Redlich R, Bürger C, Dohm K, Grotegerd D, Opel N, Zaremba D, Meinert S, Förster K, Repple J, Schnelle R, Wagenknecht C, Zavorotnyy M, Heindel W, Kugel H, Gerbaulet M, Alferink J, Arolt V, Zwanzger P, Dannlowski U
Department of Psychiatry,University of Münster,Münster,Germany.
Department of Psychiatry,University of Marburg,Marburg,Germany.
Psychol Med. 2017 Sep;47(12):2166-2176. doi: 10.1017/S0033291717000605. Epub 2017 Apr 11.
Electroconvulsive therapy (ECT) is one of the most effective treatments for severe depression. However, little is known regarding brain functional processes mediating ECT effects.
In a non-randomized prospective study, functional magnetic resonance imaging data during the automatic processing of subliminally presented emotional faces were obtained twice, about 6 weeks apart, in patients with major depressive disorder (MDD) before and after treatment with ECT (ECT, n = 24). Additionally, a control sample of MDD patients treated solely with pharmacotherapy (MED, n = 23) and a healthy control sample (HC, n = 22) were obtained.
Before therapy, both patient groups equally showed elevated amygdala reactivity to sad faces compared with HC. After treatment, a decrease in amygdala activity to negative stimuli was discerned in both patient samples indicating a normalization of amygdala function, suggesting mechanisms potentially unspecific for ECT. Moreover, a decrease in amygdala activity to sad faces was associated with symptomatic improvements in the ECT sample (r spearman = -0.48, p = 0.044), and by tendency also for the MED sample (r spearman = -0.38, p = 0.098). However, we did not find any significant association between pre-treatment amygdala function to emotional stimuli and individual symptom improvement, neither for the ECT sample, nor for the MED sample.
In sum, the present study provides first results regarding functional changes in emotion processing due to ECT treatment using a longitudinal design, thus validating and extending our knowledge gained from previous treatment studies. A limitation was that ECT patients received concurrent medication treatment.
电休克治疗（ECT）是重度抑郁症最有效的治疗方法之一。然而，关于介导ECT疗效的脑功能过程知之甚少。
在一项非随机前瞻性研究中，对24例接受ECT治疗的重度抑郁症（MDD）患者在治疗前和治疗后约6周两次获取在潜意识呈现情绪面孔自动加工过程中的功能磁共振成像数据。此外，还获取了仅接受药物治疗的MDD患者对照样本（MED，n = 23）和健康对照样本（HC，n = 22）。
治疗前，与HC相比，两个患者组对悲伤面孔的杏仁核反应性均同样升高。治疗后，两个患者样本中对负面刺激的杏仁核活动均降低，表明杏仁核功能正常化，提示可能是非ECT特异性的机制。此外，ECT样本中对悲伤面孔的杏仁核活动降低与症状改善相关（斯皮尔曼相关系数r = -0.48，p = 0.044），MED样本也有这种趋势（斯皮尔曼相关系数r = -0.38，p = 0.098）。然而，无论是ECT样本还是MED样本，我们均未发现治疗前杏仁核对情绪刺激的功能与个体症状改善之间存在任何显著关联。
总之，本研究使用纵向设计首次提供了关于ECT治疗导致的情绪加工功能变化的结果，从而验证并扩展了我们从先前治疗研究中获得的知识。一个局限性是ECT患者接受了联合药物治疗。
