joseph U Kim
- Neurocognitive Research Laboratory, Department of Psychiatry, University of Texas (UT) Southwestern Medical Center, Dallas, Texas (McClintock, Kallioniemi, Martin); Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (McClintock); Black Dog Institute, Sydney, Australia, and School of Psychiatry, University of New South Wales, Sydney (Martin); Department of Psychiatry, University of Utah School of Medicine, Salt Lake City (Kim, Weisenbach); VA Salt Lake City, Mental Health Program (Weisenbach); Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque (Abbott)
| | - Sara L Weisenbach
- Neurocognitive Research Laboratory, Department of Psychiatry, University of Texas (UT) Southwestern Medical Center, Dallas, Texas (McClintock, Kallioniemi, Martin); Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (McClintock); Black Dog Institute, Sydney, Australia, and School of Psychiatry, University of New South Wales, Sydney (Martin); Department of Psychiatry, University of Utah School of Medicine, Salt Lake City (Kim, Weisenbach); VA Salt Lake City, Mental Health Program (Weisenbach); Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque (Abbott)
| | - Christopher C Abbott
- Neurocognitive Research Laboratory, Department of Psychiatry, University of Texas (UT) Southwestern Medical Center, Dallas, Texas (McClintock, Kallioniemi, Martin); Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (McClintock); Black Dog Institute, Sydney, Australia, and School of Psychiatry, University of New South Wales, Sydney (Martin); Department of Psychiatry, University of Utah School of Medicine, Salt Lake City (Kim, Weisenbach); VA Salt Lake City, Mental Health Program (Weisenbach); Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque (Abbott)
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Gibson BC, Sanguinetti JL, Badran BW, Yu AB, Klein EP, Abbott CC, Hansberger JT, Clark VP. Increased Excitability Induced in the Primary Motor Cortex by Transcranial Ultrasound Stimulation. Front Neurol 2018; 9:1007. [PMID: 30546342 PMCID: PMC6280333 DOI: 10.3389/fneur.2018.01007] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 11/07/2018] [Indexed: 12/29/2022] Open
Abstract
Background: Transcranial Ultrasound Stimulation (tUS) is an emerging technique that uses ultrasonic waves to noninvasively modulate brain activity. As with other forms of non-invasive brain stimulation (NIBS), tUS may be useful for altering cortical excitability and neuroplasticity for a variety of research and clinical applications. The effects of tUS on cortical excitability are still unclear, and further complications arise from the wide parameter space offered by various types of devices, transducer arrangements, and stimulation protocols. Diagnostic ultrasound imaging devices are safe, commonly available systems that may be useful for tUS. However, the feasibility of modifying brain activity with diagnostic tUS is currently unknown. Objective: We aimed to examine the effects of a commercial diagnostic tUS device using an imaging protocol on cortical excitability. We hypothesized that imaging tUS applied to motor cortex could induce changes in cortical excitability as measured using a transcranial magnetic stimulation (TMS) motor evoked potential (MEP) paradigm. Methods: Forty-three subjects were assigned to receive either verum (n = 21) or sham (n = 22) diagnostic tUS in a single-blind design. Baseline motor cortex excitability was measured using MEPs elicited by TMS. Diagnostic tUS was subsequently administered to the same cortical area for 2 min, immediately followed by repeated post-stimulation MEPs recorded up to 16 min post-stimulation. Results: Verum tUS increased excitability in the motor cortex (from baseline) by 33.7% immediately following tUS (p = 0.009), and 32.4% (p = 0.047) 6 min later, with excitability no longer significantly different from baseline by 11 min post-stimulation. By contrast, subjects receiving sham tUS showed no significant changes in MEP amplitude. Conclusion: These findings demonstrate that tUS delivered via a commercially available diagnostic imaging ultrasound system transiently increases excitability in the motor cortex as measured by MEPs. Diagnostic tUS devices are currently used for internal imaging in many health care settings, and the present results suggest that these same devices may also offer a promising tool for noninvasively modulating activity in the central nervous system. Further studies exploring the use of diagnostic imaging devices for neuromodulation are warranted.
