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Kiebs M, Farrar DC, Yrondi A, Cardoner N, Tuovinen N, Redlich R, Dannlowski U, Soriano-Mas C, Dols A, Takamiya A, Tendolkar I, Narr KL, Espinoza R, Laroy M, van Eijndhoven P, Verwijk E, van Waarde J, Verdijk J, Maier HB, Nordanskog P, van Wingen G, van Diermen L, Emsell L, Bouckaert F, Repple J, Camprodon JA, Wade BSC, Donaldson KT, Oltedal L, Kessler U, Hammar Å, Sienaert P, Hebbrecht K, Urretavizcaya M, Belge JB, Argyelan M, Baradits M, Obbels J, Draganski B, Philipsen A, Sartorius A, Rhebergen D, Ousdal OT, Hurlemann R, McClintock S, Erhardt EB, Abbott CC. Electroconvulsive therapy and cognitive performance from the Global ECT MRI Research Collaboration. J Psychiatr Res 2024; 179:199-208. [PMID: 39312853 DOI: 10.1016/j.jpsychires.2024.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 09/03/2024] [Accepted: 09/09/2024] [Indexed: 09/25/2024]
Abstract
The Global ECT MRI Research Collaboration (GEMRIC) has collected clinical and neuroimaging data of patients treated with electroconvulsive therapy (ECT) from around the world. Results to date have focused on neuroimaging correlates of antidepressant response. GEMRIC sites have also collected longitudinal cognitive data. Here, we summarize the existing GEMRIC cognitive data and provide recommendations for prospective data collection for future ECT-imaging investigations. We describe the criteria for selection of cognitive measures for mega-analyses: Trail Making Test Parts A (TMT-A) and B (TMT-B), verbal fluency category (VFC), verbal fluency letter (VFL), and percent retention from verbal learning and memory tests. We performed longitudinal data analysis focused on the pre-/post-ECT assessments with healthy comparison (HC) subjects at similar timepoints and assessed associations between demographic and ECT parameters with cognitive changes. The study found an interaction between electrode placement and treatment number for VFC (F(1,107) = 4.14, p = 0.04). Higher treatment was associated with decreased VFC performance with right unilateral electrode placement. Percent retention showed a main effect for group, with post-hoc analysis indicating decreased cognitive performance among the HC group. However, there were no significant effects of group or group interactions observed for TMT-A, TMT-B, or VFL. We assessed the current GEMRIC cognitive data and acknowledge the limitations associated with this data set including the limited number of neuropsychological domains assessed. Aside from the VFC and treatment number relationship, we did not observe ECT-mediated neurocognitive effects in this investigation. We provide prospective cognitive recommendations for future ECT-imaging investigations focused on strong psychometrics and minimal burden to subjects.
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Affiliation(s)
- Maximilian Kiebs
- Department of Psychiatry and Psychotherapy, School of Medicine and Health Sciences, University of Oldenburg, Oldenberg, Germany; Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany.
| | - Danielle C Farrar
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Antoine Yrondi
- Service de Psychiatrie et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Toulouse, France; Université de Toulouse, INSERM, UPS, Toulouse, France
| | - Narcis Cardoner
- Sant Pau Mental Health Research Group, Institut d'Investigació Biomèdica Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, School of Medicine Bellaterra, Universitat Autònoma de Barcelona, Barcelona, Spain; Network Center for Biomedical Research on Mental Health (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Noora Tuovinen
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
| | - Ronny Redlich
- Department of Psychology, University of Halle, Germany; Institute of Translational Psychiatry, University of Muenster, Germany; Halle-Jena-Magdeburg, German Center for Mental Health (DZPG), Germany
| | - Udo Dannlowski
- Institute of Translational Psychiatry, University of Muenster, Germany
| | - Carles Soriano-Mas
- Network Center for Biomedical Research on Mental Health (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain; Department of Social Psychology and Quantitative Psychology, Institute of Neurosciences, Universitat de Barcelona - UB, Barcelona, Spain
| | - Annemiek Dols
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Psychiatry, Amsterdam UMC location, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Akihiro Takamiya
- Department of Neurosciences, Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium; Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan
| | - Indira Tendolkar
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Katherine L Narr
- Departments of Neurology and Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Randall Espinoza
- Departments of Neurology and Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Maarten Laroy
- Department of Neurosciences, Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Philip van Eijndhoven
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Esmée Verwijk
- Department of Psychology, Brain and Cognition, University of Amsterdam, Amsterdam, the Netherlands; Department of Medical Psychology, UMC Amsterdam, Amsterdam, the Netherlands; ECT-Department, Parnassia Psychiatric Institute, The Hague, the Netherlands
| | | | - Joey Verdijk
- Department of Psychiatry, Rijnstate, Arnhem, the Netherlands
| | - Hannah B Maier
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Germany
| | - Pia Nordanskog
- Center for Social and Affective Neuroscience (CSAN), Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Psychiatry in Linköping, Linköping, Sweden
| | - Guido van Wingen
- Department of Psychiatry, Amsterdam UMC location, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Neuroscience Amsterdam, the Netherlands
| | - Linda van Diermen
- Department of Psychiatry, University Hospital of Liège, Liege, Belgium; Department of Psychiatry, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Louise Emsell
- Department of Neurosciences, Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium; Geriatric Psychiatry, University Psychiatry Center (UPC), KU Leuven, Leuven, Belgium
| | - Filip Bouckaert
- Department of Neurosciences, Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium; Geriatric Psychiatry, University Psychiatry Center (UPC), KU Leuven, Leuven, Belgium
| | - Jonathan Repple
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt, Germany; Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Joan A Camprodon
- Division of Neuropsychiatry and Neuromodulation, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Benjamin S C Wade
- Division of Neuropsychiatry and Neuromodulation, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - K Tristan Donaldson
- Division of Neuropsychiatry and Neuromodulation, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Leif Oltedal
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Ute Kessler
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway; University of Bergen, Bergen, Norway
| | - Åsa Hammar
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway; Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden; Office for Psychiatry and Habilitation, Psychiatry Research Skåne, Skåne, Sweden
| | - Pascal Sienaert
- Academic Center for ECT and Neuromodulation (AcCENT), Department of Neurosciences, Neuropsychiatry, University Psychiatry Center (UPC), KU Leuven, Leuven, Belgium
| | - Kaat Hebbrecht
- Academic Center for ECT and Neuromodulation (AcCENT), Department of Neurosciences, Neuropsychiatry, University Psychiatry Center (UPC), KU Leuven, Leuven, Belgium
| | - Mikel Urretavizcaya
- Network Center for Biomedical Research on Mental Health (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Neurosciences Group - Psychiatry and Mental Health, Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Jean-Baptiste Belge
- Department of Psychiatry, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Miklos Argyelan
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA; Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA
| | - Mate Baradits
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA
| | - Jasmien Obbels
- Academic Center for ECT and Neuromodulation (AcCENT), Department of Neurosciences, Neuropsychiatry, University Psychiatry Center (UPC), KU Leuven, Leuven, Belgium
| | - Bogdan Draganski
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Neurology Department, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Alexander Sartorius
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Didericke Rhebergen
- Department of Psychiatry, Amsterdam UMC location, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; GGZ Central, Mental Health Institute, Amersfoort, the Netherlands
| | - Olga Therese Ousdal
- Department of Biomedicine, Faculty of Medicine, University of Bergen, Norway
| | - René Hurlemann
- Department of Psychiatry and Psychotherapy, School of Medicine and Health Sciences, University of Oldenburg, Oldenberg, Germany
| | - Shawn McClintock
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Erik B Erhardt
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, NM, USA
| | - Christopher C Abbott
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, NM, USA.
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Abe Y, Erchinger VJ, Ousdal OT, Oltedal L, Tanaka KF, Takamiya A. Neurobiological mechanisms of electroconvulsive therapy for depression: Insights into hippocampal volumetric increases from clinical and preclinical studies. J Neurochem 2024; 168:1738-1750. [PMID: 38238933 DOI: 10.1111/jnc.16054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/26/2023] [Accepted: 01/08/2024] [Indexed: 10/04/2024]
Abstract
Depression is a highly prevalent and disabling psychiatric disorder. The hippocampus, which plays a central role in mood regulation and memory, has received considerable attention in depression research. Electroconvulsive therapy (ECT) is the most effective treatment for severe pharmacotherapy-resistant depression. Although the working mechanism of ECT remains unclear, recent magnetic resonance imaging (MRI) studies have consistently reported increased hippocampal volumes following ECT. The clinical implications of these volumetric increases and the specific cellular and molecular significance are not yet fully understood. This narrative review brings together evidence from animal models and human studies to provide a detailed examination of hippocampal volumetric increases following ECT. In particular, our preclinical MRI research using a mouse model is consistent with human findings, demonstrating a marked increase in hippocampal volume following ECT. Notable changes were observed in the ventral hippocampal CA1 region, including dendritic growth and increased synaptic density at excitatory synapses. Interestingly, inhibition of neurogenesis did not affect the ECT-related hippocampal volumetric increases detected on MRI. However, it remains unclear whether these histological and volumetric changes would be correlated with the clinical effect of ECT. Hence, future research on the relationships between cellular changes, ECT-related brain volumetric changes, and antidepressant effect could benefit from a bidirectional translational approach that integrates human and animal models. Such translational research may provide important insights into the mechanisms and potential biomarkers associated with ECT-induced hippocampal volumetric changes, thereby advancing our understanding of ECT for the treatment of depression.
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Affiliation(s)
- Yoshifumi Abe
- Division of Brain Sciences, Institute for Advanced Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Vera J Erchinger
- Department of Biomedicine, The Faculty of Medicine, University of Bergen, Bergen, Norway
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Olga Therese Ousdal
- Department of Biomedicine, The Faculty of Medicine, University of Bergen, Bergen, Norway
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Leif Oltedal
- Department of Biomedicine, The Faculty of Medicine, University of Bergen, Bergen, Norway
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Kenji F Tanaka
- Division of Brain Sciences, Institute for Advanced Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Akihiro Takamiya
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
- Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan
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Denier N, Grieder M, Jann K, Breit S, Mertse N, Walther S, Soravia LM, Meyer A, Federspiel A, Wiest R, Bracht T. Analyzing fractal dimension in electroconvulsive therapy: Unraveling complexity in structural and functional neuroimaging. Neuroimage 2024; 297:120671. [PMID: 38901774 DOI: 10.1016/j.neuroimage.2024.120671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/21/2024] [Accepted: 06/06/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Numerous studies show that electroconvulsive therapy (ECT) induces hippocampal neuroplasticity, but findings are inconsistent regarding its clinical relevance. This study aims to investigate ECT-induced plasticity of anterior and posterior hippocampi using mathematical complexity measures in neuroimaging, namely Higuchi's fractal dimension (HFD) for fMRI time series and the fractal dimension of cortical morphology (FD-CM). Furthermore, we explore the potential of these complexity measures to predict ECT treatment response. METHODS Twenty patients with a current depressive episode (16 with major depressive disorder and 4 with bipolar disorder) underwent MRI-scans before and after an ECT-series. Twenty healthy controls matched for age and sex were also scanned twice for comparison purposes. Resting-state fMRI data were processed, and HFD was computed for anterior and posterior hippocampi. Group-by-time effects for HFD in anterior and posterior hippocampi were calculated and correlations between HFD changes and improvement in depression severity were examined. For FD-CM analyses, we preprocessed structural MRI with CAT12's surface-based methods. We explored group-by-time effects for FD-CM and the predictive value of baseline HFD and FD-CM for treatment outcome. RESULTS Patients exhibited a significant increase in bilateral hippocampal HFD from baseline to follow-up scans. Right anterior hippocampal HFD increase was associated with reductions in depression severity. We found no group differences and group-by-time effects in FD-CM. After applying a whole-brain regression analysis, we found that baseline FD-CM in the left temporal pole predicted reduction of overall depression severity after ECT. Baseline hippocampal HFD did not predict treatment outcome. CONCLUSION This study suggests that HFD and FD-CM are promising imaging markers to investigate ECT-induced neuroplasticity associated with treatment response.
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Affiliation(s)
- Niklaus Denier
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland.
| | - Matthias Grieder
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Kay Jann
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Sigrid Breit
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | - Nicolas Mertse
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | - Leila M Soravia
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | - Agnes Meyer
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Andrea Federspiel
- Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland; Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Bern, Switzerland
| | - Roland Wiest
- Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland; Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Bern, Switzerland
| | - Tobias Bracht
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
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4
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Laroy M, Bouckaert F, Ousdal OT, Dols A, Rhebergen D, van Exel E, van Wingen G, van Waarde J, Verdijk J, Kessler U, Bartsch H, Jorgensen MB, Paulson OB, Nordanskog P, Prudic J, Sienaert P, Vandenbulcke M, Oltedal L, Emsell L. Characterization of gray matter volume changes from one week to 6 months after termination of electroconvulsive therapy in depressed patients. Brain Stimul 2024; 17:876-886. [PMID: 39059711 DOI: 10.1016/j.brs.2024.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 07/18/2024] [Accepted: 07/23/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Increased gray matter volume (GMV) following electroconvulsive therapy (ECT) has been well-documented, with limited studies reporting a subsequent decrease in GMV afterwards. OBJECTIVE This study characterized the reversion pattern of GMV after ECT and its association with clinical depression outcome, using multi-site triple time-point data from the Global ECT-MRI Research Collaboration (GEMRIC). METHODS 86 subjects from the GEMRIC database were included, and GMV in 84 regions-of-interest (ROI) was obtained from automatic segmentation of T1 MRI images at three timepoints: pre-ECT (T0), within one-week post-ECT (T1), and one to six months post-ECT (T2). RM-ANOVAs were used to assess longitudinal changes and LMM analyses explored associations between GMV changes and demographical and clinical characteristics. RESULTS 63 of the 84 ROIs showed a significant increase-and-decrease pattern (RM-ANOVA, Bonferroni corrected p < 0.00059). Post hoc tests indicated a consistent pattern in each of these 63 ROIs: significant increase from T0 to T1inGMV, followed by significant decrease from T1 to T2 and no difference between T0 and T2, except for both amygdalae, right hippocampus and pars triangularis, which showed the same increase and decrease but GMV at T2 remained higher compared to T0. No consistent relationship was found between GMV change pattern and clinical status. CONCLUSION The GEMRIC cohort confirmed a rapid increase of GMV after ECT followed by reversion of GMV one to six months thereafter. The lack of association between the GMV change pattern and depression outcome scores implies a transient neurobiological effect of ECT unrelated to clinical improvement.
