ECT vs Ketamine: NEJM Article Sets Up False Equivalency

 

A new Belgian neuroimaging study out today on PubMed looks at the relationship between psychomotor symptoms in depression and the basal ganglia:

The Basal Ganglia: A Central Hub for the Psychomotor Effects of Electroconvulsive Therapy

Jan-Baptist Belge 1, Linda Van Diermen 2, Didier Schrijvers 2, Bernard Sabbe 2, Eric Constant 3, Philippe de Timary 3, Sven De Keyzer 4, Paul Parizel 4, Kristof Vansteelandt 5, Pascal Sienaert 6, Philip van Eijndhoven 7

https://drive.google.com/file/d/11Sb4SQJKlXMKdhGF57zM5bW-5Iqcxzsp/view?usp=sharing

This is an excellent study, carefully conducted and the paper is well written.
Psychomotor symptoms (mainly retardation and agitation) were assessed in 17 patients with severe depression before and after ECT, using the CORE rating scale.

The main findings were significant volume increases in nucleus accumbens, putamen and pallidum. Volume increases in accumbens correlated with improvement in retardation, while volume increases in pallidum correlated negatively  with improvement in agitation.The authors conclude, "...the importance of the basal ganglia, and, principally, the striatum and pallidum, in the neurobiology of depression is compelling."

The article includes an excellent review of basal ganglia anatomy and function, with a fabulous color MRI figure.

As a side note, the authors report exact ECT stimulus dosing parameters in Table 2. This should be a model for other investigators to follow.