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Affiliation(s)
- Benjamin C. Gibson
- Psychology Clinical Neuroscience Center, Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - Joseph L. Sanguinetti
- Psychology Clinical Neuroscience Center, Department of Psychology, University of New Mexico, Albuquerque, NM, United States
- U.S. Army Research Laboratory, Aberdeen Proving Ground, MD, United States
| | - Bashar W. Badran
- Psychology Clinical Neuroscience Center, Department of Psychology, University of New Mexico, Albuquerque, NM, United States
- U.S. Army Research Laboratory, Aberdeen Proving Ground, MD, United States
- Department of Biomedical Engineering, The City College of New York, New York, NY, United States
- Brain Stimulation Laboratory, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States
| | - Alfred B. Yu
- U.S. Army Research Laboratory, Aberdeen Proving Ground, MD, United States
| | - Evan P. Klein
- Psychology Clinical Neuroscience Center, Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - Christopher C. Abbott
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | | | - Vincent P. Clark
- Psychology Clinical Neuroscience Center, Department of Psychology, University of New Mexico, Albuquerque, NM, United States
- Department of Neurosciences, University of New Mexico School of Medicine, Albuquerque, NM, United States
- The Mind Research Network & LBERI, Albuquerque, NM, United States
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36
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Jiang R, Abbott CC, Jiang T, Du Y, Espinoza R, Narr KL, Wade B, Yu Q, Song M, Lin D, Chen J, Jones T, Argyelan M, Petrides G, Sui J, Calhoun VD. SMRI Biomarkers Predict Electroconvulsive Treatment Outcomes: Accuracy with Independent Data Sets. Neuropsychopharmacology 2018; 43:1078-1087. [PMID: 28758644 PMCID: PMC5854791 DOI: 10.1038/npp.2017.165] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/18/2017] [Accepted: 07/21/2017] [Indexed: 02/06/2023]
Abstract
Owing to the rapid and robust clinical effects, electroconvulsive therapy (ECT) represents an optimal model to develop and test treatment predictors for major depressive disorders (MDDs), whereas imaging markers can be informative in identifying MDD patients who will respond to a specific antidepressant treatment or not. Here we aim to predict post-ECT depressive rating changes and remission status using pre-ECT gray matter (GM) in 38 MDD patients and validate in two independent data sets. Six GM regions including the right hippocampus/parahippocampus, right orbitofrontal gyrus, right inferior temporal gyrus (ITG), left postcentral gyrus/precuneus, left supplementary motor area, and left lingual gyrus were identified as predictors of ECT response, achieving accuracy of 89, 90 and 86% for remission prediction in three independent, age-matched data sets, respectively. For MDD patients, GM density increases only in the left supplementary motor cortex and left postcentral gyrus/precuneus after ECT. These results suggest that treatment-predictive and treatment-responsive regions may be anatomically different but functionally related in the context of ECT response. To the best of our knowledge, this is the first attempt to quantitatively identify and validate the ECT treatment biomarkers using multi-site GM data. We address a major clinical challenge and provide potential opportunities for more effective and timely interventions for electroconvulsive treatment.
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Affiliation(s)
- Rongtao Jiang
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China,University of Chinese Academy of Sciences, Beijing, China
| | | | - Tianzi Jiang
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China,University of Chinese Academy of Sciences, Beijing, China,Chinese Academy of Sciences Center for Excellence in Brain Science, Institute of Automation, Beijing, China
| | - Yuhui Du
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA,School of Computer and Information Technology, Shanxi University, Taiyuan, China
| | - Randall Espinoza
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA, USA
| | - Katherine L Narr
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA, USA,Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Benjamin Wade
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Qingbao Yu
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Ming Song
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Dongdong Lin
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Jiayu Chen
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Thomas Jones
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Miklos Argyelan
- Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA,Division of Psychiatry Research, Zucker Hillside Hospital, Northwell System, Glen Oaks, NY, USA,Departments of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Georgios Petrides
- Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA,Division of Psychiatry Research, Zucker Hillside Hospital, Northwell System, Glen Oaks, NY, USA,Departments of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Jing Sui
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China,University of Chinese Academy of Sciences, Beijing, China,Chinese Academy of Sciences Center for Excellence in Brain Science, Institute of Automation, Beijing, China,The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA,National Laboratory of Pattern Recognition and Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, 95 Zhongguancun East Road, Beijing 100190, China, Tel: +86 82544518, Fax: +86 82544777, E-mail:
| | - Vince D Calhoun
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA,The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA,Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, NM, USA
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37
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Abbott CC, Khafaja M. Editorial Comment: Stress and Late-Life Depression. Am J Geriatr Psychiatry 2017; 25:978-979. [PMID: 28602383 PMCID: PMC8344408 DOI: 10.1016/j.jagp.2017.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Christopher C Abbott
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM.
