Electroconvulsive therapy, depression, the immune system and inflammation: A systematic review

Is Molecular Inflammatory Profiling a Useful Tool for Personalized Brain Stimulation in Psychiatric Disorders?

“…In a recent review, Yrandi and colleagues assessed clinical trials aimed at determining the value of cytokine analysis and found altered plasma levels of pro-inflammatory IL-1β, IL-6, and TNF-α in patients with depression under adjunctive first ECT treatment. A sufficient conclusion was limited mainly due to the uncontrolled and small-scale study designs published so far (5). Another uncontrolled clinical cohort study assessed changes in serum concentration of oxytocin and its possible relation to acute (first session) ECT treatment in a mixed study population (n = 33) including patients with schizophrenia, depression, mania, and non-affective-psychosis; this study found no correlation between ECT responsiveness and changes in serum levels of oxytocin (5).…”

“…For instance, it has been suggested that the previously observed effects of the autonomic nervous system in depression and schizophrenia may in part be driven by the neuro-immune properties of the vagal nerve (4). Based on these findings and on the inflammatory hypothesis of psychiatric disorders, molecular assays exploring changes in inflammatory mediators have been utilized in studies involving electroconvulsive therapy (ECT) for depression, the majority of which were limited in providing relational evidence due to a biased study design (5). In a recent review, Yrandi and colleagues assessed clinical trials aimed at determining the value of cytokine analysis and found altered plasma levels of pro-inflammatory IL-1β, IL-6, and TNF-α in patients with depression under adjunctive first ECT treatment.…”

“…A sufficient conclusion was limited mainly due to the uncontrolled and small-scale study designs published so far (5). Another uncontrolled clinical cohort study assessed changes in serum concentration of oxytocin and its possible relation to acute (first session) ECT treatment in a mixed study population (n = 33) including patients with schizophrenia, depression, mania, and non-affective-psychosis; this study found no correlation between ECT responsiveness and changes in serum levels of oxytocin (5). In view of the low level of evidence, experimental, and in particular clinical exploration of mechanisms of neuroimmune communication in subjects treated with brain stimulation is highly recommended to close gaps between neuroscience and clinical practice.…”

“…Secondly, as suggested by panel recommendations and expert opinions, several randomized-controlled, comparative studies have been conceptualized to analyze different interventions and ensure rigorous assessment of standardized stimulation parameters (i.e., dose-response relationship) (3). In view of the rapid technical progression and availability of the applied noninvasive and invasive brain stimulation technologies, such systematically-driven data acquisition of stimulation parameters (target, frequency, intensity, duration) will help establish reliable dose-response relationships relevant for distinct psychiatric disease subtypes (biotyping), identified through imaging, electrophysiology, psychosocial characteristics, advanced statistical models, and (epi-) genetics (2)(3)(4)(5).…”

Neutrophil/Lymphocyte ratio in patients with major depression and the impact of electroconvulsive therapy

“…Electroconvulsive therapy is another important treatment option for major depression. It is effective in the acute treatment of major depression and in therapy-resistant severe depression [11]. Immediately after ECT sessions, acute immuneinflammatory responses increase as an acute stress reaction.…”