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

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 ¼ 37) were assessed before and after treatment with ECT. Healthy controls (n ¼ 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 posthoc 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 (p FWE ¼ .039). This effect was driven by responders (p FWE ¼ .023), while non-responders showed no increase. Responders also had lower pre-treatment ACC activity compared to non-responders (p FWE ¼ .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 pretreatment ACC to be associated with general antidepressive treatment response.

Dynamic Functional Connectivity Predicts Treatment Response to Electroconvulsive Therapy in Major Depressive Disorder

“…Therefore, there is an essential need for advanced therapies, such as deep brain stimulation (DBS), transcranial magnetic stimulation (TMS), and electroconvulsive therapy (ECT), which are indicated for treatment resistant depression (Settell et al, 2017;Mo et al, 2020;Williams et al, 2021). Among all mentioned therapies, ECT can be considered as one of the most effective treatments for pharmacological resistant MDD (Enneking et al, 2020) due to its faster action and higher remission rate than typical medicine-based treatments (UK ECT Review Group, 2003). One hundred thousand annual ECT treatments in the U.S revealed that the success rate of this treatment is around 75%, with typical remission rates within 3-4 weeks (Hermann et al, 1995;Weiner and American Psychiatric Association, 2001).…”

“…Among all mentioned therapies, ECT can be considered as one of the most effective treatments for pharmacological resistant MDD (Enneking et al, 2020 ) due to its faster action and higher remission rate than typical medicine-based treatments (UK ECT Review Group, 2003 ). One hundred thousand annual ECT treatments in the U.S revealed that the success rate of this treatment is around 75%, with typical remission rates within 3–4 weeks (Hermann et al, 1995 ; Weiner and American Psychiatric Association, 2001 ).…”

Altered voxel-level whole-brain functional connectivity in multiple system atrophy patients with depression symptoms

“…The functioning of the ACC was not only associated with cognitive control but also with emotion regulation-related process; the ACC is one of the most consistently recurring brain regions in patients with major depressive disorder [ 19 , 20 ]. Evidence from voxel-based morphometry studies has shown that decreased gray matter volume in the ACC is associated with depression severity in patients with major depressive disorder patients, whereas an increased in the ACC is the primary reason for the improvement on negative emotional stimuli under an electroconvulsive therapy [ 21 , 22 ], suggesting that ACC plays a key role in the depression process. Only one study reported that the ACC’s involvement of ACC in regulation of depression symptoms in MSA patients.…”

Current progress in neuroimaging research for the treatment of major depression with electroconvulsive therapy

“…Some studies have found that ECT increases the volume of the hippocampus and amygdala in the temporal lobe system in patients with depression[ 62 - 64 ]. The strongest evidence of structural changes in the brain after ECT was an increase in the volume of the temporal lobe and subcortical structures, such as the hippocampal-amygdala complex, anterior cingulate cortex and striatum[ 65 ].…”