| | - Mohamad Khafaja
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM
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38
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Hanlon FM, Dodd AB, Ling JM, Bustillo JR, Abbott CC, Mayer AR. From Behavioral Facilitation to Inhibition: The Neuronal Correlates of the Orienting and Reorienting of Auditory Attention. Front Hum Neurosci 2017. [PMID: 28634448 PMCID: PMC5459904 DOI: 10.3389/fnhum.2017.00293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Successful adaptive behavior relies on the ability to automatically (bottom-up) orient attention to different locations in the environment. This results in a biphasic pattern in which reaction times (RT) are faster for stimuli that occur in the same spatial location (valid) for the first few hundred milliseconds, which is termed facilitation. This is followed by faster RT for stimuli that appear in novel locations (invalid) after longer delays, termed inhibition of return. The neuronal areas and networks involved in the transition between states of facilitation and inhibition remain poorly understood, especially for auditory stimuli. Functional magnetic resonance imaging (fMRI) data were therefore collected in a large sample of healthy volunteers (N = 52) at four separate auditory stimulus onset asynchronies (SOAs; 200, 400, 600, and 800 ms). Behavioral results indicated that facilitation (valid RT < invalid RT) occurred at the 200 ms SOA, with inhibition of return (valid RT > invalid RT) present at the three longer SOAs. fMRI results showed several brain areas varying their activation as a function of SOA, including bilateral superior temporal gyrus, anterior thalamus, cuneus, dorsal anterior cingulate gyrus, and right ventrolateral prefrontal cortex (VLPFC)/anterior insula. Right VLPFC was active during a behavioral state of facilitation, and its activation (invalid – valid trials) further correlated with behavioral reorienting at the 200 ms delay. These results suggest that right VLPFC plays a critical role when auditory attention must be quickly deployed or redeployed, demanding heightened cognitive and inhibitory control. In contrast to previous work, the ventral and dorsal frontoparietal attention networks were both active during valid and invalid trials across SOAs. These results suggest that the dorsal and ventral networks may not be as specialized during bottom-up auditory orienting as has been previously reported during visual orienting.
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Affiliation(s)
- Faith M Hanlon
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, AlbuquerqueNM, United States
| | - Andrew B Dodd
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, AlbuquerqueNM, United States
| | - Josef M Ling
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, AlbuquerqueNM, United States
| | - Juan R Bustillo
- Department of Psychiatry, University of New Mexico School of Medicine, AlbuquerqueNM, United States.,Department of Neurosciences, University of New Mexico School of Medicine, AlbuquerqueNM, United States
| | - Christopher C Abbott
- Department of Psychiatry, University of New Mexico School of Medicine, AlbuquerqueNM, United States
| | - Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, AlbuquerqueNM, United States.,Department of Neurology, University of New Mexico School of Medicine, AlbuquerqueNM, United States.,Department of Psychology, University of New Mexico, AlbuquerqueNM, United States
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39
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Wade BSC, Sui J, Njau S, Leaver AM, Vasvada M, Gutman BA, Thompson PM, Espinoza R, Woods RP, Abbott CC, Narr KL, Joshi SH. DATA-DRIVEN CLUSTER SELECTION FOR SUBCORTICAL SHAPE AND CORTICAL THICKNESS PREDICTS RECOVERY FROM DEPRESSIVE SYMPTOMS. Proc IEEE Int Symp Biomed Imaging 2017; 2017:502-506. [PMID: 30713592 DOI: 10.1109/isbi.2017.7950570] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Patients with major depressive disorder (MDD) who do not achieve full symptomatic recovery after antidepressant treatment have a higher risk of relapse. Compared to pharmacotherapies, electroconvulsive therapy (ECT) more rapidly produces a greater extent of response in severely depressed patients. However, prediction of which candidates are most likely to improve after ECT remains challenging. Using structural MRI data from 42 ECT patients scanned prior to ECT treatment, we developed a random forest classifier based on data-driven shape cluster selection and cortical thickness features to predict remission. Right hemisphere hippocampal shape and right inferior temporal cortical thickness was most predictive of remission, with the predicted probability of recovery decreasing when these regions were thicker prior to treatment. Remission was predicted with an average 73% balanced accuracy. Classification of MRI data may help identify treatment-responsive patients and aid in clinical decision-making. Our results show promise for the development of personalized treatment strategies.
