Department of Neurology, Ahamason-Lovelace Brain Mapping Center, Los Angeles, California.
Northwestern University Clinical and Translational Sciences Institute (NUCATS), Chicago, Illinois.
Hum Brain Mapp. 2020 May;41(7):1699-1710. doi: 10.1002/hbm.24895. Epub 2020 Mar 1.
Electroconvulsive therapy (ECT) and ketamine treatment both induce rapidly acting antidepressant effects in patients with major depressive disorder unresponsive to standard treatments, yet their specific impact on emotion processing is unknown. Here, we examined the neural underpinnings of emotion processing within and across patients (N = 44) receiving either ECT (N = 17, mean age: 36.8, 11.0 SD) or repeated subanesthetic (0.5 mg/kg) intravenous ketamine therapy (N = 27, mean age: 37.3, 10.8 SD) using a naturalistic study design. MRI and clinical data were collected before (TP1) and after treatment (TP2); healthy controls (N = 31, mean age: 34.5, 13.5 SD) completed one MRI session (TP1). An fMRI face-matching task probed negative- and positive-valence systems. Whole-brain analysis, comparing neurofunctional changes within and across treatment groups, targeted brain regions involved in emotional facial processing, and included regions-of-interest analysis of amygdala responsivity. Main findings revealed a decrease in amygdalar reactivity after both ECT and ketamine for positive and negative emotional face processing (p < .05 family wise-error (FWE) corrected). Subthreshold changes were observed between treatments within the dorsolateral prefrontal cortex and insula (p < .005, uncorrected). BOLD change for positive faces in the inferior parietal cortex significantly correlated with overall symptom improvement, and BOLD change in frontal regions correlated with anxiety for negative faces, and anhedonia for positive faces (p < .05 FWE corrected). Both serial ketamine and ECT treatment modulate amygdala response, while more subtle treatment-specific changes occur in the larger functional network. Findings point to both common and differential mechanistic upstream systems-level effects relating to fast-acting antidepressant response, and symptoms of anxiety and anhedonia, for the processing of emotionally valenced stimuli.
电抽搐治疗（ECT）和氯胺酮治疗在对标准治疗反应不佳的重度抑郁症患者中均诱导快速起效的抗抑郁作用，但它们对情绪处理的具体影响尚不清楚。在这里，我们使用自然研究设计，检查了接受 ECT（N = 17，平均年龄：36.8，11.0 SD）或重复亚麻醉（0.5 mg/kg）静脉注射氯胺酮治疗的患者（N = 27，平均年龄：37.3，10.8 SD）和健康对照组（N = 31，平均年龄：34.5，13.5 SD）内和跨治疗组的情绪处理的神经基础。在治疗前（TP1）和治疗后（TP2）采集 MRI 和临床数据；健康对照组（N = 31，平均年龄：34.5，13.5 SD）完成一次 MRI 扫描（TP1）。功能磁共振成像（fMRI）面部匹配任务探查负性和正性效价系统。全脑分析比较了治疗组内和跨治疗组的神经功能变化，针对涉及情绪面部处理的脑区，包括杏仁核反应性的感兴趣区分析。主要发现显示，ECT 和氯胺酮治疗后，正性和负性情绪面孔处理的杏仁核反应性均降低（p < 0.05 经校正的家族-wise 错误（FWE））。在背外侧前额叶皮质和岛叶内观察到治疗之间的亚阈值变化（p < 0.005，未校正）。下顶叶皮层对正性面孔的 BOLD 变化与总体症状改善显著相关，额叶区域的 BOLD 变化与负性面孔的焦虑和正性面孔的快感缺失相关（p < 0.05 FWE 校正）。连续氯胺酮和 ECT 治疗均调节杏仁核反应，而在更大的功能网络中则出现更微妙的治疗特异性变化。这些发现指向与快速起效的抗抑郁反应以及与处理情绪效价刺激相关的焦虑和快感缺失症状有关的共同和差异的上游系统水平机制效应。
