scholarly journals Changes in White Matter Microstructure After Electroconvulsive Therapy for Treatment-Resistant Depression

2019 ◽  
Vol 23 (1) ◽  
pp. 20-25
Author(s):  
Gregor Gryglewski ◽  
René Seiger ◽  
Pia Baldinger-Melich ◽  
Jakob Unterholzner ◽  
Benjamin Spurny ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
White Matter ◽  
Electroconvulsive Therapy ◽  
Electrode Placement ◽  
Treatment Resistant Depression ◽  
Resonance Imaging ◽  
Treatment Resistant ◽  
White Matter Microstructure ◽  
Resistant Depression ◽  
The Right

Abstract Background Treatment-resistant depression is among the most debilitating conditions in psychiatry. Recent studies have associated alterations in white matter microstructure measured with magnetic resonance imaging with poor antidepressant response. Therefore, the extent to which electroconvulsive therapy, the most effective therapeutic option for treatment-resistant depression, affects white matter microstructure warrants investigation. Methods A total 13 patients suffering from severe unipolar treatment-resistant depression underwent magnetic resonance imaging with a diffusion tensor imaging sequence before and after undergoing a series of right unilateral electroconvulsive therapy. Diffusivity metrics were compared voxel-wise using tract-based spatial statistics and repeated-measures ANOVA. Results A total 12 patients responded to electroconvulsive therapy and 9 were classified as remitters. An increase in axial diffusivity was observed in the posterior limb of the internal capsule of the right hemisphere (PFWE ≤ .05). The increase in this area was higher in the right compared with the left hemisphere (P < .05). No correlation of this effect with treatment response could be found. Conclusions The strong lateralization of effects to the hemisphere of electrical stimulation suggests an effect of electroconvulsive therapy on diffusivity metrics which is dependent of electrode placement. Investigation in controlled studies is necessary to reveal to what extent the effects of electroconvulsive therapy on white matter microstructure are related to clinical outcomes and electrode placement.

Elektroconvulsietherapie bij een patiënte met een bipolaire stoornis en voorgeschiedenis van ischemisch cerebrovasculair accident

2021 ◽  
Author(s):  
A. GOOSSENS ◽  
F. VAN DEN EEDE ◽  
D. SCHRIJVERS ◽  
P. CRAS ◽  
L. YPERZEELE ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Electroconvulsive Therapy ◽  
Recurrent Stroke ◽  
Careful Consideration ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Bipolaire Stoornis ◽  
History Of ◽  
Resistant Depression ◽  
The Right

Electroconvulsive therapy in a patient with bipolar disorder and a history of ischemic stroke This article is a case-report of a 35 year old female patient with a history of ischemic stroke who, after careful consideration and additional investigations, received a treatment with electroconvulsive therapy (ECT) for a treatment-resistant depression in a rapid cycling bipolar 1 disorder. A thorough neurological evaluation in patients with a history of stroke is important as stated by the guidelines. As the patient was clinically and neurologically stable since her stroke 2 years prior, the risk of complications due to ECT was estimated to be low. The literature shows that ECT is not associated with a higher risk of a recurrent stroke, when taking the right indications and monitoring into account.

scholarly journals Brain entropy and neurotrophic molecular markers accompanying clinical improvement after ketamine: Preliminary evidence in adolescents with treatment-resistant depression

2020 ◽  
pp. 026988112092820
Author(s):  
Abhrajeet V Roy ◽  
Michelle Thai ◽  
Bonnie Klimes-Dougan ◽  
Mindy Westlund Schreiner ◽  
Bryon A Mueller ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Nucleus Accumbens ◽  
Magnetic Resonance ◽  
Resting State ◽  
Preliminary Evidence ◽  
Treatment Resistant Depression ◽  
Functional Magnetic Resonance ◽  
Resonance Imaging ◽  
Treatment Resistant ◽  
Resistant Depression