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Affiliation(s)
- Benjamin S C Wade
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, UCLA.,Imaging Genetics Center, USC
| | - Jing Sui
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM
| | - Stephanie Njau
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, UCLA
| | - Amber M Leaver
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, UCLA
| | - Megha Vasvada
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, UCLA
| | | | | | | | - Roger P Woods
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, UCLA
| | | | - Katherine L Narr
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, UCLA
| | - Shantanu H Joshi
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, UCLA
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40
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Affiliation(s)
- Christopher C. Abbott
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA,Corresponding Author Christopher C. Abbott, Dept. of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA, 87131, Telephone: (505) 272-2223, Fax: (505) 272-5572,
| | - Dyani Loo
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Jing Sui
- National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China 100190, The Mind Research Network, Albuquerque, NM, USA,87106
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41
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Hanlon FM, Shaff NA, Dodd AB, Ling JM, Bustillo JR, Abbott CC, Stromberg SF, Abrams S, Lin DS, Mayer AR. Hemodynamic response function abnormalities in schizophrenia during a multisensory detection task. Hum Brain Mapp 2015; 37:745-55. [PMID: 26598791 DOI: 10.1002/hbm.23063] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/20/2015] [Accepted: 11/12/2015] [Indexed: 11/07/2022] Open
Abstract
Functional magnetic resonance imaging (fMRI) of the blood oxygen level dependent (BOLD) response has commonly been used to investigate the neuropathology underlying cognitive and sensory deficits in patients with schizophrenia (SP) by examining the positive phase of the BOLD response, assuming a fixed shape for the hemodynamic response function (HRF). However, the individual phases (positive and post-stimulus undershoot (PSU)) of the HRF may be differentially affected by a variety of underlying pathologies. The current experiment used a multisensory detection task with a rapid event-related fMRI paradigm to investigate both the positive and PSU phases of the HRF in SP and healthy controls (HC). Behavioral results indicated no significant group differences during task performance. Analyses that examined the shape of the HRF indicated two distinct group differences. First, SP exhibited a reduced and/or prolonged PSU following normal task-related positive BOLD activation in secondary auditory and visual sensory areas relative to HC. Second, SP did not show task-induced deactivation in the anterior node of the default-mode network (aDMN) relative to HC. In contrast, when performing traditional analyses that focus on the positive phase, there were no group differences. Interestingly, the magnitude of the PSU in secondary auditory and visual areas was positively associated with the magnitude of task-induced deactivation within the aDMN, suggesting a possible common neural mechanism underlying both of these abnormalities (failure in neural inhibition). Results are consistent with recent views that separate neural processes underlie the two phases of the HRF and that they are differentially affected in SP. Hum Brain Mapp 37:745-755, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Faith M Hanlon
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico
| | - Nicholas A Shaff
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico
| | - Andrew B Dodd
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico
| | - Josef M Ling
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico
| | - Juan R Bustillo
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico.,Department of Neuroscience, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Christopher C Abbott
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Shannon F Stromberg
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Swala Abrams
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Denise S Lin
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico.,Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico.,Department of Neurology, University of New Mexico School of Medicine, Albuquerque, New Mexico.,Department of Psychology, University of New Mexico, Albuquerque, New Mexico
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42
