Pelosof Rebeca, Santos Leonardo A Dos, Farhat Luis C, Gattaz Wagner F, Talib Leda, Brunoni André R
Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil.
Service of Interdisciplinary Neuromodulation, Department of Psychiatry, Laboratory of Neurosciences (LIM-27), Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil.
World J Biol Psychiatry. 2023 Jan;24(1):24-33. doi: 10.1080/15622975.2022.2058083. Epub 2022 Apr 21.
Studies have suggested Brain-Derived Neurotrophic Factors (BDNF) increase after electroconvulsive therapy (ECT) although they were methodologically limited and enrolled small sample sizes. We aimed at updating a systematic review and meta-analysis to explore BDNF changes after ECT for the treatment of depression.
PubMed, PsycInfo, Embase and Global health were searched (March, 2021). Clinical trials that measured BDNF in the blood before and after ECT in adults (≥ 18 years old) with depression (major depressive disorder or bipolar disorder) were eligible. Data were pooled through random-effects meta-analyses.
Twenty-eight studies involving 778 participants were included. Meta-analysis showed a significant increase in BDNF levels after ECT (Hedges' g = 0.28; 95% CI: 0.10, 0.46) while there was evidence of significant heterogeneity (I = 67.64%) but not publication bias/small-study effect. Subgroup analyses and meta-regressions were underpowered to detect significant differences. Meta-analysis of depression severity scores demonstrated a considerable larger treatment effect in reducing depressive symptoms after ECT (Hedge's g = -3.72 95% CI: -4.23, -3.21).
This updated review showed that BDNF blood levels increased after ECT treatment. However, there was still evidence of substantial heterogeneity and there were limited sample sizes to investigate factors driving the variability of effects across studies. Importantly, the increase in BDNF levels was substantially smaller than the observed in depressive symptomatology, which could be indicative that the former was independent than the latter. Additional studies with larger sample sizes are currently required.
研究表明，电休克治疗（ECT）后脑源性神经营养因子（BDNF）会增加，尽管这些研究在方法上存在局限性且样本量较小。我们旨在更新一项系统评价和荟萃分析，以探讨ECT治疗抑郁症后BDNF的变化。
检索了PubMed、PsycInfo、Embase和Global health（2021年3月）。纳入了在患有抑郁症（重度抑郁症或双相情感障碍）的成年人（≥18岁）中测量ECT前后血液中BDNF的临床试验。通过随机效应荟萃分析汇总数据。
纳入了28项研究，涉及778名参与者。荟萃分析显示，ECT后BDNF水平显著升高（Hedges' g = 0.28；95% CI：0.10，0.46），同时有证据表明存在显著异质性（I = 67.64%），但不存在发表偏倚/小研究效应。亚组分析和荟萃回归的检验效能不足以检测到显著差异。抑郁症严重程度评分的荟萃分析表明，ECT后在减轻抑郁症状方面有相当大的治疗效果（Hedge's g = -3.72，95% CI：-4.23，-3.21）。
这项更新的综述表明，ECT治疗后血液中BDNF水平升高。然而，仍有证据表明存在大量异质性，且研究影响变异性驱动因素的样本量有限。重要的是，BDNF水平的升高明显小于在抑郁症状学中观察到的升高，这可能表明前者独立于后者。目前需要更多样本量更大的研究。