Background: Current theory suggests that treatment-resistant depression (TRD) involves impaired neuroplasticity resulting in cognitive and neural rigidity, and that clinical improvement may require increasing brain flexibility and adaptability. Aims: In this hypothesis-generating study, we sought to identify preliminary evidence of brain flexibility correlates of clinical change within the context of an open-label ketamine trial in adolescents with TRD, focusing on two promising candidate markers of neural flexibility: (a) entropy of resting-state functional magnetic resonance imaging (fMRI) signals; and (b) insulin-stimulated phosphorylation of mammalian target of rapamycin (mTOR) and glycogen synthase-3-beta (GSK3β) in peripheral blood mononuclear cells. Methods: We collected resting-state functional magnetic resonance imaging data and blood samples from 13 adolescents with TRD before and after a series of six ketamine infusions over 2 weeks. Usable pre/post ketamine data were available from 11 adolescents for imaging and from 10 adolescents for molecular signaling. We examined correlations between treatment response and changes in the central and peripheral flexibility markers. Results: Depression reduction correlated with increased nucleus accumbens entropy. Follow-up analyses suggested that physiological changes were associated with treatment response. In contrast to treatment non-responders ( n=6), responders ( n=5) showed greater increase in nucleus accumbens entropy after ketamine, together with greater post-treatment insulin/mTOR/GSK3β signaling. Conclusions: These data provide preliminary evidence that changes in neural flexibility may underlie symptom relief in adolescents with TRD following ketamine. Future research with adequately powered samples is needed to confirm resting-state entropy and insulin-stimulated mTOR and GSK3β as brain flexibility markers and candidate targets for future clinical trials. Clinical trial name: Ketamine in adolescents with treatment-resistant depression URL: https://clinicaltrials.gov/ct2/show/NCT02078817 Registration number: NCT02078817

scholarly journals Structural changes in amygdala nuclei, hippocampal subfields and cortical thickness following electroconvulsive therapy in treatment-resistant depression: longitudinal analysis

2018 ◽  
Vol 214 (3) ◽  
pp. 159-167 ◽  
Author(s):  
Gregor Gryglewski ◽  
Pia Baldinger-Melich ◽  
René Seiger ◽  
Godber Mathis Godbersen ◽  
Paul Michenthaler ◽  
...  
Keyword(s):  
Cortical Thickness ◽  
Electroconvulsive Therapy ◽  
Structural Changes ◽  
Right Hemisphere ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Hippocampal Subfields ◽  
Transition Area ◽  
Resistant Depression ◽  
The Right

BackgroundElectroconvulsive therapy (ECT) is the treatment of choice for severe mental illness including treatment-resistant depression (TRD). Increases in volume of the hippocampus and amygdala following ECT have consistently been reported.AimsTo investigate neuroplastic changes after ECT in specific hippocampal subfields and amygdala nuclei using high-resolution structural magnetic resonance imaging (MRI) (trial registration: clinicaltrials.gov – NCT02379767).MethodMRI scans were carried out in 14 patients (11 women, 46.9 years (s.d. = 8.1)) with unipolar TRD twice before and once after a series of right unilateral ECT in a pre–post study design. Volumes of subcortical structures, including subfields of the hippocampus and amygdala, and cortical thickness were extracted using FreeSurfer. The effect of ECT was tested using repeated-measures ANOVA. Correlations of imaging and clinical parameters were explored.ResultsIncreases in volume of the right hippocampus by 139.4 mm3 (s.d. = 34.9), right amygdala by 82.3 mm3 (s.d. = 43.9) and right putamen by 73.9 mm3 (s.d. = 77.0) were observed. These changes were localised in the basal and lateral nuclei, and the corticoamygdaloid transition area of the amygdala, the hippocampal–amygdaloid transition area and the granule cell and molecular layer of the dentate gyrus. Cortical thickness increased in the temporal, parietal and insular cortices of the right hemisphere.ConclusionsFollowing ECT structural changes were observed in hippocampal subfields and amygdala nuclei that are specifically implicated in the pathophysiology of depression and stress-related disorders and retain a high potential for neuroplasticity in adulthood.Declaration of interestS.K. has received grants/research support, consulting fees and/or honoraria within the past 3 years from Angelini, AOP Orphan Pharmaceuticals AG, AstraZeneca, Celegne GmbH, Eli Lilly, Janssen-Cilag Pharma GmbH, KRKA-Pharma, Lundbeck A/S, Neuraxpharm, Pfizer, Pierre Fabre, Schwabe and Servier. R.L. received travel grants and/or conference speaker honoraria from Shire, AstraZeneca, Lundbeck A/S, Dr. Willmar Schwabe GmbH, Orphan Pharmaceuticals AG, Janssen-Cilag Pharma GmbH, and Roche Austria GmbH.

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