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Affiliation(s)
- Mauricio Tohen
- From the Department of Psychiatry and Behavioral Sciences, Health Sciences Center, University of New Mexico, Albuquerque
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43
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Quinn DK, Abbott CC. Catatonia after cerebral hypoxia: do the usual treatments apply? Psychosomatics 2014; 55:525-35. [PMID: 25262046 PMCID: PMC4182149 DOI: 10.1016/j.psym.2014.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 03/24/2014] [Accepted: 03/24/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Neurologic deterioration occurring days to weeks after a cerebral hypoxic event accompanied by diffuse white matter demyelination is called delayed posthypoxic leukoencephalopathy (DPHL). Manifestations of DPHL are diverse and include dementia, gait disturbance, incontinence, pyramidal tract signs, parkinsonism, chorea, mood and thought disorders, akinetic mutism, and rarely catatonia. METHODS We report a case of malignant catatonia in a patient diagnosed with DPHL that was refractory to electroconvulsive therapy (ECT) and review the literature on catatonia in DPHL. RESULTS The patient was a 56-year-old woman with schizoaffective disorder who was admitted with catatonia 2 weeks after hospitalization for drug overdose and respiratory failure. Her catatonic symptoms did not respond to treatment of lorazepam, amantadine, methylphenidate, or 10 sessions of bilateral ECT at maximum energy. Repeat magnetic resonance imaging revealed extensive periventricular white matter lesions not present on admission scans, and she was diagnosed with DPHL. DISCUSSION No treatment for DPHL has been proven to be widely effective. Hyperbaric oxygen treatments may reduce the rate of development, and symptom improvement has been reported with stimulants and other psychotropic agents. Review of literature reveals rare success with GABAergic agents for catatonia after cerebral hypoxia and no cases successfully treated with ECT. There are 7 case reports of neurologic decompensation during ECT treatment after a cerebral hypoxic event. CONCLUSION Caution is advised when considering ECT for catatonia when delayed sequelae of cerebral hypoxia are on the differential diagnosis, as there is a dearth of evidence to support this treatment approach.
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Affiliation(s)
- Davin K Quinn
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM..
| | - Christopher C Abbott
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM
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44
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Abbott CC, Jones T, Lemke NT, Gallegos P, McClintock SM, Mayer AR, Bustillo J, Calhoun VD. Hippocampal structural and functional changes associated with electroconvulsive therapy response. Transl Psychiatry 2014; 4:e483. [PMID: 25405780 PMCID: PMC4259994 DOI: 10.1038/tp.2014.124] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 09/10/2014] [Accepted: 10/05/2014] [Indexed: 02/07/2023] Open
Abstract
Previous animal models and structural imaging investigations have linked hippocampal neuroplasticity to electroconvulsive therapy (ECT) response, but the relationship between changes in hippocampal volume and temporal coherence in the context of ECT response is unknown. We hypothesized that ECT response would increase both hippocampal resting-state functional magnetic resonance imaging connectivity and hippocampal volumes. Patients with major depressive disorder (n=19) were scanned before and after the ECT series. Healthy, demographically matched comparisons (n=20) were scanned at one-time interval. Longitudinal changes in functional connectivity of hippocampal regions and volumes of hippocampal subfields were compared with reductions in ratings of depressive symptoms. Right hippocampal connectivity increased (normalized) after the ECT series and correlated with depressive symptom reduction. Similarly, the volumes of the right hippocampal cornu ammonis (CA2/3), dentate gyrus and subiculum regions increased, but the hippocampal subfields were unchanged relative to the comparison group. Connectivity changes were not evident in the left hippocampus, and volume changes were limited to the left CA2/3 subfields. The laterality of the right hippocampal functional connectivity and volume increases may be related to stimulus delivery method, which was predominately right unilateral in this investigation. The findings suggested that increased hippocampal functional connectivity and volumes may be biomarkers for ECT response.
