Effects of Electroconvulsive Therapy on Brain Functional Activation and Connectivity in Depression

Beall, Erik B.; Malone, Donald A.; Dale, Roman M.; Muzina, David J.; Koenig, Katherine A.; Bhattacharrya, Pallab K.; Jones, Stephen E.; Phillips, Michael; Lowe, Mark J.

doi:10.1097/yct.0b013e31825ebcc7

Cited by 73 publications

(58 citation statements)

References 47 publications

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“…Comparable effects of ECT were reported from an fMRI study by Beall et al (53). These researchers assessed regional brain activation changes from 1 week before to 1–3 weeks after treatment for six patients with major depression, who performed a working memory task and a passive task of viewing emotional pictures.…”

Section: Frontotemporal Effectssupporting

confidence: 72%

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Electroconvulsive Treatment: Hypotheses about Mechanisms of Action

Fosse¹,

Read²

2013

Front. Psychiatry

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No consensus has been reached on the mode of action of electroconvulsive treatment (ECT). We suggest that two features may aid in the delineation of the involved mechanisms. First, when effective, ECT would be likely to affect brain functions that are typically altered in its primary recipient group, people with severe depression. Central among these are the frontal and temporal lobes, the hypothalamus-pituitary-adrenal (HPA) stress axis, and the mesocorticolimbic dopamine system. Second, the involved mechanisms should be affected for a time period that matches the average endurance of clinical effects, which is indicated to be several days to a few weeks. To identify effects upon frontal and temporal lobe functioning we reviewed human studies using EEG, PET, SPECT, and fMRI. Effects upon the HPA axis and the dopamine system were assessed by reviewing both human and animal studies. The EEG studies indicate that ECT decelerates neural activity in the frontal and temporal lobes (increased delta and theta wave activity) for weeks to months. Comparable findings are reported from PET and SPECT studies, with reduced cerebral blood flow (functional deactivation) for weeks to months after treatment. The EEG deceleration and functional deactivation following ECT are statistically associated with reduced depression scores. FMRI studies indicate that ECT flattens the pattern of activation and deactivation that is associated with cognitive task performance and alters cortical functional connectivity in the ultra slow frequency range. A common finding from human and animal studies is that ECT acutely activates both the HPA axis and the dopamine system. In considering this evidence, we hypothesize that ECT affects the brain in a similar manner as severe stress or brain trauma which activates the HPA axis and the dopamine system and may compromise frontotemporal functions.

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Section: Frontotemporal Effectssupporting

confidence: 72%

“…However, recent studies have reported changes following ECT in resting state FC in the ultra slow frequency range (cycles that last more than 8 s) (53–55). One of these, Perrin et al, observed a reduced FC in the ultra slow activity range within the left dorsolateral PFC and that correlated with therapeutic response.…”

Section: Frontotemporal Effectsmentioning

confidence: 99%

Electroconvulsive Treatment: Hypotheses about Mechanisms of Action

Fosse¹,

Read²

2013

Front. Psychiatry

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“…A recent study demonstrated that MDD patients showed lower voxel-mirrored homotopic connectivity (VMHC) in the medial prefrontal cortex (MPFC) than healthy subjects (Guo et al, 2013). Decreased connectivity in the frontal regions has been related to cognitive deficits in depression, and successful treatments appear to normalize these relationships (Beall et al, 2012). The present findings in our research raise the possibility that BMRMI may improve the cognitive reappraisal ability of MDD patients by regulating the functional interactions in the prefrontal cortex.…”

Section: Specific Effect Of Bmrmi On Mddssupporting

confidence: 59%

The effect of body–mind relaxation meditation induction on major depressive disorder: A resting-state fMRI study

