Clinical effects of electroconvulsive therapy in severe depression and concomitant changes in cerebral glucose metabolism—An exploratory study

Reininghaus, Eva; Reininghaus, Bernd; Ille, Rottraut; Fitz, Werner; Lassnig, Rosa-Maria; Ebner, Christoph; Painold, Annamaria; Hofmann, Peter; Kapfhammer, Hans-Peter; Aigner, Reingard; Fazekas, Franz; Ropele, Stefan; Enzinger, Christian

doi:10.1016/j.jad.2012.07.034

Cited by 22 publications

(18 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, changes in CMRglu and CBF after ECT have been inconsistent between studies. Some studies have reported increased CMRglu and CBF in unipolar depression post‐ECT whereas others have reported decreased CMRglu and CBF in unipolar depression post‐ECT . The majority of patients in these studies had a response to ECT.…”

Section: Discussionmentioning

confidence: 94%

Reversal of cerebral glucose hypometabolism on positron emission tomography with electroconvulsive therapy in an elderly patient with a psychotic episode

2016

View full text Add to dashboard Cite

AB, a 74-year-old Caucasian woman, was admitted for acute onset of psychosis, anxiety, and cognitive impairment. Pharmacotherapy was unsuccessful and the patient was referred for electroconvulsive therapy (ECT). Pre-ECT, F-fluorodeoxyglucose-positron emission tomography (PET)/computed tomography showed extensive frontal, parietal, and temporal cortical hypometabolism suggestive of a neurodegenerative disease. After eight ECT sessions, the psychotic and anxiety symptoms as well as the cognitive impairment resolved. The rapid improvement in symptoms was more suggestive of a psychotic episode rather than dementia. Two days after the ECT course, F-fluorodeoxyglucose-PET/computed tomography showed improvements in cerebral cortical hypometabolism, especially in the left parietal cortex, left temporal/occipital cortex. and bifrontal regions. At a follow-up visit 2 months after the ECT course, the psychotic episode was still in remission, and F-fluorodeoxyglucose-PET/computed tomography continued to show improved cerebral cortical hypometabolism in these areas. This case illustrated the effect of ECT in reversing cerebral glucose hypometabolism on PET. The improvement in cerebral glucose hypometabolism may represent the neurophysiological mechanism of ECT in the treatment of a psychotic episode. Improved cerebral glucose hypometabolism was present 2 months post-ECT, which suggests that ECT caused sustained functional neural changes.

show abstract

Section: Discussionmentioning

confidence: 94%

Reversal of cerebral glucose hypometabolism on positron emission tomography with electroconvulsive therapy in an elderly patient with a psychotic episode

2016

View full text Add to dashboard Cite

show abstract

“…9 The other 3 studies did not include a washout period for antidepressant medications. Reininghaus et al 11 found marginally but significantly increased metabolic activity in the left temporal cortex and a trend to decreasing activity in the left frontobasal areas 1 to 7 days after a course of ECT. Volkow et al 8 found a trend for reduction in glucose metabolism in the frontal cortical region 24 hours after the last ECT in 4 depressed individuals.…”

Section: Changes In Cerebral Metabolismmentioning

confidence: 98%

“…[8][9][10][11] One of these included a 2-week washout period for psychotropic medications before a baseline PET scan. [8][9][10][11] One of these included a 2-week washout period for psychotropic medications before a baseline PET scan.…”

Section: Changes In Cerebral Metabolismmentioning

confidence: 99%

See 1 more Smart Citation

Functional Neuroimaging Changes Subsequent to Electroconvulsive Therapy in Unipolar Depression