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Affiliation(s)
- C C Abbott
- Department of Psychiatry, Center for Psychiatric Research MSC11 6035, University of New Mexico School of Medicine, Albuquerque, NM, USA,Department of Psychiatry, Center for Psychiatric Research MSC11 6035, University of New Mexico School of Medicine, Yale Boulevard NE, Albuquerque, NM 87131, USA. E-mail:
| | - T Jones
- Department of Psychiatry, Center for Psychiatric Research MSC11 6035, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - N T Lemke
- Department of Psychiatry, Center for Psychiatric Research MSC11 6035, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - P Gallegos
- Department of Psychiatry, Center for Psychiatric Research MSC11 6035, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - S M McClintock
- Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA,Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - A R Mayer
- Mind Research Network, Albuquerque, NM, USA
| | - J Bustillo
- Department of Psychiatry, Center for Psychiatric Research MSC11 6035, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - V D Calhoun
- Department of Psychiatry, Center for Psychiatric Research MSC11 6035, University of New Mexico School of Medicine, Albuquerque, NM, USA,Mind Research Network, Albuquerque, NM, USA,Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, NM, USA
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45
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Çetin MS, Christensen F, Abbott CC, Stephen JM, Mayer AR, Cañive JM, Bustillo JR, Pearlson GD, Calhoun VD. Thalamus and posterior temporal lobe show greater inter-network connectivity at rest and across sensory paradigms in schizophrenia. Neuroimage 2014; 97:117-26. [PMID: 24736181 DOI: 10.1016/j.neuroimage.2014.04.009] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 03/15/2014] [Accepted: 04/04/2014] [Indexed: 11/25/2022] Open
Abstract
Although a number of recent studies have examined functional connectivity at rest, few have assessed differences between connectivity both during rest and across active task paradigms. Therefore, the question of whether cortical connectivity patterns remain stable or change with task engagement continues to be unaddressed. We collected multi-scan fMRI data on healthy controls (N=53) and schizophrenia patients (N=42) during rest and across paradigms arranged hierarchically by sensory load. We measured functional network connectivity among 45 non-artifactual distinct brain networks. Then, we applied a novel analysis to assess cross paradigm connectivity patterns applied to healthy controls and patients with schizophrenia. To detect these patterns, we fit a group by task full factorial ANOVA model to the group average functional network connectivity values. Our approach identified both stable (static effects) and state-based differences (dynamic effects) in brain connectivity providing a better understanding of how individuals' reactions to simple sensory stimuli are conditioned by the context within which they are presented. Our findings suggest that not all group differences observed during rest are detectable in other cognitive states. In addition, the stable differences of heightened connectivity between multiple brain areas with thalamus across tasks underscore the importance of the thalamus as a gateway to sensory input and provide new insight into schizophrenia.
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Affiliation(s)
- Mustafa S Çetin
- Computer Science Department, University of New Mexico, Albuquerque, NM 87131, United States.