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Affiliation(s)
- Maarten Laroy
- KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry, B-3000, Leuven, Belgium.
| | - Filip Bouckaert
- KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry, B-3000, Leuven, Belgium; Geriatric Psychiatry, University Psychiatric Center KU Leuven, B-3000, Leuven, Belgium
| | - Olga Therese Ousdal
- Mohn Medical Imaging and Visualization Center, Department of Radiology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Annemieke Dols
- Department of Psychiatry, UMC Utrecht, Division Brain, Utrecht, the Netherlands; Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, the Netherlands
| | - Didi Rhebergen
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, the Netherlands; Mental Health Institute, GGZ Centraal, Amersfoort, the Netherlands
| | - Eric van Exel
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, the Netherlands
| | - Guido van Wingen
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Jeroen van Waarde
- Department of Psychiatry, Rijnstate Hospital, Arnhem, the Netherlands
| | - Joey Verdijk
- Department of Psychiatry, Rijnstate Hospital, Arnhem, the Netherlands; University of Twente, Department of Clinical Neurophysiology, Enschede, the Netherlands
| | - Ute Kessler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Hauke Bartsch
- Mohn Medical Imaging and Visualization Center, Department of Radiology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Martin Balslev Jorgensen
- Psychiatric Center Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Olaf B Paulson
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Neurobiology Research Unit, Rigshospitalet, Copenhagen, Denmark
| | - Pia Nordanskog
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Joan Prudic
- Department of Psychiatry, Columbia University Irving Medical Center, USA
| | - Pascal Sienaert
- KU Leuven, Department of Neurosciences, Academic Centre for ECT and Neuromodulation, B-3000, Leuven, Belgium
| | - Mathieu Vandenbulcke
- KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry, B-3000, Leuven, Belgium; Geriatric Psychiatry, University Psychiatric Center KU Leuven, B-3000, Leuven, Belgium
| | - Leif Oltedal
- Mohn Medical Imaging and Visualization Center, Department of Radiology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Louise Emsell
- KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry, B-3000, Leuven, Belgium; Geriatric Psychiatry, University Psychiatric Center KU Leuven, B-3000, Leuven, Belgium; KU Leuven, Leuven Brain Institute, Department of Imaging and Pathology, Translational MRI, B-3000, Leuven, Belgium
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Lundin RM, Falcao VP, Kannangara S, Eakin CW, Abdar M, O'Neill J, Khosravi A, Eyre H, Nahavandi S, Loo C, Berk M. Machine Learning in Electroconvulsive Therapy: A Systematic Review. J ECT 2024:00124509-990000000-00167. [PMID: 38857315 DOI: 10.1097/yct.0000000000001009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
ABSTRACT Despite years of research, we are still not able to reliably predict who might benefit from electroconvulsive therapy (ECT) treatment. As we exhaust what is possible using traditional statistical analysis, ECT remains a good candidate for machine learning approaches due to the large data sets with data captured through electroencephalography (EEG) and other objective measures. A systematic review of 6 databases led to the full-text examination of 26 articles using machine learning approaches in examining data predicting response to ECT treatment. The identified articles used a wide variety of data types covering structural and functional imaging data (n = 15), clinical data (n = 5), a combination of clinical and imaging data (n = 2), EEG (n = 3), and social media posts (n = 1). The clinical indications in which response prediction was assessed were depression (n = 21) and psychosis (n = 4). Changes in multiple anatomical regions in the brain were identified as holding a predictive value for response to ECT. These primarily centered on the limbic system and associated networks. Clinical features predicting good response to ECT in depression included shorter duration, lower severity, higher medication dose, psychotic features, low cortisol levels, and positive family history. It has also been possible to predict the likelihood of relapse of readmission with psychosis after ECT treatment, including a better response if higher transfer entropy was calculated from EEG signals. A transdisciplinary approach with an international consortium collecting a wide range of retrospective and prospective data may help to refine and extend these outcomes and translate them into clinical practice.
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Affiliation(s)
| | | | | | - Charles W Eakin
- From the Mental Health, Drug and Alcohol Services, Barwon Health
| | - Moloud Abdar
- Institute for Intelligent Systems Research and Innovation, Deakin University, Geelong, Victoria, Australia
| | - John O'Neill
- Waikato District Health Board, Hamilton, New Zealand
| | - Abbas Khosravi
- Institute for Intelligent Systems Research and Innovation, Deakin University, Geelong, Victoria, Australia
| | | | - Saeid Nahavandi
- Institute for Intelligent Systems Research and Innovation, Deakin University, Geelong, Victoria, Australia
| | | | - Michael Berk
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
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6
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Bruin WB, Oltedal L, Bartsch H, Abbott C, Argyelan M, Barbour T, Camprodon J, Chowdhury S, Espinoza R, Mulders P, Narr K, Oudega M, Rhebergen D, Ten Doesschate F, Tendolkar I, van Eijndhoven P, van Exel E, van Verseveld M, Wade B, van Waarde J, Zhutovsky P, Dols A, van Wingen G. Development and validation of a multimodal neuroimaging biomarker for electroconvulsive therapy outcome in depression: a multicenter machine learning analysis. Psychol Med 2024; 54:495-506. [PMID: 37485692 DOI: 10.1017/s0033291723002040] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is the most effective intervention for patients with treatment resistant depression. A clinical decision support tool could guide patient selection to improve the overall response rate and avoid ineffective treatments with adverse effects. Initial small-scale, monocenter studies indicate that both structural magnetic resonance imaging (sMRI) and functional MRI (fMRI) biomarkers may predict ECT outcome, but it is not known whether those results can generalize to data from other centers. The objective of this study was to develop and validate neuroimaging biomarkers for ECT outcome in a multicenter setting. METHODS Multimodal data (i.e. clinical, sMRI and resting-state fMRI) were collected from seven centers of the Global ECT-MRI Research Collaboration (GEMRIC). We used data from 189 depressed patients to evaluate which data modalities or combinations thereof could provide the best predictions for treatment remission (HAM-D score ⩽7) using a support vector machine classifier. RESULTS Remission classification using a combination of gray matter volume and functional connectivity led to good performing models with average 0.82-0.83 area under the curve (AUC) when trained and tested on samples coming from the three largest centers (N = 109), and remained acceptable when validated using leave-one-site-out cross-validation (0.70-0.73 AUC). CONCLUSIONS These results show that multimodal neuroimaging data can be used to predict remission with ECT for individual patients across different treatment centers, despite significant variability in clinical characteristics across centers. Future development of a clinical decision support tool applying these biomarkers may be feasible.
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Affiliation(s)
- Willem Benjamin Bruin
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Leif Oltedal
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Hauke Bartsch
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Christopher Abbott
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Miklos Argyelan
- The Feinstein Institutes for Medical Research, Manhasset, NY, USA
- The Zucker Hillside Hospital, Glen Oaks, NY, USA
| | - Tracy Barbour
- Division of Neuropsychiatry and Neuromodulation, Massachusetts General Hospital, Harvard Medical School. Boston, MA, USA
| | - Joan Camprodon
- Division of Neuropsychiatry and Neuromodulation, Massachusetts General Hospital, Harvard Medical School. Boston, MA, USA
| | - Samadrita Chowdhury
- Division of Neuropsychiatry and Neuromodulation, Massachusetts General Hospital, Harvard Medical School. Boston, MA, USA
| | - Randall Espinoza
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, USA
| | - Peter Mulders
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, The Netherlands
| | - Katherine Narr
- Ahmanson-Lovelace Brain Mapping Center, Departments of Neurology, and Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, USA
| | - Mardien Oudega
- Department of Old Age Psychiatry, GGZinGeest, Department of Psychiatry, Amsterdam UMC, location VUmc, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Didi Rhebergen
- Mental Health Institute GGZ Centraal, Amersfoort; Department of Psychiatry, Amsterdam UMC, location VUmc, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Freek Ten Doesschate
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Rijnstate, Department of Psychiatry, Arnhem, The Netherlands
| | - Indira Tendolkar
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, The Netherlands
| | - Philip van Eijndhoven
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, The Netherlands
| | - Eric van Exel
- Department of Old Age Psychiatry, GGZinGeest, Department of Psychiatry, Amsterdam UMC, location VUmc, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | | | - Benjamin Wade
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, UCLA, Los Angeles, USA
| | | | - Paul Zhutovsky
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Annemiek Dols
- Department of Old Age Psychiatry, GGZinGeest, Department of Psychiatry, Amsterdam UMC, location VUmc, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Guido van Wingen
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, The Netherlands
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7
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Argyelan M, Deng ZD, Ousdal OT, Oltedal L, Angulo B, Baradits M, Spitzberg AJ, Kessler U, Sartorius A, Dols A, Narr KL, Espinoza R, van Waarde JA, Tendolkar I, van Eijndhoven P, van Wingen GA, Takamiya A, Kishimoto T, Jorgensen MB, Jorgensen A, Paulson OB, Yrondi A, Péran P, Soriano-Mas C, Cardoner N, Cano M, van Diermen L, Schrijvers D, Belge JB, Emsell L, Bouckaert F, Vandenbulcke M, Kiebs M, Hurlemann R, Mulders PC, Redlich R, Dannlowski U, Kavakbasi E, Kritzer MD, Ellard KK, Camprodon JA, Petrides G, Malhotra AK, Abbott CC. Electroconvulsive therapy-induced volumetric brain changes converge on a common causal circuit in depression. Mol Psychiatry 2024; 29:229-237. [PMID: 37985787 PMCID: PMC11116108 DOI: 10.1038/s41380-023-02318-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/23/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023]
Abstract
Neurostimulation is a mainstream treatment option for major depression. Neuromodulation techniques apply repetitive magnetic or electrical stimulation to some neural target but significantly differ in their invasiveness, spatial selectivity, mechanism of action, and efficacy. Despite these differences, recent analyses of transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS)-treated individuals converged on a common neural network that might have a causal role in treatment response. We set out to investigate if the neuronal underpinnings of electroconvulsive therapy (ECT) are similarly associated with this causal depression network (CDN). Our aim here is to provide a comprehensive analysis in three cohorts of patients segregated by electrode placement (N = 246 with right unilateral, 79 with bitemporal, and 61 with mixed) who underwent ECT. We conducted a data-driven, unsupervised multivariate neuroimaging analysis Principal Component Analysis (PCA) of the cortical and subcortical volume changes and electric field (EF) distribution to explore changes within the CDN associated with antidepressant outcomes. Despite the different treatment modalities (ECT vs TMS and DBS) and methodological approaches (structural vs functional networks), we found a highly similar pattern of change within the CDN in the three cohorts of patients (spatial similarity across 85 regions: r = 0.65, 0.58, 0.40, df = 83). Most importantly, the expression of this pattern correlated with clinical outcomes (t = -2.35, p = 0.019). This evidence further supports that treatment interventions converge on a CDN in depression. Optimizing modulation of this network could serve to improve the outcome of neurostimulation in depression.
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Affiliation(s)
- Miklos Argyelan
- Feinstein Institutes for Medical Research, Institute of Behavioral Science, Manhasset, NY, USA.