Zhuo

Yu²

2014

The Journal of ECT

View full text Add to dashboard Cite

Electroconvulsive therapy (ECT) is an effective treatment for major depressive episodes; however, the neural mechanisms underlying its therapeutic effects remain largely unknown. This review summarizes the findings of functional neuroimaging studies on the effects of the ECT treatment in patients with unipolar depression. Functional neuroimaging studies show that ECT induces changes in cerebral metabolism, blood flow, neurotransmitter activity, neuronal metabolites, and brain functional connectivity. Nevertheless, most of these studies are cross-sectional, with small sample sizes, and the findings across these studies are inconsistent and often contradictory. The levels of brain functional changes are seldom correlated with alleviation of depressive symptoms. Based on the results of current functional neuroimaging studies, one cannot draw any conclusions about the exact neural mechanisms of the antidepressant effect of ECT. Additional multicenter, large-sample, unified-protocol studies with long-term follow-up and multiple observational markers are needed to clarify and cross-validate the neural mechanisms of the antidepressant effect of ECT and to explore validated neuroimaging markers for predicting and evaluating the clinical efficacy of ECT treatment.

show abstract

“…Einer solchen Interpretation von differierenden neuronalen Behandlungseffekten entspricht die Tatsache, dass EKT auch bei (pharmako-)therapieresistenter depressiver Episode gute klinische Wirksamkeit zeigt. Die überwiegend inkonsistente Befundlage, ein Trend in Richtung einer geringeren Anzahl von signifikanten Befunden zu neuronalen Effekten der EKT in neueren, methodisch hochwertigeren SPECT-und PET-Studien sowie die eingeschränkt erscheinende Vereinbarkeit mit Befunden zur funktionellen Neuroanatomie der Depression lassen einige Autoren von neueren nuklearmedizinischen Studien zur EKT allerdings ebenso schlussfolgern, dass SPECT und PET möglicherweise nicht geeignet sein könnten, um Veränderungen der Gehirnfunktion unter EKT valide zu erfassen[40]. Mit der moderneren fMRT wurden neuronale Therapieeffekte von EKT bislang annähernd ausschließlich in Bezug auf prä-zu postinterventionellen Veränderungen der Konnektivität interessierender Gehirnareale im Ruhezustand untersucht.…”

unclassified

Elektrokonvulsive Therapie bei Depression: Welche Erkenntnisse erbringen fMRT-, PET- und SPECT-Untersuchungen?

Depping

Nolte

Palm

et al. 2014

Fortschr Neurol Psychiatr

View full text Add to dashboard Cite

Electroconvulsive therapy (ECT) is the most potent and rapidly acting of all antidepressant treatments in major depressive disorder (MDD). Nuclear and functional magnetic (fMRI) brain imaging studies of ECT have substantially contributed to the neurobiological understanding of this treatment modality. Neuroimaging methods may also validate potential mechanisms of antidepressant action. Models of neural dysfunction in MDD suggest impaired modulation of activity within a cortico-limbic circuitry, along with alterations in the functional organisation of multiple brain networks implicated in emotional processes. Nuclear imaging techniques have demonstrated consistent patterns of ECT-induced ictal changes in brain activity that appear to be linked to efficacy and side effects of ECT. Interictally, widespread alterations of brain function have been reported, however, results remain inconclusive. FMRI studies of ECT have demonstrated longer-lasting, interictal changes of neural activity in multiple cerebral regions that are in accordance with functional neuroanatomical models of mood disorders. Future research detailing ECT interactions with brain pathophysiology in MDD could potentially provide a clinically useful framework to better predict ECT treatment response and/or side effects, and may also facilitate the development of more focused brain stimulation techniques.

show abstract

Clinical effects of electroconvulsive therapy in severe depression and concomitant changes in cerebral glucose metabolism—An exploratory study

Cited by 22 publications

References 36 publications

Reversal of cerebral glucose hypometabolism on positron emission tomography with electroconvulsive therapy in an elderly patient with a psychotic episode

Reversal of cerebral glucose hypometabolism on positron emission tomography with electroconvulsive therapy in an elderly patient with a psychotic episode

Functional Neuroimaging Changes Subsequent to Electroconvulsive Therapy in Unipolar Depression

Elektrokonvulsive Therapie bei Depression: Welche Erkenntnisse erbringen fMRT-, PET- und SPECT-Untersuchungen?

Contact Info

Product

Resources

About