Chen

Fang

et al. 2015

Journal of Affective Disorders

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, The effect of body-mind relaxation meditation induction on major depressive disorder: A resting-state FMRI study, Journal of Affective Disorders, http://dx.doi. org/10.1016/j.jad. 2015.04.030 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. AbstractBackground: Meditation has been increasingly evaluated as an important complementary therapeutic tool for the treatment of depression. The present study employed resting-state functional magnetic resonance imaging (rs-fMRI) to examine the effect of body-mind relaxation meditation induction (BMRMI) on the brain activity of depressed patients and to investigate possible mechanisms of action for this complex intervention.Method: 21 major depressive disorder patients (MDDs) and 24 age and gender-matched healthy controls (HCs) received rs-fMRI scans at baseline and after listening to a selection of audio designed to induce body-mind relaxation 2 meditation. The rs-fMRI data were analyzed using Matlab toolbox to obtain the amplitude of low-frequency fluctuations (ALFF) of the BOLD signal for the whole brain. A mixed-design repeated measures analysis of variance (ANOVA) was performed on the whole brain to find which brain regions were affected by the BMRMI. An additional functional connectivity analysis was used to identify any atypical connection patterns after the BMRMI.Results: After the BMRMI experience, both the MDDs and HCs showed decreased ALFF values in the bilateral frontal pole (BA10). Additionally, increased functional connectivity from the right dorsal medial prefrontal cortex (dmPFC) to the left dorsal lateral prefrontal cortex (dlPFC) and the left lateral orbitofrontal cortex (OFC) was identified only in the MDDs after the BMRMI.Limitation: In order to exclude the impact of other events on the participants' brain activity, the Hamilton Rating Scales for Depression (HDRS) were not measured after the body-mind relaxation induction. Conclusion:Our findings support the hypothesis that body-mind relaxation meditation induction may regulate the activities of the prefrontal cortex and thus may have the potential to help patients construct reappraisal strategies that can modulate the brain activity in multiple emotion-processing systems.

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“…However, the study reported no formal statistical association between change in neural connectivity and clinical outcome, nor was there any report of change in neurocognitive function. Bealle et al [114] found normalization of GABA levels and significantly decreased blood oxygenation level dependent contrast in the orbitofrontal cortex after ECT, which may have been associated with changes in both depression severity and working memory. However, there was no neurocognitive information collected before and after the ECT course, which limited the analysis of neurocognitive moderating factors.…”

Section: Underlying Neurophysiological Factorsmentioning

confidence: 99%

Multifactorial Determinants of the Neurocognitive Effects of Electroconvulsive Therapy

McClintock¹,

et al. 2014

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For many patients with neuropsychiatric illnesses, standard psychiatric treatments with mono or combination pharmacotherapy, psychotherapy, and transcranial magnetic stimulation are ineffective. For these patients with treatment resistant neuropsychiatric illnesses, a main therapeutic option is electroconvulsive therapy (ECT). Decades of research have found ECT to be highly effective; however, it can also result in adverse neurocognitive effects. Specifically, ECT results in disorientation after each session, anterograde amnesia for recently learned information, and retrograde amnesia for previously learned information. Unfortunately, the neurocognitive effects and underlying mechanisms of action of ECT remain poorly understood. The purpose of this paper is to synthesize the multiple moderating and mediating factors that are thought to underlie the neurocognitive effects of ECT into a coherent model. Such factors include demographic and neuropsychological characteristics, neuropsychiatric symptoms, ECT technical parameters, and ECT associated neurophysiological changes. Future research is warranted to evaluate and test this model, so that these findings may support the development of more refined clinical seizure therapy delivery approaches and efficacious cognitive remediation strategies to improve the utility of this important and widely used intervention tool for neuropsychiatric diseases.

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Effects of Electroconvulsive Therapy on Brain Functional Activation and Connectivity in Depression

Abstract: These results suggest that successful ECT for MDD is associated with decreased activation to cognitive and emotional tasks and an increase in resting connectivity.

Cited by 73 publications

References 47 publications

Electroconvulsive Treatment: Hypotheses about Mechanisms of Action

Electroconvulsive Treatment: Hypotheses about Mechanisms of Action

The effect of body–mind relaxation meditation induction on major depressive disorder: A resting-state fMRI study

Multifactorial Determinants of the Neurocognitive Effects of Electroconvulsive Therapy

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