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Belge JB, Sabbe BGCC. Long-acting second-generation injectable antipsychotics for the maintenance treatment of bipolar disorder: a narrative review. Expert Opin Pharmacother 2024; 25:295-299. [PMID: 38465894 DOI: 10.1080/14656566.2024.2329743] [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: 12/11/2023] [Accepted: 03/08/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Non-adherence to medication significantly affects bipolar disorder outcomes. Long-Acting Injectable antipsychotics show promise by ensuring adherence and averting relapses. AREAS COVERED This narrative review sought to evaluate the efficacy of second-generation injectable antipsychotics in bipolar disorder through searches in Embase, MEDLINE, and PsycInfo for randomized controlled trials and mirror-image studies.Risperidone and aripiprazole Long-Acting Injectables demonstrated effectiveness in preventing mood recurrences compared to placebos in adults with bipolar disorder. They showed superiority in preventing mania/hypomania relapses over placebos but did not appear to significantly outperform active oral controls. Notably, active controls seem to be more effective in preventing depression relapses than Long-Acting Injectables. Mirror-Image studies point toward the reduction of hospitalization rates following LAI initiation. EXPERT OPINION The available evidence points thus toward the efficacy of LAIs, especially in managing manic episodes and reducing hospitalizations, The current evidence does not however immediately support prioritizing LAIs over oral medications in bipolar disorder treatment. More high-quality studies, especially comparing LAIs directly with active controls, are crucial to gain a comprehensive understanding of their efficacy. These findings highlight the need for further research to guide clinicians in optimizing treatment strategies for bipolar disorder.
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Affiliation(s)
- Jean-Baptiste Belge
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Bernard G C C Sabbe
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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2
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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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3
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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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4
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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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5
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Belge JB, van Eijndhoven P, Mulders PCR. Mechanism of Action of ECT in Depression. Curr Top Behav Neurosci 2023. [PMID: 37962811 DOI: 10.1007/7854_2023_450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Electroconvulsive therapy (ECT) remains the most potent antidepressant treatment available for patients with major depressive disorder (MDD). ECT is highly effective, achieving a response rate of 70-80% and a remission rate of 50-60% even in treatment-resistant patients. The underlying mechanisms of ECT are not fully understood, although several hypotheses have been proposed, including the monoamine hypothesis, anticonvulsive hypothesis, neuroplastic effects, and immunomodulatory properties. In this paper, we provide an overview of magnetic resonance imaging evidence that addresses the neuroplastic changes that occur after ECT at the human systems level and elaborate further on ECTs potent immunomodulatory properties. Despite a growing body of evidence that suggests ECT may normalize many of the structural and functional changes in the brain associated with severe depression, there is a lack of convergence between neurobiological changes and the robust clinical effects observed in depression. This may be due to sample sizes used in ECT studies being generally small and differences in data processing and analysis pipelines. Collaborations that acquire large datasets, such as the GEMRIC consortium, can help translate ECT's clinical efficacy into a better understanding of its mechanisms of action.
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Affiliation(s)
- Jean-Baptiste Belge
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Philip van Eijndhoven
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Centre for Medical Neuroscience, Nijmegen, The Netherlands
| | - Peter C R Mulders
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Centre for Medical Neuroscience, Nijmegen, The Netherlands
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6
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Deng ZD, Ousdal OT, Oltedal L, Angulo B, Baradits M, Spitzberg A, Kessler U, Sartorius A, Dols A, Narr K, Espinoza R, Van Waarde J, Tendolkar I, van Eijndhoven P, van Wingen G, Takamiya A, Kishimoto T, Jorgensen M, Jorgensen A, Paulson O, Yrondi A, Peran 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 P, Redlich R, Dannlowski U, Kavakbasi E, Kritzer M, Ellard K, Camprodon J, Petrides G, Maholtra A, Abbott C, Argyelan M. Electroconvulsive therapy-induced volumetric brain changes converge on a common causal circuit in depression. Res Sq 2023:rs.3.rs-2925196. [PMID: 37398308 PMCID: PMC10312966 DOI: 10.21203/rs.3.rs-2925196/v1] [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] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
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 common causal network (CCN). 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 CCN 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 CCN 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. This evidence further supports that treatment interventions converge on a CCN in depression. Optimizing modulation of this network could serve to improve the outcome of neurostimulation in depression.
