Brain Stimulation (Jul 2020)

Brain functional effects of electroconvulsive therapy during emotional processing in major depressive disorder

  • Verena Enneking,
  • Fanni Dzvonyar,
  • Kerstin Dück,
  • Katharina Dohm,
  • Dominik Grotegerd,
  • Katharina Förster,
  • Susanne Meinert,
  • Hannah Lemke,
  • Melissa Klug,
  • Lena Waltemate,
  • Janik Goltermann,
  • Carina Hülsmann,
  • Tiana Borgers,
  • Joscha Böhnlein,
  • Lisa Sindermann,
  • Maike Richter,
  • Elisabeth J. Leehr,
  • Jonathan Repple,
  • Nils Opel,
  • Bernhard T. Baune,
  • Udo Dannlowski,
  • Ronny Redlich

Journal volume & issue
Vol. 13, no. 4
pp. 1051 – 1058

Abstract

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Background: In treatment-resistant major depressive disorder (MDD), electroconvulsive therapy (ECT) is a treatment with high efficacy. While knowledge regarding changes in brain structure following ECT is growing, the effects of ECT on brain function during emotional processing are largely unknown. Objective: We investigated the effects of ECT on the activity of the anterior cingulate cortex (ACC) and amygdala during negative emotional stimuli processing and its association with clinical response. Methods: In this non-randomized longitudinal study, patients with MDD (n = 37) were assessed before and after treatment with ECT. Healthy controls (n = 37) were matched regarding age and gender. Functional magnetic resonance imaging (fMRI) was obtained twice, at baseline and after six weeks using a supraliminal face-matching paradigm. In order to evaluate effects of clinical response, additional post-hoc analyses were performed comparing responders to non-responders. Results: After ECT, patients with MDD showed a statistically significant increase in ACC activity during processing of negative emotional stimuli (pFWE = .039). This effect was driven by responders (pFWE = .023), while non-responders showed no increase. Responders also had lower pre-treatment ACC activity compared to non-responders (pFWE = .025). No significant effects in the amygdala could be observed. Conclusions: ECT leads to brain functional changes in the ACC, a relevant region for emotional regulation during processing of negative stimuli. Furthermore, baseline ACC activity might serve as a biomarker for treatment response. Findings are in accordance with recent studies highlighting properties of pre-treatment ACC to be associated with general antidepressive treatment response.

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