- The Zucker Hillside Hospital, Glen Oaks, NY, USA.
| | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Olga Therese Ousdal
- Department of Biomedicine, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Leif Oltedal
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Brian Angulo
- Feinstein Institutes for Medical Research, Institute of Behavioral Science, Manhasset, NY, USA
| | - Mate Baradits
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | | | - Ute Kessler
- Department of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Hungary
| | - Alexander Sartorius
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Annemiek Dols
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Neuroscience, Amsterdam, The Netherlands
| | - Katherine L Narr
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Randall Espinoza
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Indira Tendolkar
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, the Netherlands
| | - Philip van Eijndhoven
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, the Netherlands
| | - Guido A van Wingen
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Akihiro Takamiya
- Department of Neuropsychiatry Keio University School of Medicine, Tokyo, Japan
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Belgium
| | - Taishiro Kishimoto
- Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan
| | - Martin B Jorgensen
- Psychiatric Center Copenhagen and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anders Jorgensen
- Psychiatric Center Copenhagen and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Olaf B Paulson
- Neurobiological Research Unit Rigshospitalet and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Antoine Yrondi
- Service de Psychiatrie et Psychologie Médicale, Centre Expert Dépression Résistante, Fondation Fondamental, CHU Toulouse, ToNIC, Toulouse NeuroImaging Center, Univerité de Toulouse, Inserm, UPS, Toulouse, France
| | - Patrice Péran
- ToNIC, Toulouse NeuroImaging Center, Univeristé de Toulouse, Inserm, UPS, Toulouse, France
| | - Carles Soriano-Mas
- Department of Social Psychology and Quantitative Psychology, Universitat de Barcelona-UB, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, Barcelona, Spain
- CIBERSAM, Carlos III Health Institute, Madrid, Spain
| | - Narcis Cardoner
- CIBERSAM, Carlos III Health Institute, Madrid, Spain
- Sant Pau Mental Health Research Group, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, School of Medicine Bellaterra, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Cano
- CIBERSAM, Carlos III Health Institute, Madrid, Spain
- Sant Pau Mental Health Research Group, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Linda van Diermen
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Psychiatric Center Bethanie, Andreas Vesaliuslaan 39, 2980, Zoersel, Belgium
| | - Didier Schrijvers
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- University Psychiatric Center Duffel, Stationstraat 22, Duffel, 2570, Belgium
| | - Jean-Baptiste Belge
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Psychiatry, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Louise Emsell
- Geriatric Psychiatry, University Psychiatric Center-KU Leuven, Leuven, Belgium
| | - Filip Bouckaert
- Geriatric Psychiatry, University Psychiatric Center-KU Leuven, Leuven, Belgium
| | | | - Maximilian Kiebs
- School of Medicine & Health Sciences University Hospital Oldenburg, Oldenburg, Germany
- Department of Psychiatry and Psychotherapy University Hospital Bonn, Bonn, Germany
| | - René Hurlemann
- School of Medicine & Health Sciences University Hospital Oldenburg, Oldenburg, Germany
| | - Peter Cr Mulders
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, the Netherlands
| | - Ronny Redlich
- Department of Psychology, University of Halle, Halle, Germany
- German Center for Mental Health (DZPG), Site Jena-Magdeburg-Halle, Halle, Germany
| | - Udo Dannlowski
- Department of Translational Psychiatry, University of Muenster, Muenster, Germany
| | - Erhan Kavakbasi
- Department of Mental Health, University of Muenster, Muenster, Germany
| | - Michael D Kritzer
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristen K Ellard
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joan A Camprodon
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Anil K Malhotra
- Feinstein Institutes for Medical Research, Institute of Behavioral Science, Manhasset, NY, USA
- The Zucker Hillside Hospital, Glen Oaks, NY, USA
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8
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Verdijk JPAJ, van de Mortel LA, Ten Doesschate F, Pottkämper JCM, Stuiver S, Bruin WB, Abbott CC, Argyelan M, Ousdal OT, Bartsch H, Narr K, Tendolkar I, Calhoun V, Lukemire J, Guo Y, Oltedal L, van Wingen G, van Waarde JA. Longitudinal resting-state network connectivity changes in electroconvulsive therapy patients compared to healthy controls. Brain Stimul 2024; 17:140-147. [PMID: 38101469 PMCID: PMC11145948 DOI: 10.1016/j.brs.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/28/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is effective for major depressive episodes. Understanding of underlying mechanisms has been increased by examining changes of brain connectivity but studies often do not correct for test-retest variability in healthy controls (HC). In this study, we investigated changes in resting-state networks after ECT in a multicenter study. METHODS Functional resting-state magnetic resonance imaging data, acquired before start and within one week after ECT, from 90 depressed patients were analyzed, as well as longitudinal data of 24 HC. Group-information guided independent component analysis (GIG-ICA) was used to spatially restrict decomposition to twelve canonical resting-state networks. Selected networks of interest were the default mode network (DMN), salience network (SN), and left and right frontoparietal network (LFPN, and RFPN). Whole-brain voxel-wise analyses were used to assess group differences at baseline, group by time interactions, and correlations with treatment effectiveness. In addition, between-network connectivity and within-network strengths were computed. RESULTS Within-network strength of the DMN was lower at baseline in ECT patients which increased after ECT compared to HC, after which no differences were detected. At baseline, ECT patients showed lower whole-brain voxel-wise DMN connectivity in the precuneus. Increase of within-network strength of the LFPN was correlated with treatment effectiveness. We did not find whole-brain voxel-wise or between-network changes. CONCLUSION DMN within-network connectivity normalized after ECT. Within-network increase of the LFPN in ECT patients was correlated with higher treatment effectiveness. In contrast to earlier studies, we found no whole-brain voxel-wise changes, which highlights the necessity to account for test-retest effects.
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Affiliation(s)
- Joey P A J Verdijk
- Rijnstate Hospital, Department of Psychiatry, P.O. Box 9555, 6800 TA Arnhem, the Netherlands; University of Twente, Department of Clinical Neurophysiology, Enschede, the Netherlands.
| | - Laurens A van de Mortel
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Freek Ten Doesschate
- Rijnstate Hospital, Department of Psychiatry, P.O. Box 9555, 6800 TA Arnhem, the Netherlands; Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Julia C M Pottkämper
- Rijnstate Hospital, Department of Psychiatry, P.O. Box 9555, 6800 TA Arnhem, the Netherlands; University of Twente, Department of Clinical Neurophysiology, Enschede, the Netherlands
| | - Sven Stuiver
- Rijnstate Hospital, Department of Psychiatry, P.O. Box 9555, 6800 TA Arnhem, the Netherlands; University of Twente, Department of Clinical Neurophysiology, Enschede, the Netherlands
| | - Willem B Bruin
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Christopher C Abbott
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Miklos Argyelan
- Center for Psychiatric Neuroscience at the Feinstein Institute for Medical Research, New York, NY, USA
| | - Olga T Ousdal
- Department of Biomedicine, University of Bergen, Bergen, Norway; Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Hauke Bartsch
- Department of Computer Science, University of Bergen, Bergen, Norway; Mohn Medical Imaging and Visualization Center, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Katherine Narr
- Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Indira Tendolkar
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, the Netherlands
| | - Vince Calhoun
- Tri-institutional center for Translational Research in Neuroimaging and Data Science (TReNDS) Center, Emory University, USA
| | - Joshua Lukemire
- Emory Center for Biomedical Imaging Statistics, Emory University, USA
| | - Ying Guo
- Emory Center for Biomedical Imaging Statistics, Emory University, USA
| | - Leif Oltedal
- Mohn Medical Imaging and Visualization Center, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Guido van Wingen
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Jeroen A van Waarde
- Rijnstate Hospital, Department of Psychiatry, P.O. Box 9555, 6800 TA Arnhem, the Netherlands
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9
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Takamiya A, Kishimoto T, Mimura M. What Can We Tell About the Effect of Electroconvulsive Therapy on the Human Hippocampus? Clin EEG Neurosci 2023; 54:584-593. [PMID: 34547937 DOI: 10.1177/15500594211044066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Electroconvulsive therapy (ECT) is the most effective antidepressant treatment, although its mechanisms of action remain unclear. Since 2010, several structural magnetic resonance imaging studies based on a neuroplastic hypothesis have consistently reported increases in the hippocampal volume following ECT. Moreover, volume increases in the human dentate gyrus, where neurogenesis occurs, have also been reported. These results are in line with the preclinical findings of ECT-induced neuroplastic changes, including neurogenesis, gliogenesis, synaptogenesis, and angiogenesis, in rodents and nonhuman primates. Despite this robust evidence of an effect of ECT on hippocampal plasticity, the clinical relevance of these human hippocampal changes continues to be questioned. This narrative review summarizes recent findings regarding ECT-induced hippocampal volume changes. Furthermore, this review also discusses methodological considerations and future directions in this field.
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Affiliation(s)
- Akihiro Takamiya
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Taishiro Kishimoto
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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10
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Frid LM, Kessler U, Ousdal OT, Hammar Å, Haavik J, Riemer F, Hirnstein M, Ersland L, Erchinger VJ, Ronold EH, Nygaard G, Jakobsen P, Craven AR, Osnes B, Alisauskiene R, Bartsch H, Le Hellard S, Stavrum AK, Oedegaard KJ, Oltedal L. Neurobiological mechanisms of ECT and TMS treatment in depression: study protocol of a multimodal magnetic resonance investigation. BMC Psychiatry 2023; 23:791. [PMID: 37904091 PMCID: PMC10617235 DOI: 10.1186/s12888-023-05239-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 09/30/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Noninvasive neurostimulation treatments are increasingly being used to treat major depression, which is a common cause of disability worldwide. While electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) are both effective in treating depressive episodes, their mechanisms of action are, however, not completely understood. ECT is given under general anesthesia, where an electrical pulse is administered through electrodes placed on the patient's head to trigger a seizure. ECT is used for the most severe cases of depression and is usually not prescribed before other options have failed. With TMS, brain stimulation is achieved through rapidly changing magnetic fields that induce electric currents underneath a ferromagnetic coil. Its efficacy in depressive episodes has been well documented. This project aims to identify the neurobiological underpinnings of both the effects and side effects of the neurostimulation techniques ECT and TMS. METHODS The study will utilize a pre-post case control longitudinal design. The sample will consist of 150 subjects: 100 patients (bipolar and major depressive disorder) who are treated with either ECT (N = 50) or TMS (N = 50) and matched healthy controls (N = 50) not receiving any treatment. All participants will undergo multimodal magnetic resonance imaging (MRI) as well as neuropsychological and clinical assessments at multiple time points before, during and after treatment. Arterial spin labeling MRI at baseline will be used to test whether brain perfusion can predict outcomes. Signs of brain disruption, potentiation and rewiring will be explored with resting-state functional MRI, magnetic resonance spectroscopy and multishell diffusion weighted imaging (DWI). Clinical outcome will be measured by clinician assessed and patient reported outcome measures. Memory-related side effects will be investigated, and specific tests of spatial navigation to test hippocampal function will be administered both before and after treatment. Blood samples will be stored in a biobank for future analyses. The observation time is 6 months. Data will be explored in light of the recently proposed disrupt, potentiate and rewire (DPR) hypothesis. DISCUSSION The study will contribute data and novel analyses important for our understanding of neurostimulation as well as for the development of enhanced and more personalized treatment. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05135897.
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Affiliation(s)
- Leila Marie Frid
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Ute Kessler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Olga Therese Ousdal
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Åsa Hammar
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden
- Office for Psychiatry and Habilitation, , Psychiatry Research Skåne, Region Skåne, Sweden
| | - Jan Haavik
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Frank Riemer
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Marco Hirnstein
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Lars Ersland
- Department of Clinical Engineering, Haukeland University Hospital, Bergen, Norway
| | - Vera Jane Erchinger
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Eivind Haga Ronold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Gyrid Nygaard
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Petter Jakobsen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Alexander R Craven
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Department of Clinical Engineering, Haukeland University Hospital, Bergen, Norway
| | - Berge Osnes
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | | | - Hauke Bartsch
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Stephanie Le Hellard
- NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway
- Dr. Einar Martens Research Group for Biological Psychiatry, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Anne-Kristin Stavrum
- NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway
- Dr. Einar Martens Research Group for Biological Psychiatry, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Ketil J Oedegaard
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Leif Oltedal
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway.
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
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11
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Bellini H, Cretaz E, Carneiro AM, da Silva PHR, dos Santos LA, Gallucci-Neto J, Brunoni AR. Magnetic Waves vs. Electric Shocks: A Non-Inferiority Study of Magnetic Seizure Therapy and Electroconvulsive Therapy in Treatment-Resistant Depression. Biomedicines 2023; 11:2150. [PMID: 37626647 PMCID: PMC10452083 DOI: 10.3390/biomedicines11082150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/22/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023] Open
Abstract
Treatment-resistant depression (TRD), characterized by the failure to achieve symptomatic remission despite multiple pharmacotherapeutic treatments, poses a significant challenge for clinicians. Electroconvulsive therapy (ECT) is an effective but limited option due to its cognitive side effects. In this context, magnetic seizure therapy (MST) has emerged as a promising alternative, offering comparable antidepressant efficacy with better cognitive outcomes. However, the clinical outcomes and cognitive effects of MST require further investigation. This double-blinded, randomized, non-inferiority study aims to compare the efficacy, tolerability, cognitive adverse effects, and neurophysiological biomarkers of MST with bilateral ECT (BT ECT) in patients with TRD. This study will employ multimodal nuclear magnetic resonance imaging (MRI) and serum neurotrophic markers to gain insight into the neurobiological basis of seizure therapy. Additionally, neurophysiological biomarkers will be evaluated as secondary outcomes to predict the antidepressant and cognitive effects of both techniques. The study design, recruitment methods, ethical considerations, eligibility criteria, interventions, and blinding procedures are described. The expected outcomes will advance the field by offering a potential alternative to ECT with improved cognitive outcomes and a better understanding of the underlying pathophysiology of depression and antidepressant therapies.
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Affiliation(s)
- Helena Bellini
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; (H.B.); (E.C.); (A.M.C.); (P.H.R.d.S.); (L.A.d.S.); (J.G.-N.)
- Service of Electroconvulsive Therapy, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Eric Cretaz
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; (H.B.); (E.C.); (A.M.C.); (P.H.R.d.S.); (L.A.d.S.); (J.G.-N.)
- Service of Electroconvulsive Therapy, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Adriana Munhoz Carneiro
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; (H.B.); (E.C.); (A.M.C.); (P.H.R.d.S.); (L.A.d.S.); (J.G.-N.)
- Service of Electroconvulsive Therapy, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Pedro Henrique Rodrigues da Silva
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; (H.B.); (E.C.); (A.M.C.); (P.H.R.d.S.); (L.A.d.S.); (J.G.-N.)
- Service of Electroconvulsive Therapy, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Leonardo Afonso dos Santos
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; (H.B.); (E.C.); (A.M.C.); (P.H.R.d.S.); (L.A.d.S.); (J.G.-N.)
- Service of Electroconvulsive Therapy, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - José Gallucci-Neto
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; (H.B.); (E.C.); (A.M.C.); (P.H.R.d.S.); (L.A.d.S.); (J.G.-N.)
