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Structural–functional brain changes in depressed patients during and after electroconvulsive therapy

  • Antoine Yrondi (a1) (a2), Patrice Péran (a2), Anne Sauvaget (a3) (a4), Laurent Schmitt (a1) and Christophe Arbus (a1) (a2)...
Abstract
Objectives

Electroconvulsive therapy (ECT) is a non-pharmacological treatment that is effective in treating severe and treatment-resistant depression. Although the efficacy of ECT has been demonstrated to treat major depressive disorder (MDD), the brain mechanisms underlying this process remain unclear. Structural–functional changes occur with the use of ECT as a treatment for depression based on magnetic resonance imaging (MRI). For this reason, we have tried to identify the changes that were identified by MRI to try to clarify some operating mechanisms of ECT. We focus to brain changes on MRI [structural MRI (sMRI), functional MRI (fMRI) and diffusion tensor imging (DTI)] after ECT.

Methods

A systematic search of the international literature was performed using the bibliographic search engines PubMed and Embase. The research focused on papers published up to 30 September 2015. The following Medical Subject Headings (MESH) terms were used: electroconvulsive therapy AND (MRI OR fMRI OR DTI). Papers published in English were included. Four authors searched the database using a predefined strategy to identify potentially eligible studies.

Results

There were structural changes according to the sMRI performed before and after ECT treatment. These changes do not seem to be entirely due to oedema. This investigation assessed the functional network connectivity associated with the ECT response in MDD. ECT response reverses the relationship from negative to positive between the two pairs of networks.

Conclusion

We found structural–functional changes in MRI post-ECT. Because of the currently limited MRI data on ECT in the literature, it is necessary to conduct further investigations using other MRI technology.

