More on Inflammatory Markers in ECT: Study From Lithuania

Out on PubMed, from researchers in Lithuania, is this paper:

Brain stimulation effects on serum BDNF, VEGF, and TNFα in treatment-resistant psychiatric disorders.

Valiuliene G, Valiulis V, Dapsys K, Vitkeviciene A, Gerulskis G, Navakauskiene R, Germanavicius A.Eur J Neurosci. 2021 Apr 16. doi: 10.1111/ejn.15232. Online ahead of print.PMID: 33861484

The abstract is copied below:

Resistance to pharmacological treatment poses a notable challenge for psychiatry. Such cases are usually treated with brain stimulation techniques, including repetitive transcranial magnetic stimulation (rTMS) and electroconvulsive therapy (ECT). Empirical evidence links treatment resistance to insufficient brain plasticity and chronic inflammation. Therefore, this study encompasses analysis of neurotrophic and inflammatory factors in psychiatric patients undergoing rTMS and ECT in order to refine the selection of patients and predict clinical outcomes. This study enrolled 25 drug-resistant depressive patients undergoing rTMS and 31 drug-resistant schizophrenia patients undergoing ECT. Clinical efficacy of brain stimulation therapies was gauged using MADRS and HAM-D scales in the depression group and PANSS scale in the schizophrenia group. Blood-derived BDNF, VEGF, and TNFα were analysed during the treatment course. For reference, 19 healthy control subjects were also enrolled. After statistical analysis, no significant differences were detected in BDNF, VEGF, and TNFα concentrations among healthy, depressive, and schizophrenic subject groups before the treatment. However, depressive patient treatment with rTMS has increased BDNF concentration, while schizophrenic patient treatment with ECT has lowered the concentration of TNFα. Our findings suggest that a lower initial TNFα concentration could be a marker for treatment success in depressed patients undergoing rTMS, whereas in schizophrenic patient group treated with ECT, a higher concentration of VEGF correlates to milder symptoms post-treatment, especially in the negative scale.

Keywords: drug-treatment resistant depression; drug-treatment resistant schizophrenia; electroconvulsive therapy (ECT); repetitive transcranial magnetic stimulation (rTMS).

And from the text:

This is another small study looking at markers of inflammation before and after treatment. It is a bit of a hodge-podge, with depressed patients getting rTMS and patients with schizophrenia getting ECT. Perhaps the most interesting finding is the decrease in TNFα after ECT in the patients with schizophrenia. And the excellent clinical result with ECT for schizophrenia is again worth noting, with improvement in both positive and negative symptoms.
Our Lithuanian colleagues are to be commended for their diligence in pursuing the biomarker holy grail, but I doubt they have found it yet in blood cytokines. Larger studies are needed for replication, of course.
The analogy that cannot be unthought is that of the Paris sewer system, in which the dinner menu at the palace of Versailles is deciphered by analysis of the effluvium...
For students of the cytokine story in ECT, a full read (~20 minutes) is in order, for the rest of us, the abstract and conclusions adequately summarize the findings. 

(Please see also blog post of April 26, 2021.)