- Service of Electroconvulsive Therapy, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - André Russowsky Brunoni
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; (H.B.); (E.C.); (A.M.C.); (P.H.R.d.S.); (L.A.d.S.); (J.G.-N.)
- Service of Electroconvulsive Therapy, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil
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Ten Doesschate F, Bruin W, Zeidman P, Abbott CC, Argyelan M, Dols A, Emsell L, van Eijndhoven PFP, van Exel E, Mulders PCR, Narr K, Tendolkar I, Rhebergen D, Sienaert P, Vandenbulcke M, Verdijk J, van Verseveld M, Bartsch H, Oltedal L, van Waarde JA, van Wingen GA. Effective resting-state connectivity in severe unipolar depression before and after electroconvulsive therapy. Brain Stimul 2023; 16:1128-1134. [PMID: 37517467 DOI: 10.1016/j.brs.2023.07.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/06/2023] [Accepted: 07/27/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND 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. OBJECTIVE We investigated whether there are consistent changes in effective resting-state connectivity. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Freek Ten Doesschate
- 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.
| | - Willem Bruin
- Amsterdam UMC Location University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Peter Zeidman
- Wellcome Centre for Human Neuroimaging, 12 Queen Square, London, WC1N 3AR, UK
| | - Christopher C Abbott
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Miklos Argyelan
- Center for Psychiatric Neuroscience at the Feinstein Institute for Medical Research, New York, NY, USA
| | - Annemieke Dols
- GGZ inGeest Specialized Mental Health Care, Department of Old Age Psychiatry, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, the Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, the Netherlands
| | - Louise Emsell
- Katholieke Universiteit Leuven, University Psychiatric Center Katholieke Universiteit Leuven, Leuven, Belgium
| | - Philip F P van Eijndhoven
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, the Netherlands; Department of Psychiatry, Radboud University Medical Centre, Huispost 961, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Eric van Exel
- GGZ inGeest Specialized Mental Health Care, Department of Old Age Psychiatry, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, the Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, the Netherlands
| | - Peter C R Mulders
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, the Netherlands; Department of Psychiatry, Radboud University Medical Centre, Huispost 961, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Katherine Narr
- Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Indira Tendolkar
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, the Netherlands; Department of Psychiatry, Radboud University Medical Centre, Huispost 961, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Didi Rhebergen
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, the Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, the Netherlands
| | - Pascal Sienaert
- Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (Catholic University of Leuven), Leuven, Belgium
| | - Mathieu Vandenbulcke
- Katholieke Universiteit Leuven, University Psychiatric Center Katholieke Universiteit Leuven, Leuven, Belgium
| | - Joey Verdijk
- Department of Psychiatry, Rijnstate Hospital, Arnhem, the Netherlands
| | | | - Hauke Bartsch
- Mohn Medical Imaging and Visualization Center, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Leif Oltedal
- Mohn Medical Imaging and Visualization Center, Department of Radiology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Guido A van Wingen
- Amsterdam UMC Location University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands
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Freundlieb N, Schneider E, Brühl A, Kiebs M. GENET-GPD: A documentation tool to digitally collect longitudinal ECT treatment data and associated biosignals. Brain Stimul 2023; 16:1173-1175. [PMID: 37517468 DOI: 10.1016/j.brs.2023.07.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 08/01/2023] Open
Affiliation(s)
- Nils Freundlieb
- GIB-Stiftung, Berlin, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Affective, Stress and Sleep Disorders (ZASS), University Psychiatric Hospital (UPK), Basel, Switzerland.
| | - Else Schneider
- Center for Affective, Stress and Sleep Disorders (ZASS), University Psychiatric Hospital (UPK), Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Annette Brühl
- Center for Affective, Stress and Sleep Disorders (ZASS), University Psychiatric Hospital (UPK), Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Maximilian Kiebs
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany; Department of Psychiatry and Psychotherapy, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Germany
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14
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Erchinger VJ, Craven AR, Ersland L, Oedegaard KJ, Bartz-Johannessen CA, Hammar Å, Haavik J, Riemer F, Kessler U, Oltedal L. Electroconvulsive therapy triggers a reversible decrease in brain N-acetylaspartate. Front Psychiatry 2023; 14:1155689. [PMID: 37363174 PMCID: PMC10289547 DOI: 10.3389/fpsyt.2023.1155689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/02/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Based on previous research on electroconvulsive therapy (ECT) we have proposed a model where disruption, potentiation, and rewiring of brain networks occur in sequence and serve as the underlying therapeutic mechanism of ECT. This model implies that a temporary disturbance of neuronal networks (disruption) is followed by a trophic effect (potentiation), which enables the rewiring of neuronal circuits to a more euthymic functioning brain. We hypothesized that disruption of neuronal networks could trigger biochemical alterations leading to a temporary decrease in N-acetylaspartate (tNAA, considered a marker of neuronal integrity), while choline (a membrane component), myo-Inositol (mI, astroglia marker), and glutamate/glutamine (Glx, excitatory neurotransmitter) were postulated to increase. Previous magnetic resonance spectroscopy studies, reporting diverse findings, have used two different referencing methods - creatine ratios and tissue corrected values referenced to water - for the quantification of brain metabolites. Changes in creatine during ECT have also been reported, which may confound estimates adopting this as an internal reference. Methods Using MR spectroscopy, we investigated 31 moderately to severely depressed patients and 19 healthy controls before, during, and after ECT or at similar time points (for controls). We tested whether biochemical alterations in tNAA, choline, mI, and Glx lend support to the disrupt, potentiate, and rewire hypothesis. We used both creatine ratios and water-scaled values for the quantification of brain metabolites to validate the results across referencing methods. Results Levels of tNAA in the anterior cingulate cortex decreased after an ECT treatment series (average 10.6 sessions) by 6% (p = 0.007, creatine ratio) and 3% (p = 0.02, water referenced) but returned to baseline 6 months after ECT. Compared to after treatment series tNAA levels at 6-month follow-up had increased in both creatine ratio (+6%, p < 0.001) and water referenced data (+7%, p < 0.001). Findings for other brain metabolites varied and could not be validated across referencing methods. Discussion Our findings suggest that prior research must be interpreted with care, as several referencing and processing methods have been used in the past. Yet, the results for tNAA were robust across quantification methods and concur with relevant parts of the disrupt, potentiate, and rewire model.
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Affiliation(s)
- Vera J. Erchinger
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Alexander R. Craven
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- NORMENT—Norwegian Centre for Mental Disorders Research, University of Bergen, Bergen, Norway
- Department of Clinical Engineering, Haukeland University Hospital, Bergen, Norway
| | - Lars Ersland
- Department of Clinical Engineering, Haukeland University Hospital, Bergen, Norway
| | - Ketil J. Oedegaard
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- NORMENT—Norwegian Centre for Mental Disorders Research, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | | | - Åsa Hammar
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Jan Haavik
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Frank Riemer
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Ute Kessler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- NORMENT—Norwegian Centre for Mental Disorders Research, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Leif Oltedal
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
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15
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Deng ZD, Ousdal OT, Oltedal L, Angulo B, Baradits M, Spitzberg A, Kessler U, Sartorius A, Dols A, Narr K, Espinoza R, Van Waarde J, Tendolkar I, van Eijndhoven P, van Wingen G, Takamiya A, Kishimoto T, Jorgensen M, Jorgensen A, Paulson O, Yrondi A, Peran P, Soriano-Mas C, Cardoner N, Cano M, van Diermen L, Schrijvers D, Belge JB, Emsell L, Bouckaert F, Vandenbulcke M, Kiebs M, Hurlemann R, Mulders P, Redlich R, Dannlowski U, Kavakbasi E, Kritzer M, Ellard K, Camprodon J, Petrides G, Maholtra A, Abbott C, Argyelan M. Electroconvulsive therapy-induced volumetric brain changes converge on a common causal circuit in depression. RESEARCH SQUARE 2023:rs.3.rs-2925196. [PMID: 37398308 PMCID: PMC10312966 DOI: 10.21203/rs.3.rs-2925196/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Neurostimulation is a mainstream treatment option for major depression. Neuromodulation techniques apply repetitive magnetic or electrical stimulation to some neural target but significantly differ in their invasiveness, spatial selectivity, mechanism of action, and efficacy. Despite these differences, recent analyses of transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS)-treated individuals converged on a common neural network that might have a causal role in treatment response. We set out to investigate if the neuronal underpinnings of electroconvulsive therapy (ECT) are similarly associated with this common causal network (CCN). Our aim here is to provide a comprehensive analysis in three cohorts of patients segregated by electrode placement (N = 246 with right unilateral, 79 with bitemporal, and 61 with mixed) who underwent ECT. We conducted a data-driven, unsupervised multivariate neuroimaging analysis (Principal Component Analysis, PCA) of the cortical and subcortical volume changes and electric field (EF) distribution to explore changes within the CCN associated with antidepressant outcomes. Despite the different treatment modalities (ECT vs TMS and DBS) and methodological approaches (structural vs functional networks), we found a highly similar pattern of change within the CCN in the three cohorts of patients (spatial similarity across 85 regions: r = 0.65, 0.58, 0.40, df = 83). Most importantly, the expression of this pattern correlated with clinical outcomes. This evidence further supports that treatment interventions converge on a CCN in depression. Optimizing modulation of this network could serve to improve the outcome of neurostimulation in depression.
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Affiliation(s)
| | | | - Leif Oltedal
- Department of Clinical Medicine, University of Bergen
| | - Brian Angulo
- Department of Clinical Medicine, University of Bergen
| | - Mate Baradits
- Department of Clinical Medicine, University of Bergen
| | | | - Ute Kessler
- Department of Clinical Medicine, University of Bergen
| | | | - Annemiek Dols
- Geffen School of Medicine at the University of California, Los Angeles
| | - Katherine Narr
- Geffen School of Medicine at the University of California, Los Angeles
| | - Randall Espinoza
- Departments of Neurology, Psychiatry and Biobehavioral Sciences, University of California
| | | | - Indira Tendolkar
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry
| | | | | | | | | | | | | | | | | | | | | | - Narcís Cardoner
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau. Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Sa
| | | | | | | | | | | | | | | | | | - Rene Hurlemann
- Institute for Translational Psychiatry, University of Münster
| | - Peter Mulders
- Institute for Translational Psychiatry, University of Münster
| | - Ronny Redlich
- Institute for Translational Psychiatry, University of Münster
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster
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16
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Kritzer MD, Peterchev AV, Camprodon JA. Electroconvulsive Therapy: Mechanisms of Action, Clinical Considerations, and Future Directions. Harv Rev Psychiatry 2023; 31:101-113. [PMID: 37171471 PMCID: PMC10198476 DOI: 10.1097/hrp.0000000000000365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
LEARNING OBJECTIVES • Outline and discuss the fundamental physiologic, cellular, and molecular mechanisms of ECT to devise strategies to optimize therapeutic outcomes• Summarize the overview of ECT, its efficacy in treating depression, the known effects on cognition, evidence of mechanisms, and future directions. ABSTRACT Electroconvulsive therapy (ECT) is the most effective treatment for a variety of psychiatric illnesses, including treatment-resistant depression, bipolar depression, mania, catatonia, and clozapine-resistant schizophrenia. ECT is a medical and psychiatric procedure whereby electrical current is delivered to the brain under general anesthesia to induce a generalized seizure. ECT has evolved a great deal since the 1930s. Though it has been optimized for safety and to reduce adverse effects on cognition, issues persist. There is a need to understand fundamental physiologic, cellular, and molecular mechanisms of ECT to devise strategies to optimize therapeutic outcomes. Clinical trials that set out to adjust parameters, electrode placement, adjunctive medications, and patient selection are critical steps towards the goal of improving outcomes with ECT. This narrative review provides an overview of ECT, its efficacy in treating depression, its known effects on cognition, evidence of its mechanisms, and future directions.
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Affiliation(s)
- Michael D Kritzer
- From the Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA (Drs. Kritzer, Camprodon); Department of Psychiatry and Behavioral Sciences, Department of Biomedical Engineering, Department of Electrical and Computer Engineering, Department of Neurosurgery, Duke University, Durham, NC (Dr. Peterchev)
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17
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Ahmad Hariza AM, Mohd Yunus MH, Murthy JK, Wahab S. Clinical Improvement in Depression and Cognitive Deficit Following Electroconvulsive Therapy. Diagnostics (Basel) 2023; 13:diagnostics13091585. [PMID: 37174977 PMCID: PMC10178332 DOI: 10.3390/diagnostics13091585] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/17/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
Electroconvulsive therapy (ECT) is a long-standing treatment choice for disorders such as depression when pharmacological treatments have failed. However, a major drawback of ECT is its cognitive side effects. While numerous studies have investigated the therapeutic effects of ECT and its mechanism, much less research has been conducted regarding the mechanism behind the cognitive side effects of ECT. As both clinical remission and cognitive deficits occur after ECT, it is possible that both may share a common mechanism. This review highlights studies related to ECT as well as those investigating the mechanism of its outcomes. The process underlying these effects may lie within BDNF and NMDA signaling. Edema in the astrocytes may also be responsible for the adverse cognitive effects and is mediated by metabotropic glutamate receptor 5 and the protein Homer1a.