Copyright
Corresponding author
Dr. Antoine Yrondi, Service de psychiatrie et psychologie médicale, CHU Toulouse-Purpan, 330 avenue de Grande Bretagne, 31059 Toulouse, France. Tel: +33 5 34 55 75 37; Fax: +33 5 34 55 75 32; E-mail: antoineyrondi@gmail.com
References
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1. ANAES. Indications et modalités de l’électroconvulsivothérapie. Fédération Française de Psychiatrie, Société Française d’Anesthésie et de Réanimation, Agence Nationale d’Accréditation et d’Evaluation en Santé (ANAES); 1998.
2. Baghai, TC, Möller, H-J. Electroconvulsive therapy and its different indications. Dialogues Clin Neurosci 2008;10:105117.
3. UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet 2003;361:799808.
4. Loo, C. ECT in the 21st century: optimizing treatment: state of the art in the 21st century. J ECT 2010;26:157.
5. Pagnin, D, de Queiroz, V, Pini, S, Cassano, GB. Efficacy of ECT in depression: a meta-analytic review. J ECT 2004;20:1320.
6. Gangadhar, BN, Janakiramaiah, N, Subbakrishna, DK, Praveen, J, Reddy, AK. Twice versus thrice weekly ECT in melancholia: a double-blind prospective comparison. J Affect Disord 1993;27:273278.
7. Janakiramaiah, N, Motreja, S, Gangadhar, BN, Subbakrishna, DK, Parameshwara, G. Once vs. three times weekly ECT in melancholia: a randomized controlled trial. Acta Psychiatr Scand 1998;98:316320.
8. Lerer, B, Shapira, B, Calev, A et al. Antidepressant and cognitive effects of twice- versus three-times-weekly ECT. Am J Psychiatry 1995;152:564570.
9. Taylor, S. Electroconvulsive therapy: a review of history, patient selection, technique, and medication management. South Med J 2007;100:494498.
10. Svensson, M, Hallin, T, Broms, J, Ekstrand, J, Tingström, A. Spatial memory impairment in Morris water maze after electroconvulsive seizures. Acta Neuropsychiatr 2016;6231-10. DOI: https://doi.org/10.1017/neu.2016.22.
11. Siskind, D, Charlson, F, Saraf, S, Scheurer, R, Lie, DC. Twice versus thrice weekly ECT in a clinical population: an evaluation of patient outcomes. Psychiatry Res 2012;199:208211.
12. Charlson, F, Siskind, D, Doi, SAR, McCallum, E, Broome, A, Lie, DC. ECT efficacy and treatment course: a systematic review and meta-analysis of twice vs thrice weekly schedules. J Affect Disord 2012;138:18.
13. Husain, SS, Kevan, IM, Linnell, R, Scott, AIF. Electroconvulsive therapy in depressive illness that has not responded to drug treatment. J Affect Disord 2004;83:121126.
14. Hoy, KE, Fitzgerald, PB. Brain stimulation in psychiatry and its effects on cognition. Nat Rev Neurol 2010;6:267275.
15. Rudorfer, M, Henry, M, Sackeim, H. Electroconvulsive therapy. In: Tasman A, Kay J, Lieberman JA editors Psychiatry Therapeutics. Chichester: John Wiley & Sons, 2003.
16. Saijo, T, Takano, A, Suhara, T et al. Electroconvulsive therapy decreases dopamine D2 receptor binding in the anterior cingulate in patients with depression: a controlled study using positron emission tomography with radioligand [11C]FLB 457. J Clin Psychiatry 2010;71:793799.
17. Saijo, T, Takano, A, Suhara, T et al. Effect of electroconvulsive therapy on 5-HT1A receptor binding in patients with depression: a PET study with [11C]WAY 100635. Int J Neuropsychopharmacol 2010;13:785791.
18. Lanzenberger, R, Baldinger, P, Hahn, A et al. Global decrease of serotonin-1A receptor binding after electroconvulsive therapy in major depression measured by PET. Mol Psychiatry 2013;18:93100.
19. Sackeim, HA. The anticonvulsant hypothesis of the mechanisms of action of ECT: current status. J ECT 1999;15:526.
20. Chen, F, Madsen, TM, Wegener, G, Nyengaard, JR. Repeated electroconvulsive seizures increase the total number of synapses in adult male rat hippocampus. Eur Neuropsychopharmacol 2009;19:329338.
21. Madsen, TM, Treschow, A, Bengzon, J, Bolwig, TG, Lindvall, O, Tingström, A. Increased neurogenesis in a model of electroconvulsive therapy. Biol Psychiatry 2000;47:10431049.
22. Scott, BW, Wojtowicz, JM, Burnham, WM. Neurogenesis in the dentate gyrus of the rat following electroconvulsive shock seizures. Exp Neurol 2000;165:231236.