| | - Fletcher Christensen
- Mathematics Department, University of New Mexico, Albuquerque, NM 87131, United States
| | - Christopher C Abbott
- Psychiatry Department, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - Julia M Stephen
- The Mind Research Network, Albuquerque, NM 87106, United States
| | - Andrew R Mayer
- The Mind Research Network, Albuquerque, NM 87106, United States; Psychology Department, University of New Mexico, Albuquerque, NM 87131, United States; Neurology Department, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - José M Cañive
- Psychiatry Department, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States; Psychiatry Research Program, New Mexico VA Health Care System, Albuquerque, NM 87108, United States; Department of Neurosciences, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - Juan R Bustillo
- Psychiatry Department, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States; Department of Neurosciences, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - Godfrey D Pearlson
- Departments of Psychiatry & Neurobiology, Yale University, New Haven, CT 06511, United States
| | - Vince D Calhoun
- Psychiatry Department, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States; The Mind Research Network, Albuquerque, NM 87106, United States; Electrical and Computer Engineering Department, University of New Mexico, Albuquerque, NM 87131, United States
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46
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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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47
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Quinn DK, Deligtisch A, Rees C, Brodsky A, Evans D, Khafaja M, Abbott CC. Differential diagnosis of psychiatric symptoms after deep brain stimulation for movement disorders. Neuromodulation 2014; 17:629-36; discussion 636. [PMID: 24512146 DOI: 10.1111/ner.12153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 11/28/2013] [Accepted: 12/12/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The presence of a deep brain stimulator (DBS) in a patient with a movement disorder who develops psychiatric symptoms poses unique diagnostic and therapeutic challenges for the treating clinician. Few sources discuss approaches to diagnosing and treating these symptoms. MATERIALS AND METHODS The authors review the literature on psychiatric complications in DBS for movement disorders and propose a heuristic for categorizing symptoms according to their temporal relationship with the DBS implantation process. RESULTS Psychiatric symptoms after DBS can be categorized as preimplantation, intra-operative/perioperative, stimulation related, device malfunction, medication related, and chronic stimulation related/long term. Once determined, the specific etiology of a symptom guides the practitioner in treatment. CONCLUSIONS A structured approach to psychiatric symptoms in DBS patients allows practitioners to effectively diagnose and treat them when they arise.
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Affiliation(s)
- Davin K Quinn
- Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Abbott CC, Jaramillo A, Wilcox CE, Hamilton DA. Antipsychotic drug effects in schizophrenia: a review of longitudinal FMRI investigations and neural interpretations. Curr Med Chem 2014; 20:428-37. [PMID: 23157635 DOI: 10.2174/0929867311320030014] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 09/10/2012] [Accepted: 09/26/2012] [Indexed: 12/11/2022]
Abstract
The evidence that antipsychotics improve brain function and reduce symptoms in schizophrenia is unmistakable, but how antipsychotics change brain function is poorly understood, especially within neuronal systems. In this review, we investigated the hypothesized normalization of the functional magnetic resonance imaging (fMRI) blood oxygen level dependent signal in the context of antipsychotic treatment. First, we conducted a systematic PubMed search to identify eight fMRI investigations that met the following inclusion criteria: case-control, longitudinal design; pre- and post-treatment contrasts with a healthy comparison group; and antipsychotic-free or antipsychotic-naive patients with schizophrenia at the start of the investigation. We hypothesized that aberrant activation patterns or connectivity between patients with schizophrenia and healthy comparisons at the first imaging assessment would no longer be apparent or "normalize" at the second imaging assessment. The included studies differed by analysis method and fMRI task but demonstrated normalization of fMRI activation or connectivity during the treatment interval. Second, we reviewed putative mechanisms from animal studies that support normalization of the BOLD signal in schizophrenia. We provided several neuronal-based interpretations of these changes of the BOLD signal that may be attributable to long-term antipsychotic administration.
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Affiliation(s)
- C C Abbott
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA.
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Abbott CC, Lemke NT, Gopal S, Thoma RJ, Bustillo J, Calhoun VD, Turner JA. Electroconvulsive therapy response in major depressive disorder: a pilot functional network connectivity resting state FMRI investigation. Front Psychiatry 2013; 4:10. [PMID: 23459749 PMCID: PMC3585433 DOI: 10.3389/fpsyt.2013.00010] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 02/17/2013] [Indexed: 12/16/2022] Open
Abstract
Major depressive disorder (MDD) is associated with increased functional connectivity in specific neural networks. Electroconvulsive therapy (ECT), the gold-standard treatment for acute, treatment-resistant MDD, but temporal dependencies between networks associated with ECT response have yet to be investigated. In the present longitudinal, case-control investigation, we used independent component analysis to identify distinct networks of brain regions with temporally coherent hemodynamic signal change and functional network connectivity (FNC) to assess component time course correlations across these networks. MDD subjects completed imaging and clinical assessments immediately prior to the ECT series and a minimum of 5 days after the last ECT treatment. We focused our analysis on four networks affected in MDD: the subcallosal cingulate gyrus, default mode, dorsal lateral prefrontal cortex, and dorsal medial prefrontal cortex (DMPFC). In an older sample of ECT subjects (n = 12) with MDD, remission associated with the ECT series reverses the relationship from negative to positive between the posterior default mode (p_DM) and two other networks: the DMPFC and left dorsal lateral prefrontal cortex (l_DLPFC). Relative to demographically healthy subjects (n = 12), the FNC between the p_DM areas and the DMPFC normalizes with ECT response. The FNC changes following treatment did not correlate with symptom improvement; however, a direct comparison between ECT remitters and non-remitters showed the pattern of increased FNC between the p_DM and l_DLPFC following ECT to be specific to those who responded to the treatment. The differences between ECT remitters and non-remitters suggest that this increased FNC between p_DM areas and the left dorsolateral prefrontal cortex is a neural correlate and potential biomarker of recovery from a depressed episode.