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Affiliation(s)
- Ahmad Mus'ab Ahmad Hariza
- Department of Physiology, Faculty of Medicine, UKM Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
| | - Mohd Heikal Mohd Yunus
- Department of Physiology, Faculty of Medicine, UKM Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
| | - Jaya Kumar Murthy
- Department of Physiology, Faculty of Medicine, UKM Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
| | - Suzaily Wahab
- Department of Psychiatry, Faculty of Medicine, UKM Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
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18
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Blanken MAJT, Oudega ML, Hoogendoorn AW, Sonnenberg CS, Rhebergen D, Klumpers UMH, Van Diermen L, Birkenhager T, Schrijvers D, Redlich R, Dannlowski U, Heindel W, Coenjaerts M, Nordanskog P, Oltedal L, Kessler U, Frid LM, Takamiya A, Kishimoto T, Jorgensen MB, Jorgensen A, Bolwig T, Emsell L, Sienaert P, Bouckaert F, Abbott CC, Péran P, Arbus C, Yrondi A, Kiebs M, Philipsen A, van Waarde JA, Prinsen E, van Verseveld M, Van Wingen G, Ten Doesschate F, Camprodon JA, Kritzer M, Barbour T, Argyelan M, Cardoner N, Urretavizcaya M, Soriano-Mas C, Narr KL, Espinoza RT, Prudic J, Rowny S, van Eijndhoven P, Tendolkar I, Dols A. Sex-specifics of ECT outcome. J Affect Disord 2023; 326:243-248. [PMID: 36632848 DOI: 10.1016/j.jad.2022.12.144] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 12/23/2022] [Accepted: 12/25/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is the most effective treatment for patients with severe major depressive disorder (MDD). Given the known sex differences in MDD, improved knowledge may provide more sex-specific recommendations in clinical guidelines and improve outcome. In the present study we examine sex differences in ECT outcome and its predictors. METHODS Clinical data from 20 independent sites participating in the Global ECT-MRI Research Collaboration (GEMRIC) were obtained for analysis, totaling 500 patients with MDD (58.6 % women) with a mean age of 54.8 years. Severity of depression before and after ECT was assessed with validated depression scales. Remission was defined as a HAM-D score of 7 points or below after ECT. Variables associated with remission were selected based on literature (i.e. depression severity at baseline, age, duration of index episode, and presence of psychotic symptoms). RESULTS Remission rates of ECT were independent of sex, 48.0 % in women and 45.7 % in men (X2(1) = 0.2, p = 0.70). In the logistic regression analyses, a shorter index duration was identified as a sex-specific predictor for ECT outcome in women (X2(1) = 7.05, p = 0.01). The corresponding predictive margins did show overlapping confidence intervals for men and women. CONCLUSION The evidence provided by our study suggests that ECT as a biological treatment for MDD is equally effective in women and men. A shorter duration of index episode was an additional sex- specific predictor for remission in women. Future research should establish whether the confidence intervals for the corresponding predictive margins are overlapping, as we find, or not.
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Affiliation(s)
- M A J T Blanken
- Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam UMC, location Vumc, Amsterdam, the Netherlands.
| | - M L Oudega
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands; Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam UMC, location Vumc, Amsterdam, the Netherlands
| | - A W Hoogendoorn
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands; Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam UMC, location Vumc, Amsterdam, the Netherlands
| | - C S Sonnenberg
- Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; GGZ Parnassia NH, Specialized Mental Health Care, Castricum, the Netherlands
| | - D Rhebergen
- Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam UMC, location Vumc, Amsterdam, the Netherlands; GGZ Centraal, Specialized Mental Health Care, Amersfoort, the Netherlands
| | - U M H Klumpers
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands; Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam UMC, location Vumc, Amsterdam, the Netherlands
| | - L Van Diermen
- Psychiatric Center Bethanië, Andreas Vesaliuslaan 39, 2980 Zoersel, Belgium; Department of Biomedical Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp. Universiteitsplein 1, 2610 Antwerp, Belgium; University Psychiatric Center (UPC) Duffel, Stationsstraat 22c, 2570 Duffel, Belgium
| | - T Birkenhager
- Department of Biomedical Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp. Universiteitsplein 1, 2610 Antwerp, Belgium; Erasmus MC, Rotterdam, the Netherlands
| | - D Schrijvers
- Department of Biomedical Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp. Universiteitsplein 1, 2610 Antwerp, Belgium; University Psychiatric Center (UPC) Duffel, Stationsstraat 22c, 2570 Duffel, Belgium
| | - R Redlich
- Department of Psychology, University of Halle, Germany; Institute for Translational Psychiatry, University of Münster Germany, Germany
| | - U Dannlowski
- Institute for Translational Psychiatry, University of Münster Germany, Germany
| | - W Heindel
- Department of Radiology, University of Münster Germany, Germany
| | - M Coenjaerts
- Division of Medical Psychology, Department of Psychiatry and Psychotherapy, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - P Nordanskog
- Center for Social and Affective Neuroscience (CSAN), Department of Biomedical and Clinical Sciences, Linköping University, Department of Psychiatry, Linköping University Hospital, Sweden
| | - L Oltedal
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - U Kessler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - L M Frid
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - A Takamiya
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan; Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Belgium
| | - T Kishimoto
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan
| | - M B Jorgensen
- Psychiatric Centre Copenhagen and Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - A Jorgensen
- Psychiatric Centre Copenhagen and Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - T Bolwig
- Psychiatric Centre Copenhagen and Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - L Emsell
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Belgium
| | - P Sienaert
- Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center (UPC) - KU Leuven, Kortenberg, Belgium
| | - F Bouckaert
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Belgium
| | - C C Abbott
- University of New Mexico Department of Psychiatry, 87131, United States of America
| | - P Péran
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - C Arbus
- Service de Psychiatrie et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU Toulouse, Hospital Purpan, ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - A Yrondi
- Service de Psychiatrie et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU Toulouse, Hospital Purpan, ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - M Kiebs
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany; Section of Medical Psychology, University of Bonn, Bonn, Germany; School of Medicine & Health Sciences University Hospital Oldenburg at the Karl-Jaspers Clinic, Germany
| | - A Philipsen
- Section of Medical Psychology, University of Bonn, Bonn, Germany
| | | | | | | | - G Van Wingen
- Amsterdam UMC, location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - F Ten Doesschate
- Rijnstate Arnhem, the Netherlands; Amsterdam UMC, location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, the Netherlands
| | - J A Camprodon
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - M Kritzer
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - T Barbour
- Massachusetts General Hospital, United States of America
| | - M Argyelan
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, United States of America
| | - N Cardoner
- Sant Pau Mental Health Research Group, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, School of Medicine Bellaterra, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBERSAM, Carlos III Health Institute, Madrid, Spain
| | - M Urretavizcaya
- CIBERSAM, Carlos III Health Institute, Madrid, Spain; Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, Barcelona, Spain; Department of Clinical Sciences, Bellvitge Campus, Universitat de Barcelona-UB, Barcelona, Spain
| | - C Soriano-Mas
- CIBERSAM, Carlos III Health Institute, Madrid, Spain; Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, Barcelona, Spain; Department of Social Psychology and Quantitative Psychology, Universitat de Barcelona-UB, Barcelona, Spain
| | - K L Narr
- Department of Neurology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, United States of America
| | - R T Espinoza
- Department of Neurology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, United States of America
| | - J Prudic
- Columbia University Irving Medical Center, United States of America
| | - S Rowny
- Columbia University Irving Medical Center, United States of America
| | | | - I Tendolkar
- Radboud University, Nijmegen, the Netherlands
| | - A Dols
- Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam UMC, location Vumc, Amsterdam, the Netherlands; Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
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19
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Hsieh MH. Electroconvulsive therapy for treatment-resistant depression. PROGRESS IN BRAIN RESEARCH 2023; 281:69-90. [PMID: 37806717 DOI: 10.1016/bs.pbr.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Electroconvulsive therapy (ECT), the oldest brain stimulation procedure in psychiatry, is associated with rapid response and remission in majority of patients with resistant, severe, and sometimes life-threatening depression. ECT has been included as an essential component in the definition of treatment-resistant depression (TRD) to display the course and diversification of TRD. On the other hand, ECT remains the treatment of choice for the most severe incapacitating forms of TRD and is a cost-effective treatment. In this chapter, we reviewed some essential studies, meta-analysis, and expert guidelines regarding ECT in TRD. ECT should not be considered as a treatment of last resort, and its administration should be considered on the basis of individual patient and illness factors. The clinical role of ECT vs other neurostimulation treatments for TRD, that is, repetitive transcranial magnetic stimulation, were also explored. Much effort has been directed toward the clinical and basic research about mechanisms of action of ECT in depression. A thorough understanding of the neurobiological effects of ECT may increase our understanding of its therapeutic effects, ultimately leading to improved patient care. We also showed that the distinct mechanisms of ECT in biological treatments of major depressive disorder (MDD) and some recent approaches to understand this most common psychiatric disorder. ECT should remain a standard part of modern psychiatric medicine. We recommend a more careful and thoughtful application of this traditional but effective technology.
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Affiliation(s)
- Ming H Hsieh
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
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20
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Shavitt RG, Sheshachala K, Hezel DM, Wall MM, Balachander S, Lochner C, Narayanaswamy JC, Costa DLC, de Mathis MA, van Balkom AJLM, de Joode NT, Narayan M, van den Heuvel OA, Stein DJ, Miguel EC, Simpson HB, Reddy YCJ. Measurement fidelity of clinical assessment methods in a global study on identifying reproducible brain signatures of obsessive-compulsive disorder. Neuropsychology 2023; 37:330-343. [PMID: 36442004 PMCID: PMC10073274 DOI: 10.1037/neu0000849] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To describe the steps of ensuring measurement fidelity of core clinical measures in a five-country study on brain signatures of obsessive-compulsive disorder (OCD). METHOD We collected data using standardized instruments, which included the Yale-Brown Obsessive-Compulsive Scale (YBOCS), the Dimensional YBOCS (DYBOCS), the Brown Assessment of Beliefs Scale (BABS), the 17-item Hamilton Depression Scale (HAM-D), the Hamilton Anxiety Scale (HAM-A), and the Structured Clinical Interview for DSM-5 (SCID). Steps to ensure measurement fidelity included translating instruments, developing a clinical decision manual, and continuing reliability training with 11-13 transcripts of each instrument by 13 independent evaluators across sites over 4 years. We use multigroup confirmatory factor analysis (MGCFA) to report interrater reliability (IRR) among the evaluators and factor structure for each scale in 206 participants with OCD. RESULTS The overall IRR for most scales was high (ICC > 0.94) and remained good to excellent throughout the study. Consistent factor structures (configural invariance) were found for all instruments across the sites, while similarity in the factor loadings for the items (metric invariance) could be established only for the DYBOCS and the BABS. CONCLUSIONS It is feasible to achieve measurement fidelity of clinical measures in multisite, multilinguistic global studies, despite the challenges inherent to such endeavors. Future studies should not only report IRR but also consider reporting methods of standardization of data collection and measurement invariance to identify factor structures of core clinical measures. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Roseli G Shavitt
- Obsessive-Compulsive Spectrum Disorders Program (PROTOC-IPq-HCFMUSP)
| | | | | | | | | | - Christine Lochner
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders
| | | | - Daniel L C Costa
- Obsessive-Compulsive Spectrum Disorders Program (PROTOC-IPq-HCFMUSP)
| | | | | | | | | | | | - Dan J Stein
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders
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21
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Greenstein SP, Petrides G, Fricchione G. Consultation-Liaison Case Conference: Malignantly Catatonic and Unable to Receive Electroconvulsive Therapy. J Acad Consult Liaison Psychiatry 2023; 64:158-165. [PMID: 36283620 DOI: 10.1016/j.jaclp.2022.10.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
We present the case of a 65-year-old female with a past psychiatric history of obsessive-compulsive disorder and anxiety who recently underwent diagnostic laparoscopy in the setting of a recent computerized tomography scan revealing a peritoneal mass. Postoperatively, she was delirious and soon found to be malignantly catatonic. This patient's treatment was complicated by an acute stroke, which was a relative contraindication for electroconvulsive therapy. Top experts in the consultation-liaison psychiatry and electroconvulsive therapy fields provide guidance for this clinical scenario based on their experience and a review of the available literature. Key teaching points include a review of diagnosing and treating catatonia, a review of electroconvulsive therapy for the treatment of catatonia, as well as a review of the role of the consultation-liaison psychiatrist in medically complex cases. Specifically, we offer guidance in treating patients that have malignant catatonia when electroconvulsive therapy is unavailable.
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Affiliation(s)
- Samuel P Greenstein
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY; Consultation-Liaison Psychiatry, Long Island Jewish Medical Center/Northwell Health, New Hyde Park, NY; Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.
| | - Georgios Petrides
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY; Consultation-Liaison Psychiatry, Long Island Jewish Medical Center/Northwell Health, New Hyde Park, NY; Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Gregory Fricchione
- Division of Psychiatry and Medicine, Mass General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
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22
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Cano M, Lee E, Worthley A, Ellard K, Barbour T, Soriano-Mas C, Camprodon JA. Electroconvulsive therapy effects on anhedonia and reward circuitry anatomy: A dimensional structural neuroimaging approach. J Affect Disord 2022; 313:243-250. [PMID: 35764228 DOI: 10.1016/j.jad.2022.06.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/30/2022] [Accepted: 06/22/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Anhedonia is a core symptom of major depressive disorder (MDD) resulting from maladaptive reward processing. Electroconvulsive therapy (ECT) is an effective treatment for patients with MDD. No previous neuroimaging studies have taken a dimensional approach to assess whether ECT-induced volume changes are specifically related to improvements in anhedonia and positive valence emotional constructs. We aimed to assess the relationship between ECT-induced brain volumetric changes and improvement in anhedonia and reward processing in patients with MDD. METHODS We evaluated 15 patients with MDD before and after ECT. We used magnetic resonance imaging, clinical scales (i.e., Quick Inventory of Depressive Symptomatology for syndromal depression severity and Snaith-Hamilton Pleasure Scale for anhedonia) and the Temporal Experience of Pleasure Scale for anticipatory and consummatory experiences of pleasure. We identified 5 regions of interest within the reward circuit and a 6th control region relevant for MDD but not core to the reward system (Brodmann Area 25). RESULTS Anhedonia, anticipatory and consummatory reward processing improved after ECT. Volume increases within the right reward system separated anhedonia responders and non-responders. Improvement in anticipatory (but not consummatory) reward correlated with increases in volume in hippocampus, amygdala, ventral tegmental area and nucleus accumbens. LIMITATIONS We evaluated a modest sample size of patients with concurrent pharmacological treatment using a subjective psychometric assessment. CONCLUSIONS We highlight the importance of a dimensional and circuit-based approach to understanding target engagement and the mechanism of action of ECT, with the goal to define symptom- and circuit-specific response biomarkers for device neuromodulation therapies.