23. Wennström, M, Hellsten, J, Tingström, A. Electroconvulsive seizures induce proliferation of NG2-expressing glial cells in adult rat amygdala. Biol Psychiatry 2004;55:464471.
24. Lekwauwa, RE, McQuoid, DR, Steffens, DC. Hippocampal volume as a predictor of short-term ECT outcomes in older patients with depression. Am J Geriatr Psychiatry 2005;13:910913.
25. Lekwauwa, R, McQuoid, D, Steffens, DC. Hippocampal volume is associated with physician-reported acute cognitive deficits after electroconvulsive therapy. J Geriatr Psychiatry Neurol 2006;19:2125.
26. Nordanskog, P, Dahlstrand, U, Larsson, MR, Larsson, E-M, Knutsson, L, Johanson, A. Increase in hippocampal volume after electroconvulsive therapy in patients with depression: a volumetric magnetic resonance imaging study. J ECT 2010;26:6267.
27. Blumberg, HP, Kaufman, J, Martin, A et al. Amygdala and hippocampal volumes in adolescents and adults with bipolar disorder. Arch Gen Psychiatry 2003;60:12011208.
28. Stone, VE, Baron-Cohen, S, Calder, A, Keane, J, Young, A. Acquired theory of mind impairments in individuals with bilateral amygdala lesions. Neuropsychologia 2003;41:209220.
29. Koenigs, M, Grafman, J. The functional neuroanatomy of depression: distinct roles for ventromedial and dorsolateral prefrontal cortex. Behav Brain Res 2009;201:239243.
30. Mayberg, HS. Modulating dysfunctional limbic-cortical circuits in depression: towards development of brain-based algorithms for diagnosis and optimised treatment. Br Med Bull 2003;65:193207.
31. Phillips, ML, Ladouceur, CD, Drevets, WC. A neural model of voluntary and automatic emotion regulation: implications for understanding the pathophysiology and neurodevelopment of bipolar disorder. Mol Psychiatry 2008;13:829 833–857.
32. Bertolino, A, Arciero, G, Rubino, V et al. Variation of human amygdala response during threatening stimuli as a function of 5’HTTLPR genotype and personality style. Biol Psychiatry 2005;57:15171525.
33. Hariri, AR, Drabant, EM, Munoz, KE et al. A susceptibility gene for affective disorders and the response of the human amygdala. Arch Gen Psychiatry 2005;62:146152.
34. Heinz, A, Smolka, MN, Braus, DF et al. Serotonin transporter genotype (5-HTTLPR): effects of neutral and undefined conditions on amygdala activation. Biol Psychiatry 2007;61:10111014.
35. Schultz, W. Behavioral dopamine signals. Trends Neurosci 2007;30:203210.
36. Dannlowski, U, Ohrmann, P, Bauer, J et al. Amygdala reactivity to masked negative faces is associated with automatic judgmental bias in major depression: a 3 T fMRI study. J Psychiatry Neurosci JPN 2007;32:423429.
37. Fales, CL, Barch, DM, Rundle, MM et al. Altered emotional interference processing in affective and cognitive-control brain circuitry in major depression. Biol Psychiatry 2008;63:377384.
38. Fu, CHY, Mourao-Miranda, J, Costafreda, SG et al. Pattern classification of sad facial processing: toward the development of neurobiological markers in depression. Biol Psychiatry 2008;63:656662.
39. Keedwell, PA, Andrew, C, Williams, SCR, Brammer, MJ, Phillips, ML. A double dissociation of ventromedial prefrontal cortical responses to sad and happy stimuli in depressed and healthy individuals. Biol Psychiatry 2005;58:495503.
40. Surguladze, S, Brammer, MJ, Keedwell, P et al. A differential pattern of neural response toward sad versus happy facial expressions in major depressive disorder. Biol Psychiatry 2005;57:201209.
41. Fitzgerald, PB, Laird, AR, Maller, J, Daskalakis, ZJ. A meta-analytic study of changes in brain activation in depression. Hum Brain Mapp 2008;29:683695.
42. Zhuo, C, Yu, C. Functional neuroimaging changes subsequent to electroconvulsive therapy in unipolar depression: a review of the literature. J ECT 2014;30:265274.
43. Bolwig, TG. Neuroimaging and electroconvulsive therapy: a review. J ECT 2014;30:138142.
44. Abbott, CC, Gallegos, P, Rediske, N, Lemke, NT, Quinn, DK. A review of longitudinal electroconvulsive therapy: neuroimaging investigations. J Geriatr Psychiatry Neurol 2014;27:3346.
45. Moher, D, Liberati, A, Tetzlaff, J, Altman, DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6:e1000097.