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Affiliation(s)
- Christopher C Abbott
- Department of Psychiatry, School of Medicine, University of New Mexico Albuquerque, NM, USA
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50
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Abbott CC, Merideth F, Ruhl D, Yang Z, Clark VP, Calhoun VD, Hanlon FM, Mayer AR. Auditory orienting and inhibition of return in schizophrenia: a functional magnetic resonance imaging study. Prog Neuropsychopharmacol Biol Psychiatry 2012; 37:161-8. [PMID: 22230646 PMCID: PMC3690330 DOI: 10.1016/j.pnpbp.2011.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 12/19/2011] [Accepted: 12/23/2011] [Indexed: 11/26/2022]
Abstract
Patients with schizophrenia (SP) exhibit deficits in both attentional reorienting and inhibition of return (IOR) during visual tasks. However, it is currently unknown whether these deficits are supramodal in nature and how these deficits relate to other domains of cognitive dysfunction. In addition, the neuronal correlates of this pathological orienting response have not been investigated in either the visual or auditory modality. Therefore, 30 SP and 30 healthy controls (HC) were evaluated with an extensive clinical protocol and functional magnetic resonance imaging (fMRI) during an auditory cuing paradigm. SP exhibited both increased costs and delayed IOR during auditory orienting, suggesting a prolonged interval for attentional disengagement from cued locations. Moreover, a delay in the development of IOR was associated with cognitive deficits on formal neuropsychological testing in the domains of attention/inhibition and working memory. Event-related fMRI showed the characteristic activation of a frontoparietal network (invalid trials>valid trials), but there were no differences in functional activation between patients and HC during either attentional reorienting or IOR. Current results suggest that orienting deficits are supramodal in nature in SP, and are related to higher-order cognitive deficits that directly interfere with day-to-day functioning.
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Affiliation(s)
- Christopher C. Abbott
- Psychiatry Department, University of New Mexico School of Medicine, Albuquerque, NM 87131
| | | | - David Ruhl
- The Mind Research Network, Albuquerque, NM 87106
| | - Zhen Yang
- The Mind Research Network, Albuquerque, NM 87106
| | - Vincent P. Clark
- The Mind Research Network, Albuquerque, NM 87106,Psychology Department, University of New Mexico, Albuquerque, NM 87131
| | - Vince D. Calhoun
- Psychiatry Department, University of New Mexico School of Medicine, Albuquerque, NM 87131,The Mind Research Network, Albuquerque, NM 87106,Electrical and Computer Engineering Department, University of New Mexico, Albuquerque, NM 87131
| | - Faith M. Hanlon
- Psychiatry Department, University of New Mexico School of Medicine, Albuquerque, NM 87131,The Mind Research Network, Albuquerque, NM 87106,Psychology Department, University of New Mexico, Albuquerque, NM 87131
| | - Andrew R. Mayer
- The Mind Research Network, Albuquerque, NM 87106,Psychology Department, University of New Mexico, Albuquerque, NM 87131,Neurology Department, University of New Mexico School of Medicine, Albuquerque, NM 87131,Corresponding author: Andrew Mayer, Ph.D., The Mind Research Network, Pete & Nancy Domenici Hall, 1101 Yale Blvd. NE, Albuquerque, NM 87106; Tel: 505-272-0769; Fax: 505-272-8002;
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