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Affiliation(s)
- Marta Cano
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Mental Health Department, Unitat de Neurociència Traslacional, Parc Tauli University Hospital, Institut d'Investigació i Innovació Sanitària Parc Tauli (I3PT), Barcelona, Spain; CIBERSAM, Carlos III Health Institute, Madrid, Spain; Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Erik Lee
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexis Worthley
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristen Ellard
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tracy Barbour
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Carles Soriano-Mas
- CIBERSAM, Carlos III Health Institute, Madrid, Spain; Department of Psychiatry, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Social Psychology and Quantitative Psychology, Universitat de Barcelona-UB, Barcelona, Spain.
| | - Joan A Camprodon
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Zandi PP, Morreale M, Reti IM, Maixner DF, McDonald WM, Patel PD, Achtyes E, Bhati MT, Carr BR, Conroy SK, Cristancho M, Dubin MJ, Francis A, Glazer K, Ingram W, Khurshid K, McClintock SM, Pinjari OF, Reeves K, Rodriguez NF, Sampson S, Seiner SJ, Selek S, Sheline Y, Smetana RW, Soda T, Trapp NT, Wright JH, Husain M, Weiner RD. National Network of Depression Centers' Recommendations on Harmonizing Clinical Documentation of Electroconvulsive Therapy. J ECT 2022; 38:159-164. [PMID: 35704844 PMCID: PMC9420739 DOI: 10.1097/yct.0000000000000840] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 01/07/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Electroconvulsive therapy (ECT) is a highly therapeutic and cost-effective treatment for severe and/or treatment-resistant major depression. However, because of the varied clinical practices, there is a great deal of heterogeneity in how ECT is delivered and documented. This represents both an opportunity to study how differences in implementation influence clinical outcomes and a challenge for carrying out coordinated quality improvement and research efforts across multiple ECT centers. The National Network of Depression Centers, a consortium of 26+ US academic medical centers of excellence providing care for patients with mood disorders, formed a task group with the goals of promoting best clinical practices for the delivery of ECT and to facilitate large-scale, multisite quality improvement and research to advance more effective and safe use of this treatment modality. The National Network of Depression Centers Task Group on ECT set out to define best practices for harmonizing the clinical documentation of ECT across treatment centers to promote clinical interoperability and facilitate a nationwide collaboration that would enable multisite quality improvement and longitudinal research in real-world settings. This article reports on the work of this effort. It focuses on the use of ECT for major depressive disorder, which accounts for the majority of ECT referrals in most countries. However, most of the recommendations on clinical documentation proposed herein will be applicable to the use of ECT for any of its indications.
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Affiliation(s)
- Peter P. Zandi
- From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Michael Morreale
- From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Irving M. Reti
- From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - William M. McDonald
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Paresh D. Patel
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - Eric Achtyes
- Division of Psychiatry and Behavioral Medicine, Michigan State University, Grand Rapids, MI
| | - Mahendra T. Bhati
- Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Brent R. Carr
- Department of Psychiatry, University of Florida Health, Gainsville, FL
| | - Susan K. Conroy
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - Mario Cristancho
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Marc J. Dubin
- Department of Psychiatry, Weill Cornell Medicine, New York, NY
| | - Andrew Francis
- Department of Psychiatry and Behavioral Health, Penn State University, Hershey, PA
| | - Kara Glazer
- From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Wendy Ingram
- Department of Mental Health, Johns Hopkins University, Baltimore, MD
| | - Khurshid Khurshid
- Department of Psychiatry, UMass Memorial Health Care, Worchester, MA
| | | | - Omar F. Pinjari
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Care Center at Houston, Houston, TX
| | - Kevin Reeves
- Department of Psychiatry and Behavioral Health, Ohio State University College of Medicine
| | - Nelson F. Rodriguez
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinatti, OH
| | - Shirlene Sampson
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | | | - Salih Selek
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Care Center at Houston, Houston, TX
| | - Yvette Sheline
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Roy W. Smetana
- Department of Psychiatry, Weill Cornell Medicine, New York, NY
| | - Takahiro Soda
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Nicholas T. Trapp
- Department of Psychiatry, Carver College of Medicine, University of Iowa Healthcare, Iowa City, IA
| | - Jesse H. Wright
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY
| | - Mustafa Husain
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX
| | - Richard D. Weiner
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
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The Association Between Sample and Treatment Characteristics and the Efficacy of Repetitive Transcranial Magnetic Stimulation in Depression: A Meta-analysis and Meta-regression of Sham-controlled Trials. Neurosci Biobehav Rev 2022; 141:104848. [PMID: 36049675 DOI: 10.1016/j.neubiorev.2022.104848] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is a form of non-invasive neuromodulation that is increasingly used to treat major depressive disorder (MDD). However, treatment with rTMS could be optimized by identifying optimal treatment parameters or characteristics of patients that are most likely to benefit. This meta-analysis and meta-regression aims to identify sample and treatment characteristics that are associated with change in depressive symptom level, treatment response and remission. METHODS The databases PubMed, Embase, Web of Science and Cochrane library were searched for randomized controlled trials (RCTs) reporting on the therapeutic efficacy of high-frequent, low-frequent, or bilateral rTMS for MDD compared to sham. Study and sample characteristics as well as rTMS parameters and outcome variables were extracted. Effect sizes were calculated for change in depression score and risk ratios for response and remission. RESULTS Sixty-five RCTs with a total of 2982 subjects were included in this meta-analysis. Active rTMS resulted in a larger depressive symptom reduction than sham protocol (Hedges' g = -0.791 95% CI -0.977; -0.605). Risk ratios for response and remission were 2.378 (95% CI 1.882; 3.005) and 2.450 (95% CI 1.779; 3.375), respectively. We found no significant association between sample and treatment parameters and rTMS efficacy. CONCLUSIONS rTMS is an efficacious treatment for MDD. No associations between sample or treatment characteristics and efficacy were found, for which we caution that publication bias, heterogeneity and lack of consistency in the definition of remission might bias these latter null findings. Our results are clinically relevant and support the use of rTMS as a non-invasive and effective treatment option for depression.
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Leaver AM, Espinoza R, Wade B, Narr KL. Parsing the Network Mechanisms of Electroconvulsive Therapy. Biol Psychiatry 2022; 92:193-203. [PMID: 35120710 PMCID: PMC9196257 DOI: 10.1016/j.biopsych.2021.11.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/03/2021] [Accepted: 11/19/2021] [Indexed: 12/17/2022]
Abstract
Electroconvulsive therapy (ECT) is one of the oldest and most effective forms of neurostimulation, wherein electrical current is used to elicit brief, generalized seizures under general anesthesia. When electrodes are positioned to target frontotemporal cortex, ECT is arguably the most effective treatment for severe major depression, with response rates and times superior to other available antidepressant therapies. Neuroimaging research has been pivotal in improving the field's mechanistic understanding of ECT, with a growing number of magnetic resonance imaging studies demonstrating hippocampal plasticity after ECT, in line with evidence of upregulated neurotrophic processes in the hippocampus in animal models. However, the precise roles of the hippocampus and other brain regions in antidepressant response to ECT remain unclear. Seizure physiology may also play a role in antidepressant response to ECT, as indicated by early positron emission tomography, single-photon emission computed tomography, and electroencephalography research and corroborated by recent magnetic resonance imaging studies. In this review, we discuss the evidence supporting neuroplasticity in the hippocampus and other brain regions during and after ECT, and their associations with antidepressant response. We also offer a mechanistic, circuit-level model that proposes that core mechanisms of antidepressant response to ECT involve thalamocortical and cerebellar networks that are active during seizure generalization and termination over repeated ECT sessions, and their interactions with corticolimbic circuits that are dysfunctional prior to treatment and targeted with the electrical stimulus.
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Affiliation(s)
- Amber M Leaver
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Evanston, Illinois.
| | - Randall Espinoza
- Department of Psychiatry and Behavioral Sciences, Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Benjamin Wade
- Department of Neurology, Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Katherine L Narr
- Department of Neurology, Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Department of Psychiatry and Behavioral Sciences, Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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26
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Multimodal multi-center analysis of electroconvulsive therapy effects in depression: Brainwide gray matter increase without functional changes. Brain Stimul 2022; 15:1065-1072. [DOI: 10.1016/j.brs.2022.07.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 11/18/2022] Open
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27
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Jiang Y, Duan M, He H, Yao D, Luo C. Structural and Functional MRI Brain Changes in Patients with Schizophrenia Following Electroconvulsive Therapy: A Systematic Review. Curr Neuropharmacol 2022; 20:1241-1252. [PMID: 34370638 PMCID: PMC9886826 DOI: 10.2174/1570159x19666210809101248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/17/2021] [Accepted: 07/31/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Schizophrenia (SZ) is a severe psychiatric disorder typically characterized by multidimensional psychotic syndromes. Electroconvulsive therapy (ECT) is a treatment option for medication-resistant patients with SZ or treating acute symptoms. Although the efficacy of ECT has been demonstrated in clinical use, its therapeutic mechanisms in the brain remain elusive. OBJECTIVE This study aimed to summarize brain changes on structural magnetic resonance imaging (sMRI) and functional MRI (fMRI) after ECT. METHODS According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was carried out. The PubMed and Medline databases were systematically searched using the following medical subject headings (MeSH): (electroconvulsive therapy OR ECT) AND (schizophrenia) AND (MRI OR fMRI OR DTI OR DWI). RESULTS This review yielded 12 MRI studies, including 4 with sMRI, 5 with fMRI and 3 with multimodal MRI. Increases in volumes of the hippocampus and its adjacent regions (parahippocampal gyrus and amygdala), as well as the insula and frontotemporal regions, were noted after ECT. fMRI studies found ECT-induced changes in different brain regions/networks, including the hippocampus, amygdala, default model network, salience network and other regions/networks that are thought to highly correlate with the pathophysiologic characteristics of SZ. The results of the correlation between brain changes and symptom remissions are inconsistent. CONCLUSION Our review provides evidence supporting ECT-induced brain changes on sMRI and fMRI in SZ and explores the relationship between these changes and symptom remission.
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Affiliation(s)
- Yuchao Jiang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, P.R. China; ,High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, P.R. China;
| | - Mingjun Duan
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, P.R. China; ,Address correspondence to these authors at the The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Second North Jianshe Road, Chengdu 610054, China; Tel: 86-28-83201018; Fax: 86-28-83208238; E-mails: (C. Luo) and (M. Duan)
| | - Hui He
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, P.R. China; ,High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, P.R. China;
| | - Dezhong Yao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, P.R. China; ,High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, P.R. China; ,Research Unit of NeuroInformation (2019RU035), Chinese Academy of Medical Sciences, Chengdu, P.R. China
| | - Cheng Luo
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, P.R. China; ,High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, P.R. China; ,Research Unit of NeuroInformation (2019RU035), Chinese Academy of Medical Sciences, Chengdu, P.R. China,Address correspondence to these authors at the The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Second North Jianshe Road, Chengdu 610054, China; Tel: 86-28-83201018; Fax: 86-28-83208238; E-mails: (C. Luo) and (M. Duan)
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Deng ZD, Argyelan M, Miller J, Quinn DK, Lloyd M, Jones TR, Upston J, Erhardt E, McClintock SM, Abbott CC. Electroconvulsive therapy, electric field, neuroplasticity, and clinical outcomes. Mol Psychiatry 2022; 27:1676-1682. [PMID: 34853404 PMCID: PMC9095458 DOI: 10.1038/s41380-021-01380-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/20/2021] [Accepted: 10/26/2021] [Indexed: 01/08/2023]
Abstract
Electroconvulsive therapy (ECT) remains the gold-standard treatment for patients with depressive episodes, but the underlying mechanisms for antidepressant response and procedure-induced cognitive side effects have yet to be elucidated. Such mechanisms may be complex and involve certain ECT parameters and brain regions. Regarding parameters, the electrode placement (right unilateral or bitemporal) determines the geometric shape of the electric field (E-field), and amplitude determines the E-field magnitude in select brain regions (e.g., hippocampus). Here, we aim to determine the relationships between hippocampal E-field strength, hippocampal neuroplasticity, and antidepressant and cognitive outcomes. We used hippocampal E-fields and volumes generated from a randomized clinical trial that compared right unilateral electrode placement with different pulse amplitudes (600, 700, and 800 mA). Hippocampal E-field strength was variable but increased with each amplitude arm. We demonstrated a linear relationship between right hippocampal E-field and right hippocampal neuroplasticity. Right hippocampal neuroplasticity mediated right hippocampal E-field and antidepressant outcomes. In contrast, right hippocampal E-field was directly related to cognitive outcomes as measured by phonemic fluency. We used receiver operating characteristic curves to determine that the maximal right hippocampal E-field associated with cognitive safety was 112.5 V/m. Right hippocampal E-field strength was related to the whole-brain ratio of E-field strength per unit of stimulation current, but this whole-brain ratio was unrelated to antidepressant or cognitive outcomes. We discuss the implications of optimal hippocampal E-field dosing to maximize antidepressant outcomes and cognitive safety with individualized amplitudes.