46. Joshi, SH, Espinoza, RT, Pirnia, T et al. Structural plasticity of the hippocampus and amygdala induced by electroconvulsive therapy in major depression. Biol Psychiatry 2015; March 5.
47. Ota, M, Noda, T, Sato, N et al. Effect of electroconvulsive therapy on gray matter volume in major depressive disorder. J Affect Disord 2015;186:186191.
48. Bouckaert, F, De Winter, F-L, Emsell, L et al. Grey matter volume increase following electroconvulsive therapy in patients with late life depression: a longitudinal MRI study. J Psychiatry Neurosci JPN 2015;40:140322.
49. Dukart, J, Regen, F, Kherif, F et al. Electroconvulsive therapy-induced brain plasticity determines therapeutic outcome in mood disorders. Proc Natl Acad Sci U S A 2014;111:11561161.
50. Abbott, CC, Jones, T, Lemke, NT et al. Hippocampal structural and functional changes associated with electroconvulsive therapy response. Transl Psychiatry 2014;4:e483.
51. Tendolkar, I, van Beek, M, van Oostrom, I et al. Electroconvulsive therapy increases hippocampal and amygdala volume in therapy refractory depression: a longitudinal pilot study. Psychiatry Res 2013;214:197203.
52. Nordanskog, P, Larsson, MR, Larsson, E-M, Johanson, A. Hippocampal volume in relation to clinical and cognitive outcome after electroconvulsive therapy in depression. Acta Psychiatr Scand 2014;129:303311.
53. Kunigiri, G, Jayakumar, PN, Janakiramaiah, N, Gangadhar, BN. MRI T(2) relaxometry of brain regions and cognitive dysfunction following electroconvulsive therapy. Indian J Psychiatry 2007;49:195199.
54. Szabo, K, Hirsch, JG, Krause, M et al. Diffusion weighted MRI in the early phase after electroconvulsive therapy. Neurol Res 2007;29:256259.
55. Girish, K, Jayakumar, PN, Murali, N, Gangadhar, BN, Janakiramaiah, N, Subbakrishna, DK. Ect and t(2) relaxometry: a static walter proton magnetic resonance imaging study. Indian J Psychiatry 2001;43:2224.
56. Diehl, DJ, Keshavan, MS, Kanal, E, Nebes, RD, Nichols, TE, Gillen, JS. Post-ECT increases in MRI regional T2 relaxation times and their relationship to cognitive side effects: a pilot study. Psychiatry Res 1994;54:177184.
57. Coffey, CE, Figiel, GS, Djang, WT, Cress, M, Saunders, WB, Weiner, RD. Leukoencephalopathy in elderly depressed patients referred for ECT. Biol Psychiatry 1988;24:143161.
58. Scott, AI, Douglas, RH, Whitfield, A, Kendell, RE. Time course of cerebra; magnetic resonance changes after electroconvulsive therapy. Br J Psychiatry J Ment Sci 1990;156:551553.
59. Oudega, ML, van Exel, E, Stek, ML et al. The structure of the geriatric depressed brain and response to electroconvulsive therapy. Psychiatry Res 2014;222:19.
60. Oudega, ML, Dols, A, Adelerhof, I et al. Contribution of white matter hyperintensities, medial temporal lobe atrophy and cortical atrophy on outcome, seven to twelve years after ECT in severely depressed geriatric patients. J Affect Disord 2015;185:144148.
61. Oudega, ML, van Exel, E, Wattjes, MP et al. White matter hyperintensities and cognitive impairment during electroconvulsive therapy in severely depressed elderly patients. Am J Geriatr Psychiatry 2014;22:157166.
62. Abbott, CC, Lemke, NT, Gopal, S et al. Electroconvulsive therapy response in major depressive disorder: a pilot functional network connectivity resting state FMRI investigation. Front Psychiatry 2013;4:10.
63. Wei, Q, Tian, Y, Yu, Y et al. Modulation of interhemispheric functional coordination in electroconvulsive therapy for depression. Transl Psychiatry 2014;4:e453.
64. Perrin, JS, Merz, S, Bennett, DM et al. Electroconvulsive therapy reduces frontal cortical connectivity in severe depressive disorder. Proc Natl Acad Sci U S A 2012;109:54645468.
65. Beall, EB, Malone, DA, Dale, RM et al. Effects of electroconvulsive therapy on brain functional activation and connectivity in depression. J ECT 2012;28:234241.
66. Christ, M, Michael, N, Hihn, H et al. Auditory processing of sine tones before, during and after ECT in depressed patients by fMRI. J Neural Transm (Vienna) 2008;115:11991211.
67. Lyden, H, Espinoza, RT, Pirnia, T et al. Electroconvulsive therapy mediates neuroplasticity of white matter microstructure in major depression. Transl Psychiatry 2014;4:e380.
