Cerebral Perfusion, Efficacy and Tolerability of ECT: New Study From Denmark

Out on PubMed, from investigators in Denmark, is this study:

Cerebral perfusion is related to antidepressant effect and cognitive side effects of Electroconvulsive Therapy.

Gbyl K, Lindberg U, Wiberg Larsson HB, Rostrup E, Videbech P.Brain Stimul. 2022 Nov 1:S1935-861X(22)00230-3. doi: 10.1016/j.brs.2022.10.007. Online ahead of print.PMID: 36332891
The abstract is copied below:
Background: The mechanisms underlying the antidepressant effect and cognitive side effects of Electroconvulsive Therapy (ECT) remain elusive. The measurement of cerebral perfusion provides an insight into brain physiology.

Objective: We investigated ECT-related perfusion changes in depressed patients and tested whether these changes correlate with clinical effects.

Methods: A sample of 22 in-patients was examined at three time points: 1) within two days before, 2) within one week after, and 3) six months after an ECT series. Cerebral perfusion was quantified using arterial spin labeling magnetic resonance imaging. The primary regions of interest were the bilateral dorsolateral prefrontal cortices (DL-PFC) and hippocampi. The depression severity was assessed by the six-item Hamilton Depression Rating Scale, and cognitive performance by the Screen for Cognitive Impairment in Psychiatry. A linear mixed model and partial correlation were used for statistical analyses.

Results: Following an ECT series, perfusion decreased in the right (-6.0%, p = 0.01) and left DL-PFC (-5.6%, p = 0.001). Perfusion increased in the left hippocampus (4.8%, p = 0.03), while on the right side the increase was insignificant (2.3%, p = 0.23). A larger perfusion reduction in the right DL-PFC correlated with a better antidepressant effect, and a larger perfusion increase in the right hippocampus with worse cognitive impairment.

Conclusion: ECT-induced attenuation of prefrontal activity may be related to clinical improvement, whereas a hippocampal process triggered by the treatment is likely associated with cognitive side effects.

Keywords: Cerebral blood flow; Cerebral perfusion; Depression; Electroconvulsive therapy; Functional MRI; Major depressive disorder.

The article is here.

And from the text:











This is an interesting study that should be of great interest to those who follow the ECT mechanism-of-action literature. It is very small study, so I would consider the findings preliminary, but theoretically provocative.
The paradox of ECT further lowering low baseline CBF, the anticonvulsant theory, "rebalancing inter-hemispheric activity"; there is something for everyone here.
The data are well-presented, making this a very pleasant, ~15 minute read.

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