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Affiliation(s)
- Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Miklos Argyelan
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA
- Center for Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA
- Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry, Hempstead, NY, USA
| | - Jeremy Miller
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Davin K Quinn
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Megan Lloyd
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Thomas R Jones
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Joel Upston
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Erik Erhardt
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, NM, USA
| | - Shawn M McClintock
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
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Affiliation(s)
- Randall T Espinoza
- From the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (R.T.E.); and the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (C.H.K.)
| | - Charles H Kellner
- From the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (R.T.E.); and the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (C.H.K.)
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30
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Li XK, Qiu HT. Current progress in neuroimaging research for the treatment of major depression with electroconvulsive therapy. World J Psychiatry 2022; 12:128-139. [PMID: 35111584 PMCID: PMC8783162 DOI: 10.5498/wjp.v12.i1.128] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/20/2021] [Accepted: 09/06/2021] [Indexed: 02/06/2023] Open
Abstract
Electroconvulsive therapy (ECT) uses a certain amount of electric current to pass through the head of the patient, causing convulsions throughout the body, to relieve the symptoms of the disease and achieve the purpose of treatment. ECT can effectively improve the clinical symptoms of patients with major depression, but its therapeutic mechanism is still unclear. With the rapid development of neuroimaging technology, it is necessary to explore the neurobiological mechanism of major depression from the aspects of brain structure, brain function and brain metabolism, and to find that ECT can improve the brain function, metabolism and even brain structure of patients to a certain extent. Currently, an increasing number of neuroimaging studies adopt various neuroimaging techniques including functional magnetic resonance imaging (MRI), positron emission tomography, magnetic resonance spectroscopy, structural MRI, and diffusion tensor imaging to reveal the neural effects of ECT. This article reviews the recent progress in neuroimaging research on ECT for major depression. The results suggest that the neurobiological mechanism of ECT may be to modulate the functional activity and connectivity or neural structural plasticity in specific brain regions to the normal level, to achieve the therapeutic effect.
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Affiliation(s)
- Xin-Ke Li
- College of Medical Informatics, Chongqing Medical University, Chongqing 400016, China
| | - Hai-Tang Qiu
- Mental Health Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Nuninga JO, Mandl RCW, Siero J, Nieuwdorp W, Heringa SM, Boks MP, Somers M, Sommer IEC. Shape and volume changes of the superior lateral ventricle after electroconvulsive therapy measured with ultra-high field MRI. Psychiatry Res Neuroimaging 2021; 317:111384. [PMID: 34537602 DOI: 10.1016/j.pscychresns.2021.111384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/11/2021] [Accepted: 08/31/2021] [Indexed: 11/18/2022]
Abstract
The subventricular zone (SVZ) of the lateral ventricles harbors neuronal stem cells in adult mammals. Rodent studies report neurogenic effects in the SVZ of electroconvulsive stimulation. We hypothesize that if this finding translates to depressed patients undergoing electroconvulsive therapy (ECT), this would be reflected in shape changes at the SVZ. Using T1-weighted MR images acquired at ultra-high field strength (7T), the shape and volume of the ventricles were compared from pre to post ECT after 10 ECT sessions (in patients twice weekly) or 5 weeks apart (controls) using linear mixed models with age and gender as covariates. Ventricle shape significantly changed and volume significantly decreased over time in patients for the left ventricle, but not in controls. The decrease in volume of the ventricles was associated to a decrease in depression scores, and an increase in the left dentate gyrus, However, the shape changes of the ventricles were not restricted to the neurogenic niche in the lateral walls of the ventricles, providing no clear evidence for neurogenesis as sole explanation of volume changes in the ventricles after ECT.
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Affiliation(s)
- Jasper O Nuninga
- University Groningen, University Medical Center Groningen, Department of Biomedical Sciences of Cells and Systems, Groningen, the Netherlands; Department of Psychiatry, UMC Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands.
| | - René C W Mandl
- Department of Psychiatry, UMC Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands
| | - Jeroen Siero
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands; Spinoza Centre for Neuroimaging, Amsterdam, the Netherlands
| | - Wendy Nieuwdorp
- Department of Psychiatry, UMC Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands
| | - Sophie M Heringa
- Department of Psychiatry, UMC Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands
| | - Marco P Boks
- Department of Psychiatry, UMC Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands
| | - Metten Somers
- Department of Psychiatry, UMC Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands
| | - Iris E C Sommer
- University Groningen, University Medical Center Groningen, Department of Biomedical Sciences of Cells and Systems, Groningen, the Netherlands
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Argyelan M, Lencz T, Kang S, Ali S, Masi PJ, Moyett E, Joanlanne A, Watson P, Sanghani S, Petrides G, Malhotra AK. ECT-induced cognitive side effects are associated with hippocampal enlargement. Transl Psychiatry 2021; 11:516. [PMID: 34625534 PMCID: PMC8501017 DOI: 10.1038/s41398-021-01641-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/16/2021] [Accepted: 09/09/2021] [Indexed: 02/08/2023] Open
Abstract
Electroconvulsive therapy (ECT) is of the most effective treatments available for treatment-resistant depression, yet it is underutilized in part due to its reputation of causing cognitive side effects in a significant number of patients. Despite intensive neuroimaging research on ECT in the past two decades, the underlying neurobiological correlates of cognitive side effects remain elusive. Because the primary ECT-related cognitive deficit is memory impairment, it has been suggested that the hippocampus may play a crucial role. In the current study, we investigated 29 subjects with longitudinal MRI and detailed neuropsychological testing in two independent cohorts (N = 15/14) to test if volume changes were associated with cognitive side effects. The two cohorts underwent somewhat different ECT study protocols reflected in electrode placements and the number of treatments. We used longitudinal freesurfer algorithms (6.0) to obtain a bias-free estimate of volume changes in the hippocampus and tested its relationship with neurocognitive score changes. As an exploratory analysis and to evaluate how specific the effects were to the hippocampus, we also calculated this relationship in 41 other areas. In addition, we also analyzed cognitive data from a group of healthy volunteers (N = 29) to assess practice effects. Our results supported the hypothesis that hippocampus enlargement was associated with worse cognitive outcomes, and this result was generalizable across two independent cohorts with different diagnoses, different electrode placements, and a different number of ECT sessions. We found, in both cohorts, that treatment robustly increased the volume size of the hippocampus (Cohort 1: t = 5.07, Cohort 2: t = 4.82; p < 0.001), and the volume increase correlated with the neurocognitive T-score change. (Cohort 1: r = -0.68, p = 0.005; Cohort 2: r = -0.58; p = 0.04). Overall, our research indicates that novel treatment methods serving to avoid hippocampal volume increase may result in a better side effect profile.
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Affiliation(s)
- Miklos Argyelan
- Psychiatry Research, The Zucker Hillside Hospital, Glen Cove, NY, USA.
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA.
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| | - Todd Lencz
- Psychiatry Research, The Zucker Hillside Hospital, Glen Cove, NY, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Simran Kang
- Psychiatry Research, The Zucker Hillside Hospital, Glen Cove, NY, USA
| | - Sana Ali
- Psychiatry Research, The Zucker Hillside Hospital, Glen Cove, NY, USA
| | - Paul J Masi
- Psychiatry Research, The Zucker Hillside Hospital, Glen Cove, NY, USA
| | - Emily Moyett
- Psychiatry Research, The Zucker Hillside Hospital, Glen Cove, NY, USA
| | - Andrea Joanlanne
- Psychiatry Research, The Zucker Hillside Hospital, Glen Cove, NY, USA
| | - Philip Watson
- Psychiatry Research, The Zucker Hillside Hospital, Glen Cove, NY, USA
| | - Sohag Sanghani
- Psychiatry Research, The Zucker Hillside Hospital, Glen Cove, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Georgios Petrides
- Psychiatry Research, The Zucker Hillside Hospital, Glen Cove, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Anil K Malhotra
- Psychiatry Research, The Zucker Hillside Hospital, Glen Cove, NY, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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The Neurobiological Basis of Cognitive Side Effects of Electroconvulsive Therapy: A Systematic Review. Brain Sci 2021; 11:brainsci11101273. [PMID: 34679338 PMCID: PMC8534116 DOI: 10.3390/brainsci11101273] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022] Open
Abstract
Decades of research have consistently demonstrated the efficacy of electroconvulsive therapy (ECT) for the treatment of major depressive disorder (MDD), but its clinical use remains somewhat restricted because of its cognitive side effects. The aim of this systematic review is to comprehensively summarize current evidence assessing potential biomarkers of ECT-related cognitive side effects. Based on our systematic search of human studies indexed in PubMed, Scopus, and Web of Knowledge, a total of 29 studies evaluating patients with MDD undergoing ECT were reviewed. Molecular biomarkers studies did not consistently identify concentration changes in plasma S-100 protein, neuron-specific enolase (NSE), or Aβ peptides significantly associated with cognitive performance after ECT. Importantly, these findings suggest that ECT-related cognitive side effects cannot be explained by mechanisms of neural cell damage. Notwithstanding, S-100b protein and Aβ40 peptide concentrations, as well as brain-derived neurotrophic factor (BDNF) polymorphisms, have been suggested as potential predictive biomarkers of cognitive dysfunction after ECT. In addition, recent advances in brain imaging have allowed us to identify ECT-induced volumetric and functional changes in several brain structures closely related to memory performance such as the hippocampus. We provide a preliminary framework to further evaluate neurobiological cognitive vulnerability profiles of patients with MDD treated with ECT.
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Opel N, Narr KL, Abbott C, Argyelan M, Espinoza R, Emsell L, Bouckaert F, Sienaert P, Vandenbulcke M, Nordanskog P, Repple J, Kavakbasi E, Jorgensen MB, Paulson OB, Hanson LG, Dols A, van Exel E, Oudega ML, Takamiya A, Kishimoto T, Ousdal OT, Haavik J, Hammar Å, Oedegaard KJ, Kessler U, Bartsch H, Dale AM, Baune BT, Dannlowski U, Oltedal L, Redlich R. Elevated body weight modulates subcortical volume change and associated clinical response following electroconvulsive therapy. J Psychiatry Neurosci 2021; 46:E418-E426. [PMID: 34223741 PMCID: PMC8410473 DOI: 10.1503/jpn.200176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/23/2020] [Accepted: 02/05/2021] [Indexed: 01/02/2023] Open
Abstract
Background Obesity is a frequent somatic comorbidity of major depression, and it has been associated with worse clinical outcomes and brain structural abnormalities. Converging evidence suggests that electroconvulsive therapy (ECT) induces both clinical improvements and increased subcortical grey matter volume in patients with depression. However, it remains unknown whether increased body weight modulates the clinical response and structural neuroplasticity that occur with ECT. Methods To address this question, we conducted a longitudinal investigation of structural MRI data from the Global ECT-MRI Research Collaboration (GEMRIC) in 223 patients who were experiencing a major depressive episode (10 scanning sites). Structural MRI data were acquired before and after ECT, and we assessed change in subcortical grey matter volume using FreeSurfer and Quarc. Results Higher body mass index (BMI) was associated with a significantly lower increase in subcortical grey matter volume following ECT. We observed significant negative associations between BMI and change in subcortical grey matter volume, with pronounced effects in the thalamus and putamen, where obese participants showed increases in grey matter volume that were 43.3% and 49.6%, respectively, of the increases found in participants with normal weight. As well, BMI significantly moderated the association between subcortical grey matter volume change and clinical response to ECT. We observed no significant association between BMI and clinical response to ECT. Limitations Because only baseline BMI values were available, we were unable to study BMI changes during ECT and their potential association with clinical and grey matter volume change. Conclusion Future studies should take into account the relevance of body weight as a modulator of structural neuroplasticity during ECT treatment and aim to further explore the functional relevance of this novel finding.
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Affiliation(s)
- Nils Opel
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)-KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich)
| | - Katherine L. Narr
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)-KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich)
| | - Christopher Abbott
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)-KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich)
| | - Miklos Argyelan
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)-KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich)
| | - Randall Espinoza
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)-KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich)
| | - Louise Emsell
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)-KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich)
| | - Filip Bouckaert
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)-KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich)
| | - Pascal Sienaert
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)-KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich)
| | - Mathieu Vandenbulcke
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)-KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich)
| | - Pia Nordanskog
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)-KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich)
| | - Jonathan Repple
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)-KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich)
| | - Erhan Kavakbasi
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)-KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich)
| | - Martin B. Jorgensen
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)-KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich)
| | - Olaf B. Paulson
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)-KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich)
| | - Lars G. Hanson
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)-KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich)
| | - Annemieke Dols
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)-KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich)
| | - Eric van Exel
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)-KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich)
| | - Mardien L. Oudega
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)-KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich)
| | - Akihiro Takamiya
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)-KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich)
| | - Taishiro Kishimoto
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)-KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich)
| | - Olga Therese Ousdal
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)-KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich)
| | - Jan Haavik
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)-KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich)
| | - Åsa Hammar
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)-KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich)
| | - Ketil Joachim Oedegaard
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)-KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich)
| | - Ute Kessler
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)-KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich)
| | - Hauke Bartsch
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)-KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich)
| | - Anders M. Dale
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)-KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich)
| | - Bernhard T. Baune
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)-KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich)
| | - Udo Dannlowski
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)-KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich)
| | - Leif Oltedal
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)-KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich)
| | - Ronny Redlich
- From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)-KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich)
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Oathes DJ, Balderston NL, Kording KP, DeLuisi JA, Perez GM, Medaglia JD, Fan Y, Duprat RJ, Satterthwaite TD, Sheline YI, Linn KA. Combining transcranial magnetic stimulation with functional magnetic resonance imaging for probing and modulating neural circuits relevant to affective disorders. WILEY INTERDISCIPLINARY REVIEWS. COGNITIVE SCIENCE 2021; 12:e1553. [PMID: 33470055 DOI: 10.1002/wcs.1553] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/02/2020] [Accepted: 12/23/2020] [Indexed: 12/14/2022]
Abstract
Combining transcranial magnetic stimulation (TMS) with functional magnetic resonance imaging offers an unprecedented tool for studying how brain networks interact in vivo and how repetitive trains of TMS modulate those networks among patients diagnosed with affective disorders. TMS compliments neuroimaging by allowing the interrogation of causal control among brain circuits. Together with TMS, neuroimaging can provide valuable insight into the mechanisms underlying treatment effects and downstream circuit communication. Here we provide a background of the method, review relevant study designs, consider methodological and equipment options, and provide statistical recommendations. We conclude by describing emerging approaches that will extend these tools into exciting new applications. This article is categorized under: Psychology > Emotion and Motivation Psychology > Theory and Methods Neuroscience > Clinical Neuroscience.