68. Jorgensen, A, Magnusson, P, Hanson, LG et al. Regional brain volumes, diffusivity, and metabolite changes after electroconvulsive therapy for severe depression. Acta Psychiatr Scand 2016;133:154164.
69. Peng, W, Chen, Z, Yin, L, Jia, Z, Gong, Q. Essential brain structural alterations in major depressive disorder: A voxel-wise meta-analysis on first episode, medication-naive patients. J Affect Disord 2016;199:114123.
70. Fu, CHY, Costafreda, SG, Sankar, A et al. Multimodal functional and structural neuroimaging investigation of major depressive disorder following treatment with duloxetine. BMC Psychiatry 2015;15:82.
71. Kozel, FA, Johnson, KA, Nahas, Z et al. Fractional anisotropy changes after several weeks of daily left high-frequency repetitive transcranial magnetic stimulation of the prefrontal cortex to treat major depression. J ECT 2011;27:510.
72. Peterchev, AV, Rosa, MA, Deng, Z-D, Prudic, J, Lisanby, SH. Electroconvulsive therapy stimulus parameters: rethinking dosage. J ECT 2010;26:159174.
73. Sackeim, HA, Prudic, J, Fuller, R, Keilp, J, Lavori, PW, Olfson, M. The cognitive effects of electroconvulsive therapy in community settings. Neuropsychopharmacology 2007;32:244254.
74. Sackeim, HA, Prudic, J, Nobler, MS et al. Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. Brain Stimul 2008;1:7183.
75. Sackeim, HA, Prudic, J, Devanand, DP et al. Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. N Engl J Med 1993;328:839846.
76. Sackeim, HA, Prudic, J, Devanand, DP et al. A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities. Arch Gen Psychiatry 2000;57:425434.
77. Sackeim, HA. Convulsant and anticonvulsant properties of electroconvulsive therapy: towards a focal form of brain stimulation. Clin Neurosci Res 2004;4:3957.
78. Sackeim, HA, Decina, P, Portnoy, S, Neeley, P, Malitz, S. Studies of dosage, seizure threshold, and seizure duration in ECT. Biol Psychiatry 1987;22:249268.
79. Spellman, T, Peterchev, AV, Lisanby, SH. Focal electrically administered seizure therapy: a novel form of ECT illustrates the roles of current directionality, polarity, and electrode configuration in seizure induction. Neuropsychopharmacology 2009;34:20022010.
80. Nahas, Z, Short, B, Burns, C et al. A feasibility study of a new method for electrically producing seizures in man: focal electrically administered seizure therapy [FEAST]. Brain Stimul 2013;6:403408.
81. Chahine, G, Short, B, Spicer, K et al. Regional cerebral blood flow changes associated with focal electrically administered seizure therapy (FEAST). Brain Stimul 2014;7:483485.
82. Péran, P, Cherubini, A, Assogna, F et al. Magnetic resonance imaging markers of Parkinson’s disease nigrostriatal signature.. Brain 2010;133:34233433.
83. Péran, P, Cherubini, A, Luccichenti, G et al. Volume and iron content in basal ganglia and thalamus. Hum Brain Mapp 2009;30:26672675.
84. Péran, P, Hagberg, G, Luccichenti, G et al. Voxel-based analysis of R2* maps in the healthy human brain. J Magn Reson Imaging 2007;26:14131420.
85. Cherubini, A, Péran, P, Caltagirone, C, Sabatini, U, Spalletta, G. Aging of subcortical nuclei: microstructural, mineralization and atrophy modifications measured in vivo using MRI. NeuroImage 2009;48:2936.
86. Cherubini, A, Péran, P, Spoletini, I et al. Combined volumetry and DTI in subcortical structures of mild cognitive impairment and Alzheimer’s disease patients. J Alzheimers Dis 2010;19:12731282.
87. Eustache, P, Nemmi, F, Saint-Aubert, L, Pariente, J, Péran, P. multimodal magnetic resonance imaging in Alzheimer’s disease patients at prodromal stage. J Alzheimers Dis 2016;50:10351050.
88. Spoletini, I, Cherubini, A, Banfi, G et al. Hippocampi, thalami, and accumbens microstructural damage in schizophrenia: a volumetry, diffusivity, and neuropsychological study. Schizophr Bull 2011;37:118130.
89. Cerasa, A, Cherubini, A, Peran, P, Cerasa, A, Cherubini, A, Peran, P. Multimodal MRI in neurodegenerative disorders, multimodal MRI in neurodegenerative disorders. Neurol Res Int Neurol Res Int 2011;2012:12. e287891.
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