Serum markers of brain-cell damage and C-reactive protein are unaffected by electroconvulsive therapy

Giltay, Erik J.; Kho, King H.; Blansjaar, Ben A.

doi:10.1080/15622970701310989

Cited by 28 publications

(6 citation statements)

References 20 publications

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“…Furthermore, our finding that TNF-α levels did not change in response to ECT contrasted to the findings of Hestad et al (2003), where TNF-α was markedly raised in depressed patients compared to controls, and that clinical improvement with ECT correlated with a decline in TNF-α levels, with levels comparable to controls by the study’s end (Hestad et al, 2003). Finally, the present study did not detect any significant changes in CRP related to MDD or ECT, in keeping with one previous study (Giltay et al, 2008), but in contrast with several other reports of increased positive acute phase proteins such as CRP in patients with active and remitted MDD (Howren et al, 2009; Kling et al, 2007; O’Brien et al, 2006). …”

Section: Discussionsupporting

confidence: 92%

Alteration of immune markers in a group of melancholic depressed patients and their response to electroconvulsive therapy

Rush

O’Donovan

Nagle

et al. 2016

Journal of Affective Disorders

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Background Immune system dysfunction is implicated in the pathophysiology of major depression, and is hypothesized to normalize with successful treatment. We aimed to investigate immune dysfunction in melancholic depression and its response to ECT. Methods 55 melancholic depressed patients and 26 controls participated. 33 patients (60%) were referred for ECT. Blood samples were taken at baseline, one hour after the first ECT session, and 48 hours after ECT series completion. Results At baseline, melancholic depressed patients had significantly higher levels of the pro-inflammatory cytokine IL-6, and lower levels of the regulatory cytokine TGF-β than controls. A significant surge in IL-6 levels was observed one hour after the first ECT session, but neither IL-6 nor TGF-β levels normalized after completion of ECT series. Seventy per cent (n=23) of ECT recipients showed clinical response and 42% (n=10) reached remission. Neither IL-6 nor TGF-β changes correlated with clinical improvement following ECT. No significant changes in IL-10, TNF-α and CRP levels were found in relation to melancholia or response to ECT. Limitations As a naturalistic study, some potential confounders could not be eliminated or controlled, including medication use. Conclusions Melancholic depressed patients demonstrated a peripheral increase in IL-6 and reduction in TGF-β, which did not normalize despite clinical response to ECT. These findings may be consistent with emerging hypotheses of the role of inflammation in mediating neurotropin expression. The implications of chronic inflammation in the melancholic depressed population for future medical health, particularly cardiovascular risk, are largely unknown and warrant further investigation.

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Section: Discussionsupporting

confidence: 92%

Alteration of immune markers in a group of melancholic depressed patients and their response to electroconvulsive therapy

Rush

O’Donovan

Nagle

et al. 2016

Journal of Affective Disorders

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“…The acute increase of IL-6 following initiation of ECT has been demonstrated in previous studies. 20,21 However, two previous studies demonstrated no change in CRP during ECT 23,32 , which is surprising given the robust change observed in the current study, and the fact that IL-6 induces transcription of CRP. 33 …”

Section: Discussioncontrasting

confidence: 77%

Inflammation and Improvement of Depression Following Electroconvulsive Therapy in Treatment-Resistant Depression