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Affiliation(s)
| | | | - Leif Oltedal
- Department of Clinical Medicine, University of Bergen
| | - Brian Angulo
- Department of Clinical Medicine, University of Bergen
| | - Mate Baradits
- Department of Clinical Medicine, University of Bergen
| | | | - Ute Kessler
- Department of Clinical Medicine, University of Bergen
| | | | - Annemiek Dols
- Geffen School of Medicine at the University of California, Los Angeles
| | - Katherine Narr
- Geffen School of Medicine at the University of California, Los Angeles
| | - Randall Espinoza
- Departments of Neurology, Psychiatry and Biobehavioral Sciences, University of California
| | | | - Indira Tendolkar
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry
| | | | | | | | | | | | | | | | | | | | | | - Narcís Cardoner
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau. Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Sa
| | | | | | | | | | | | | | | | | | - Rene Hurlemann
- Institute for Translational Psychiatry, University of Münster
| | - Peter Mulders
- Institute for Translational Psychiatry, University of Münster
| | - Ronny Redlich
- Institute for Translational Psychiatry, University of Münster
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster
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Belge JB, Sabbe ACF, Sabbe BGCC. An update on pharmacotherapy for recurrent depression in 2022. Expert Opin Pharmacother 2023; 24:1387-1394. [PMID: 37300545 DOI: 10.1080/14656566.2023.2223962] [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: 01/29/2023] [Accepted: 06/06/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Major depressive disorder remains a major challenge due to its biopsychosocial burden with increased morbidity and mortality. Despite successful treatment options for the acute episode, recurrence rates are high, on average four times in a life span. AREAS COVERED Both pharmacological as non-pharmacological evidence-based therapeutic options to prevent and treat recurrent depression are discussed. EXPERT OPINION Although some risk factors for recurrence are well known, better evidence is needed. Antidepressant medication should be continued after acute treatment at its full therapeutic dose for longer periods, at least 1 year. There are no clear differences between classes of antidepressant medication when treatment is focused on preventing relapse. Bupropion is the only antidepressant with a proven efficacy to prevent recurrence in seasonal affective disorder. Recent findings conclude maintenance subanesthetic ketamine and esketamine treatment can be effective in sustaining antidepressant effect following remission. Furthermore, the pharmacological approach must be integrated with lifestyle interventions, especially aerobic exercise. Finally, combining pharma- and psychotherapy seems to improve outcome. Network and complexity sciences will help to decrease the high recurrence rates of MDD by developing more integrative and personalized approaches.
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Affiliation(s)
- Jean-Baptiste Belge
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Amber C F Sabbe
- Department of Internal Medicine, University Hospital of Antwerp, Edegem, Belgium
- Campus Drie Eiken, Universiteitsplein 1, University of Antwerp, Wilrijk, Belgium
| | - Bernard G C C Sabbe
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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Belge JB, Constant E. [The neuroplastic effects of electroconvulsive therapy]. Rev Med Liege 2022; 77:527-531. [PMID: 36082600] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Major depressive disorder is an important cause of disability around the world, with a tremendous psychological burden and extensive socioeconomic consequences. Whilst both psychotherapy and psychopharmacology are effective in treating a depressive episode, often there is a delay of several weeks between the start of treatment and the first beneficial effects. More importantly, approximately 30 % of patients do not remit, even after several treatment attempts. As the oldest biological treatment in psychiatry that is still available, electroconvulsive therapy (ECT) remains the most potent of antidepressant interventions, today achieving a staggering 70-80 % response and a 50-60 % remission rate. In treatment-resistant patients, response rates are even as high as 50 %-70 %. Despite its effectiveness, the neurobiological mechanisms of ECT remain unclear. A large body of research suggests that ECT induces widespread changes in both brain structure and function. A key factor behind these powerful therapeutic properties appears to be the important neuroplastic effects of this treatment. This review of the literature will discuss the importance of neuroplasticity in the pathophysiology of depression and then bring up the neuroplastic effects of ECT.
