Department of Psychiatry, Rijnstate Hospital, Arnhem, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands.
Amsterdam UMC Location University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands.
Brain Stimul. 2023 Jul-Aug;16(4):1128-1134. doi: 10.1016/j.brs.2023.07.054. Epub 2023 Jul 28.
Electroconvulsive therapy (ECT) is one of the most effective treatments for severe depressive disorders. A recent multi-center study found no consistent changes in correlation-based (undirected) resting-state connectivity after ECT. Effective (directed) connectivity may provide more insight into the working mechanism of ECT.
We investigated whether there are consistent changes in effective resting-state connectivity.
This multi-center study included data from 189 patients suffering from severe unipolar depression and 59 healthy control participants. Longitudinal data were available for 81 patients and 24 healthy controls. We used dynamic causal modeling for resting-state functional magnetic resonance imaging to determine effective connectivity in the default mode, salience and central executive networks before and after a course of ECT. Bayesian general linear models were used to examine differences in baseline and longitudinal effective connectivity effects associated with ECT and its effectiveness.
Compared to controls, depressed patients showed many differences in effective connectivity at baseline, which varied according to the presence of psychotic features and later treatment outcome. Additionally, effective connectivity changed after ECT, which was related to ECT effectiveness. Notably, treatment effectiveness was associated with decreasing and increasing effective connectivity from the posterior default mode network to the left and right insula, respectively. No effects were found using correlation-based (undirected) connectivity.
A beneficial response to ECT may depend on how brain regions influence each other in networks important for emotion and cognition. These findings further elucidate the working mechanisms of ECT and may provide directions for future non-invasive brain stimulation research.
电抽搐疗法（ECT）是治疗重度抑郁症最有效的方法之一。最近的一项多中心研究发现，ECT 后基于相关（无向）静息态连接没有一致的变化。有效的（有向）连接可能更深入地了解 ECT 的工作机制。
我们研究了有效的静息态连接是否存在一致的变化。
这项多中心研究包括了 189 名患有严重单相抑郁症患者和 59 名健康对照参与者的数据。81 名患者和 24 名健康对照者具有纵向数据。我们使用静息态功能磁共振成像的动态因果建模来确定默认模式、突显和中央执行网络的有效连接，在 ECT 前后进行。贝叶斯广义线性模型用于检查与 ECT 及其有效性相关的基线和纵向有效连接效果的差异。
与对照组相比，抑郁患者在基线时的有效连接存在许多差异，这些差异取决于是否存在精神病特征和后期治疗结果。此外，ECT 后有效连接发生了变化，这与 ECT 的有效性有关。值得注意的是，治疗效果与从后默认模式网络到左、右岛叶的有效连接的降低和增加有关。基于相关（无向）连接的方法没有发现效果。
ECT 的有益反应可能取决于大脑区域如何在对情绪和认知重要的网络中相互影响。这些发现进一步阐明了 ECT 的工作机制，并可能为未来的非侵入性脑刺激研究提供方向。
