Elsevier

Brain Stimulation

Volume 13, Issue 4, July–August 2020, Pages 1051-1058
Brain Stimulation

Brain functional effects of electroconvulsive therapy during emotional processing in major depressive disorder

https://doi.org/10.1016/j.brs.2020.03.018Get rights and content
Under a Creative Commons license
open access

Highlights

  • Brain function was assessed before and after ECT in patients with major depression.

  • ECT increases anterior cingulate activity during negative emotional processing.

  • No changes in amygdala activity during negative emotional processing after ECT.

  • Responders differ from non-responders in pre-treatment anterior cingulate activity.

  • Anterior cingulate activity is a potential biomarker of treatment response.

Abstract

Background

In treatment-resistant major depressive disorder (MDD), electroconvulsive therapy (ECT) is a treatment with high efficacy. While knowledge regarding changes in brain structure following ECT is growing, the effects of ECT on brain function during emotional processing are largely unknown.

Objective

We investigated the effects of ECT on the activity of the anterior cingulate cortex (ACC) and amygdala during negative emotional stimuli processing and its association with clinical response.

Methods

In this non-randomized longitudinal study, patients with MDD (n = 37) were assessed before and after treatment with ECT. Healthy controls (n = 37) were matched regarding age and gender. Functional magnetic resonance imaging (fMRI) was obtained twice, at baseline and after six weeks using a supraliminal face-matching paradigm. In order to evaluate effects of clinical response, additional post-hoc analyses were performed comparing responders to non-responders.

Results

After ECT, patients with MDD showed a statistically significant increase in ACC activity during processing of negative emotional stimuli (pFWE = .039). This effect was driven by responders (pFWE = .023), while non-responders showed no increase. Responders also had lower pre-treatment ACC activity compared to non-responders (pFWE = .025). No significant effects in the amygdala could be observed.

Conclusions

ECT leads to brain functional changes in the ACC, a relevant region for emotional regulation during processing of negative stimuli. Furthermore, baseline ACC activity might serve as a biomarker for treatment response. Findings are in accordance with recent studies highlighting properties of pre-treatment ACC to be associated with general antidepressive treatment response.

Keywords

Electroconvulsive therapy
Depression
Functional magnetic resonance imaging
Emotional processing
Response
Biomarker

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