Kruse¹,

Congdon²,

Olmstead³

et al. 2018

J. Clin. Psychiatry

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Objective Electroconvulsive therapy (ECT) is the most robust acute treatment for severe major depressive disorder, yet clinical response is variable. Inflammation is associated with depression, especially in women, and levels of C-reactive protein (CRP) and interleukin-6 (IL-6) predict response to antidepressant medications. This study evaluated whether markers of inflammation predicted response to electroconvulsive therapy (ECT) in patients with treatment resistant depression, and to what extent this association differed between men and women. Methods In patients (n=29) with a current major depressive episode diagnosed using DSM-IV-TR criteria, undergoing ECT at an academic referral center, levels of CRP, IL-6, IL-8, tumor necrosis factor (TNF)-α, and severity of depressive symptoms (Montgomery-Asberg Depression Rating Scale, MADRS) were prospectively evaluated before ECT treatment, after the second ECT session, and again at the completion of the index treatment series. Data were collected between 12/2011 and 12/2014. The primary outcome was end-of-treatment MADRS score. Results In multivariate analyses, higher levels of IL-6 at baseline, but not other inflammatory markers or clinical variables, were associated with lower end-of-treatment MADRS score (p=0.01). When stratified by sex, IL-6 remained a significant predictor of end-of-treatment MADRS for women (p=0.02) but not men (p=0.1), and CRP emerged as a significant predictor for women (p=0.04) but not men (p=0.66). CRP and IL-6 increased from baseline to the second ECT session (p’s<0.01) and returned to baseline levels at end of treatment; these changes did not relate to MADRS score over the course of ECT. Conclusions Levels of IL-6 prior to ECT treatment may be useful in identifying those depressed patients most likely to benefit from ECT treatment. In contrast, acute changes in IL-6 and CRP may reflect spikes in inflammatory response related to the initiation of seizure therapy, but not mood. Assessment of pre-treatment inflammatory biomarkers, especially in women, might be useful in guiding treatment decision-making in treatment resistant depression.

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“…In fact, markers of inflammation, for example, CRP, are also associated with depressive disorders [ 22 ]; however, the effects of ECT to acute phase reactants such as CRP and PCT are not well known yet. Giltay and colleagues reported an increase of PCT during ECT treatment, whereas CRP levels remained unchanged in their study [ 23 – 25 ]. Further, hyperhomocysteinemia has been associated with the development of certain somatic and psychiatric diseases, for example, major depressive disorder or dementia [ 26 , 27 ].…”

Section: Introductionmentioning

confidence: 97%

S100B, Homocysteine, Vitamin B12, Folic Acid, and Procalcitonin Serum Levels in Remitters to Electroconvulsive Therapy: A Pilot Study

et al. 2018

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Background Electroconvulsive therapy (ECT) is one of the most effective treatment options for refractory depressed patients. To date, there are only a few predictors of response. Aim The aim was to identify predictive biomarkers of remission to ECT on a molecular level. Methods 11 patients suffering from a major depressive episode—according to the Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)—underwent 10 ECT sessions. Blood samples were taken, and the depression severity was assessed before, one hour and 24 hours after sessions 1, 4, 7, and 10 using the Montgomery Asberg Depression Rating Scale (MADRS). A MADRS total score < 12 was interpreted as remission. Results Patients remitting under ECT had significantly higher homocysteine (p < 0.001), S100B (p < 0.001), and procalcitonin (PCT) (p = 0.027) serum levels. On the contrary, serum levels of vitamin B12 (p < 0.001) and folic acid (p = 0.007) were significantly lower in remitters compared to those in nonremitters. Levels remained unchanged throughout the whole ECT course. Conclusions Our findings indicate that lower levels of vitamin B12 and folic acid associated with higher levels of homocysteine, S100B, and PCT point to a subgroup of depressed patients sensitive to ECT. Due to the limited sample size, further studies are required to replicate our findings.

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Serum markers of brain-cell damage and C-reactive protein are unaffected by electroconvulsive therapy

Cited by 28 publications

References 20 publications

Alteration of immune markers in a group of melancholic depressed patients and their response to electroconvulsive therapy

Alteration of immune markers in a group of melancholic depressed patients and their response to electroconvulsive therapy

Inflammation and Improvement of Depression Following Electroconvulsive Therapy in Treatment-Resistant Depression

S100B, Homocysteine, Vitamin B12, Folic Acid, and Procalcitonin Serum Levels in Remitters to Electroconvulsive Therapy: A Pilot Study

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