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Affiliation(s)
- J B Belge
- Département de Psychiatrie, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculté de Médecine et des Sciences de la santé, Université d'Anvers, Wilrijk, Belgique
- Département de Psychiatrie, Radboud University Medical Centre, Nijmegen, Pays-Bas
| | - E Constant
- Centre Neuropsychiatrique Spécialisé, Notre-Dame des Anges, Liège, Belgique
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Belge JB, Sabbe AC, Sabbe BG. When is pharmacotherapy necessary for the treatment of seasonal affective disorder? Expert Opin Pharmacother 2022; 23:1243-1245. [PMID: 35818803 DOI: 10.1080/14656566.2022.2100696] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
No abstract is required for the editorial.
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Affiliation(s)
- Jean-Baptiste Belge
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health SciencesUniversity of Antwerp, Campus Drie Eiken, S.033, Universiteitsplein 1, 2610 Wilrijk, Belgium.,Department of Psychiatry, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Amber Cf Sabbe
- Department of Internal Medicine, University Hospital of Antwerp, Drie Eikenstraat 655, 2650 Edegem.,University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Bernard Gcc Sabbe
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health SciencesUniversity of Antwerp, Campus Drie Eiken, S.033, Universiteitsplein 1, 2610 Wilrijk, Belgium
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Mangelinckx C, Belge JB, Maurage P, Constant E. Impaired facial and vocal emotion decoding in schizophrenia is underpinned by basic perceptivo-motor deficits. Cogn Neuropsychiatry 2017; 22:461-467. [PMID: 28974159 DOI: 10.1080/13546805.2017.1382342] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Emotional decoding impairments have been largely demonstrated in schizophrenia for facial and prosodic stimuli, when presented separately. Nevertheless, the exploration of crossmodal integration has been far less considered, despite its omnipresence in daily social interactions. Moreover, the role played by basic visuo-motor impairments in unimodal and crossmodal decoding remains unexplored. METHODS Thirty-two patients were compared with 32 matched controls in an emotional decoding task including unimodal (visual and auditory) and crossmodal (congruent and incongruent) conditions. A control perceptive task was also conducted to take potential low-level perceptual deficits into account. RESULTS Schizoprenic patients presented lower performance and higher reaction times for both unimodal tasks (visual and auditory) and crossmodal conditions. Moreover, reaction times for the visuo-perceptive task were also significantly longer for patients compared to controls. CONCLUSIONS The consistency of the results across unimodal and crossmodal tasks suggests a globalised emotional impairment in schizophrenia, independent of the sensorial modality and crossmodal nature of the stimuli. Centrally, given the results in the visuo-perceptive task, the impairments observed for emotional recognition appears at least partly explained by primary cognitive deficits, namely reduced processing speed.
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Affiliation(s)
- C Mangelinckx
- a Psychological Sciences Research Institute , Université catholique de Louvain , Louvain-la-Neuve , Belgium
| | - J B Belge
- a Psychological Sciences Research Institute , Université catholique de Louvain , Louvain-la-Neuve , Belgium
| | - P Maurage
- b Laboratory for Experimental Psychopathology, Psychological Sciences Research Institute , Université catholique de Louvain , Louvain-la-Neuve , Belgium
| | - E Constant
- c Department of Psychiatry , Saint-Luc University Hospital and Institute of Neuroscience (IoNS), Université catholique de Louvain , Brussels , Belgium
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