Department of Psychiatry, University Psychiatric Center Duffel, Duffel, Belgium; Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
Department of Psychiatry, University Psychiatric Center Duffel, Duffel, Belgium; Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
J Affect Disord. 2020 Mar 15;265:239-246. doi: 10.1016/j.jad.2020.01.033. Epub 2020 Jan 13.
Electroconvulsive therapy (ECT) is the most effective biological treatment for depression. Aside the well-known therapeutic effect on mood symptoms, it has also a unique positive impact on psychomotor agitation and retardation, which are core symptoms of depression. The neurobiology behind these effects, however, remains unclear. The basal ganglia are proposed to be important regions in the pathogenesis of psychomotor symptoms in depression. Since ECT can trigger neuroplasticity in these subcortical nuclei, we speculate that ECT-induced volumetric changes of the basal ganglia will positively influence psychomotor symptoms.
Psychomotor symptoms were analyzed in 17 patients with severe depression before and after an acute ECT course using a CORE assessment of the retardation, agitation, and non-interaction domains. The volumes of the caudate, putamen, pallidum, and accumbens regions were determined using magnetic resonance imaging one week before and after ECT.
Psychomotor functions had improved significantly after ECT and significant volume increases were found for the accumbens region, the putamen, and pallidum. The volume increase of the nucleus accumbens correlated with an improvement of psychomotor retardation, while the volume increase of the pallidum correlated negatively with an improvement of the agitation subscore.
Our findings support the notion of an association between the impact of ECT on depression-related psychomotor symptoms and volume increases of the accumbens region and pallidum, pointing to the importance of the basal ganglia in the therapeutic effect of ECT on psychomotor functioning.
电抽搐治疗（ECT）是治疗抑郁症最有效的生物学方法。除了对情绪症状有显著的治疗效果外，ECT 对精神运动迟缓和激越也有独特的积极影响，这是抑郁症的核心症状。然而，这些影响的神经生物学机制仍不清楚。基底神经节被认为是抑郁症精神运动症状发病机制中的重要区域。由于 ECT 可以在这些皮质下核团中引发神经可塑性，我们推测 ECT 诱导的基底神经节体积变化将对精神运动症状产生积极影响。
使用 CORE 评估迟滞、激越和非互动域，对 17 例重度抑郁症患者在急性 ECT 疗程前后的精神运动症状进行分析。在 ECT 前后一周，使用磁共振成像确定尾状核、壳核、苍白球和伏隔核区域的体积。
ECT 后精神运动功能明显改善，伏隔核、壳核和苍白球体积明显增加。伏隔核体积的增加与精神运动迟滞的改善相关，而苍白球体积的增加与激越子评分的改善呈负相关。
我们的发现支持 ECT 对与抑郁相关的精神运动症状的影响与伏隔核和苍白球体积增加之间存在关联的观点，这表明基底神经节在 ECT 对精神运动功能的治疗效果中具有重要作用。
