Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA.
Department of Neurology, Ahmanson-Lovelace Brain Mapping Center, Geffen School of Medicine at the University of California, Los Angeles, CA, USA.
Psychol Med. 2024 Jan;54(1):108-116. doi: 10.1017/S0033291722003555. Epub 2023 Jan 5.
Electroconvulsive therapy (ECT) is effective for treatment-resistant depression and leads to short-term structural brain changes and decreases in the inflammatory response. However, little is known about how brain structure and inflammation relate to the heterogeneity of treatment response in the months following an index ECT course.
A naturalistic six-month study following an index ECT course included 20 subjects with treatment-resistant depression. Upon conclusion of the index ECT course and again after six months, structural magnetic resonance imaging scans and peripheral inflammation measures [interleukin-6 (IL-6), IL-8, tumor necrosis factor (TNF-), and C-reactive protein] were obtained. Voxel-based morphometry processed with the CAT-12 Toolbox was used to estimate changes in gray matter volume.
Between the end of the index ECT course and the end of follow-up, we found four clusters of significant decreases in gray matter volume ( < 0.01, FWE) and no regions of increased volume. Decreased HAM-D scores were significantly related only to reduced IL-8 level. Decreased volume in one cluster, which included the right insula and Brodmann's Area 22, was related to increased HAM-D scores over six months. IL-8 levels did not mediate or moderate the relationship between volumetric change and depression.
Six months after an index ECT course, multiple regions of decreased gray matter volume were observed in a naturalistic setting. The independent relations between brain volume and inflammation to depressive symptoms suggest novel explanations of the heterogeneity of longer-term ECT treatment response.
电抽搐疗法（ECT）对治疗抵抗性抑郁症有效，可导致短期的结构性脑变化和炎症反应减少。然而，对于 ECT 疗程后数月内大脑结构和炎症与治疗反应异质性之间的关系，知之甚少。
一项自然随访 ECT 疗程的六个月研究纳入了 20 例治疗抵抗性抑郁症患者。ECT 疗程结束后，以及六个月后，分别进行结构磁共振成像扫描和外周炎症指标[白细胞介素-6（IL-6）、IL-8、肿瘤坏死因子（TNF-）和 C 反应蛋白]检测。采用 CAT-12 工具箱进行基于体素的形态计量学分析，以估计灰质体积的变化。
在 ECT 疗程结束到随访结束之间，我们发现了四个灰质体积显著下降的聚类（<0.01，FWE），没有体积增加的区域。HAM-D 评分降低仅与 IL-8 水平降低显著相关。在包括右侧脑岛和布罗德曼 22 区的一个聚类中，体积减小与六个月内 HAM-D 评分升高相关。IL-8 水平不能调节或中介体积变化与抑郁之间的关系。
ECT 疗程后六个月，在自然环境中观察到多个灰质体积减小的区域。大脑体积和炎症与抑郁症状之间的独立关系为 ECT 治疗反应的长期异质性提供了新的解释。
