Immune Response, White Matter and ECT: New Study From American ECT Researchers

 Out on PubMed, from researchers in Boston and Los Angeles, is this study:

Longitudinal trajectory of response to electroconvulsive therapy associated with transient immune response & white matter alteration post-stimulation.

Andreou B, Reid B, Lyall AE, Cetin-Karayumak S, Kubicki A, Espinoza R, Kruse J, Narr KL, Kubicki M.Transl Psychiatry. 2022 May 7;12(1):191. doi: 10.1038/s41398-022-01960-8.PMID: 35523776

The abstract is copied below:

Research suggests electroconvulsive therapy (ECT) induces an acute neuroinflammatory response and changes in white matter (WM) structural connectivity. However, whether these processes are related, either to each other or to eventual treatment outcomes, has yet to be determined. We examined the relationship between levels of peripheral pro-inflammatory cytokines and diffusion imaging-indexed changes in WM microstructure in individuals with treatment-resistant depression (TRD) who underwent ECT. Forty-two patients were assessed at baseline, after their second ECT (T2), and after completion of ECT (T3). A Montgomery Åsberg Depression Rating Scale improvement of >50% post-ECT defined ECT-responders (n = 19) from non-responders (n = 23). Thirty-four controls were also examined. Tissue-specific fractional anisotropy (FAt) was estimated using diffusion imaging data and the Free-Water method in 17 WM tracts. Inflammatory panels were evaluated from peripheral blood. Cytokines were examined to characterize the association between potential ECT-induced changes in an inflammatory state and WM microstructure. Longitudinal trajectories of both measures were also examined separately for ECT-responders and non-responders. Patients exhibited elevated Interleukin-8 (IL-8) levels at baseline compared to controls. In patients, correlations between IL-8 and FAt changes from baseline to T2 were significant in the positive direction in the right superior longitudinal fasciculus (R-SLF) and right cingulum (R-CB) (psig = 0.003). In these tracts, linear mixed-effects models revealed that trajectories of IL-8 and FAt were significantly positively correlated across all time points in responders, but not non-responders (R-CB-p = .001; R-SLF-p = 0.008). Our results suggest that response to ECT in TRD may be mediated by IL-8 and WM microstructure.

The article is here.

And from the text:

This is a sophisticated, complex study looking at relationships between immune changes with ECT, white matter fractional anisotropy and antidepressant response. Here again, the details are less important than the overall concepts of the involvement of immune response/inflammation and neurogenesis in the mechanism of action of ECT. Eventually the pieces of the puzzle will come together; in the meantime, studies such as this add important incremental knowledge. Followers of the literature on the mechanism of action of ECT will want to read it in full, ~25 minutes.