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Affiliation(s)
- Desmond J Oathes
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nicholas L Balderston
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Konrad P Kording
- Department of Neuroscience, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joseph A DeLuisi
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Gianna M Perez
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - John D Medaglia
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA.,Department of Neurology, Drexel University, Philadelphia, Pennsylvania, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yong Fan
- Center for Biomedical Image Computing and Analytics (CBICA), Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Romain J Duprat
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Theodore D Satterthwaite
- Lifespan Informatics and Neuroimaging Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Yvette I Sheline
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kristin A Linn
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Center for Biomedical Image Computing and Analytics (CBICA), Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Gryglewski G, Lanzenberger R, Silberbauer LR, Pacher D, Kasper S, Rupprecht R, Frey R, Baldinger-Melich P. Meta-analysis of brain structural changes after electroconvulsive therapy in depression. Brain Stimul 2021; 14:927-937. [PMID: 34119669 DOI: 10.1016/j.brs.2021.05.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 04/30/2021] [Accepted: 05/19/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Increases in the volume of the amygdala and hippocampus after electroconvulsive therapy (ECT) are among the most robust effects known to the brain-imaging field. Recent advances in the segmentation of substructures of these regions allow for novel insights on the relationship between brain structure and clinical outcomes of ECT. OBJECTIVE We aimed to provide a comprehensive synthesis of evidence available on changes in brain structure after ECT, including recently published data on hippocampal subfields. METHODS A meta-analysis of published studies was carried out using random-effects models of standardized mean change of regional brain volumes measured with longitudinal magnetic resonance imaging of depressive patients before and after a series of ECT. RESULTS Data from 21 studies (543 depressed patients) were analysed, including 6 studies (118 patients) on hippocampal subfields. Meta-analyses could be carried out for seven brain regions for which data from at least three published studies was available. We observed increases in left and right hippocampi, amygdalae, cornua ammonis (CA) 1, CA 2/3, dentate gyri (DG) and subicula with standardized mean change scores ranging between 0.34 and 1.15. The model did not reveal significant volume increases in the caudate. Meta-regression indicated a negative relationship between the reported increases in the DG and relative symptom improvement (-0.27 (SE: 0.09) per 10%). CONCLUSIONS ECT is accompanied by significant volume increases in the bilateral hippocampus and amygdala that are not associated with treatment outcome. Among hippocampal subfields, the most robust volume increases after ECT were measured in the dentate gyrus. The indicated negative correlation of this effect with antidepressant efficacy warrants replication in data of individual patients.
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Affiliation(s)
- Gregor Gryglewski
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Austria
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Austria
| | - Leo R Silberbauer
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Austria
| | - Daniel Pacher
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Austria
| | - Siegfried Kasper
- Center for Brain Research, Medical University of Vienna, Austria
| | - Rainer Rupprecht
- Department of Psychiatry and Psychotherapy, University of Regensburg, Germany
| | - Richard Frey
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Austria
| | - Pia Baldinger-Melich
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Austria.
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Gyger L, Regen F, Ramponi C, Marquis R, Mall JF, Swierkosz-Lenart K, von Gunten A, Toni N, Kherif F, Heuser I, Draganski B. Gradient of electro-convulsive therapy's antidepressant effects along the longitudinal hippocampal axis. Transl Psychiatry 2021; 11:191. [PMID: 33782387 PMCID: PMC8007583 DOI: 10.1038/s41398-021-01310-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 02/12/2021] [Accepted: 03/02/2021] [Indexed: 12/17/2022] Open
Abstract
Despite decades of successful treatment of therapy-resistant depression and major scientific advances in the field, our knowledge about electro-convulsive therapy's (ECT) mechanisms of action is still scarce. Building on strong empirical evidence for ECT-induced hippocampus anatomy changes, we sought to test the hypothesis that ECT has a differential impact along the hippocampus longitudinal axis. We acquired behavioural and brain anatomy magnetic resonance imaging (MRI) data in patients with depressive episode undergoing ECT (n = 9) or pharmacotherapy (n = 24) and healthy controls (n = 30) at two time points 3 months apart. Using whole-brain voxel-based statistical parametric mapping and topographic analysis focused on the hippocampus, we observed ECT-induced gradient of grey matter volume increase along the hippocampal longitudinal axis with predominant impact on its anterior portion. Clinical outcome measures showed strong correlations with both baseline volume and rate of ECT-induced change exclusively for the anterior, but not posterior hippocampus. We interpret our findings confined to the anterior hippocampus and amygdala as additional evidence of the regional specific impact of ECT that unfolds its beneficial effect on depression via the "limbic" system. Main limitations of the study are patients' polypharmacy, heterogeneity of psychiatric diagnosis, and long-time interval between scans.
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Affiliation(s)
- Lucien Gyger
- LREN, Dept. of clinical neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Francesca Regen
- Department of Psychiatry, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Cristina Ramponi
- LREN, Dept. of clinical neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Renaud Marquis
- EEG and Epilepsy Unit, Department of Clinical Neuroscience, University Hospital of Geneva and Faculty of Medicine, Geneva, Switzerland
| | - Jean-Frederic Mall
- Old Age Psychiatry service, Department of Psychiatry, Lausanne University Hospital (CHUV), and University of Lausanne, Lausanne, Switzerland
| | - Kevin Swierkosz-Lenart
- Old Age Psychiatry service, Department of Psychiatry, Lausanne University Hospital (CHUV), and University of Lausanne, Lausanne, Switzerland
| | - Armin von Gunten
- Old Age Psychiatry service, Department of Psychiatry, Lausanne University Hospital (CHUV), and University of Lausanne, Lausanne, Switzerland
| | - Nicolas Toni
- Centre for Psychiatric Neurosciences, Department of Psychiatry, Lausanne University Hospital (CHUV) and Lausanne University, Lausanne, Switzerland
| | - Ferath Kherif
- LREN, Dept. of clinical neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Isabella Heuser
- Department of Psychiatry, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Bogdan Draganski
- LREN, Dept. of clinical neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
- Neurology Department, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
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Jehna M, Wurm W, Pinter D, Vogel K, Holl A, Hofmann P, Ebner C, Ropele S, Fuchs G, Kapfhammer HP, Deutschmann H, Enzinger C. Do increases in deep grey matter volumes after electroconvulsive therapy persist in patients with major depression? A longitudinal MRI-study. J Affect Disord 2021; 281:908-917. [PMID: 33279261 DOI: 10.1016/j.jad.2020.11.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/30/2020] [Accepted: 11/07/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Previous MRI studies reported deep grey matter volume increases after electroconvulsive therapy (ECT) in patients with major depressive disorder (MDD). However, the clinical correlates of these changes are still unclear. It remains debated whether such volume changes are transient, and if they correlate with affective changes over time. We here investigated if ECT induces deep grey matter volume increases in MDD-patients; and, if so, whether volume changes persist over more than 9 months and whether they are related to the clinical outcome. METHODS We examined 16 MDD-patients with 3Tesla MRI before (baseline) and after an ECT-series and followed 12 of them up for 10-36 months. Patients' data were compared to 16 healthy controls. Affective scales were used to investigate the relationship between therapy-outcome and MRI changes. RESULTS At baseline, MDD-patients had lower values in global brain volume, white matter and peripheral grey matter compared to healthy controls, but we observed no significant differences in deep grey matter volumes. After ECT, the differences in peripheral grey matter disappeared, and patients demonstrated significant volume increases in the right hippocampus and both thalami, followed by subsequent decreases after 10-36 months, especially in ECT-responders. Controls did not show significant changes over time. LIMITATIONS Beside the relatively small, yet carefully characterized cohort, we address the variability in time between the third scanning session and the baseline. CONCLUSIONS ECT-induced deep grey matter volume increases are transient. Our results suggest that the thalamus might be a key region for the understanding of the mechanisms of ECT action.
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Affiliation(s)
- Margit Jehna
- Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, 8036 Graz, Medical University of Graz, Austria
| | - Walter Wurm
- Department of Psychiatry and Psychotherapeutic Medicine, 8036 Graz, Medical University of Graz, Austria
| | - Daniela Pinter
- Department of Neurology, Division of General Neurology, 8036 Graz, Medical University of Graz, Austria; Research Unit for Neuronal Repair and Plasticity, 8036 Graz, Medical University of Graz, Austria
| | - Katrin Vogel
- Department of Psychiatry and Psychotherapeutic Medicine, 8036 Graz, Medical University of Graz, Austria
| | - Anna Holl
- Department of Psychiatry and Psychotherapeutic Medicine, 8036 Graz, Medical University of Graz, Austria
| | - Peter Hofmann
- Department of Psychiatry and Psychotherapeutic Medicine, 8036 Graz, Medical University of Graz, Austria
| | - Christoph Ebner
- Department of Psychiatry and Psychotherapeutic Medicine, 8036 Graz, Medical University of Graz, Austria
| | - Stefan Ropele
- Department of Neurology, Division of General Neurology, 8036 Graz, Medical University of Graz, Austria
| | - Gottfried Fuchs
- Department of Anesthesiology and Intensive Care Medicine, Division of Special Anesthesiology, Pain and Intensive Care Medicine, 8036 Graz, Medical University of Graz, Austria
| | - Hans-Peter Kapfhammer
- Department of Psychiatry and Psychotherapeutic Medicine, 8036 Graz, Medical University of Graz, Austria
| | - Hannes Deutschmann
- Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, 8036 Graz, Medical University of Graz, Austria
| | - Christian Enzinger
- Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, 8036 Graz, Medical University of Graz, Austria; Department of Neurology, Division of General Neurology, 8036 Graz, Medical University of Graz, Austria; Research Unit for Neuronal Repair and Plasticity, 8036 Graz, Medical University of Graz, Austria.
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Gbyl K, Rostrup E, Raghava JM, Andersen C, Rosenberg R, Larsson HBW, Videbech P. Volume of hippocampal subregions and clinical improvement following electroconvulsive therapy in patients with depression. Prog Neuropsychopharmacol Biol Psychiatry 2021; 104:110048. [PMID: 32730916 DOI: 10.1016/j.pnpbp.2020.110048] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/08/2020] [Accepted: 07/21/2020] [Indexed: 12/14/2022]
Abstract
It is thought that the hippocampal neurogenesis is an important mediator of the antidepressant effect of electroconvulsive therapy (ECT). However, most previous studies failed to demonstrate the relationship between the increase in the hippocampal volume and the antidepressant effect. We reinvestigated this relationship by looking at distinct hippocampal subregions and applying repeated measures correlation. Using a 3 Tesla MRI-scanner, we scanned 22 severely depressed in-patients at three time points: before the ECT series, after the series, and at six-month follow-up. The depression severity was assessed by the 17-item Hamilton Rating Scale for Depression (HAMD-17). The hippocampus was segmented into subregions using Freesurfer software. The dentate gyrus (DG) was the primary region of interest (ROI), due to the role of this region in neurogenesis. The other major hippocampal subregions were the secondary ROIs (n = 20). The general linear mixed model and the repeated measures correlation were used for statistical analyses. Immediately after the ECT series, a significant volume increase was present in the right DG (Cohen's d = 1.7) and the left DG (Cohen's d = 1.5), as well as 15 out of 20 secondary ROIs. The clinical improvement, i.e., the decrease in HAMD-17 score, was correlated to the increase in the right DG volume (rrm = -0.77, df = 20, p < .001), and the left DG volume (rrm = -0.75, df = 20, p < .001). Similar correlations were observed in 14 out of 20 secondary ROIs. Thus, ECT induces an increase not only in the volume of the DG, but also in the volume of other major hippocampal subregions. The volumetric increases may reflect a neurobiological process that may be related to the ECT's antidepressant effect. Further investigation of the relationship between hippocampal subregions and the antidepressant effect is warranted. A statistical approach taking the repeated measurements into account should be preferred in the analyses.
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Affiliation(s)
- Krzysztof Gbyl
- Center for Neuropsychiatric Depression Research, Mental Health Center Glostrup, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Science, The University of Copenhagen, Copenhagen, Denmark.
| | - Egill Rostrup
- Center for Neuropsychiatric Schizophrenia Research, and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Center Glostrup, Glostrup, Denmark
| | - Jayachandra Mitta Raghava
- Center for Neuropsychiatric Schizophrenia Research, and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Center Glostrup, Glostrup, Denmark; Functional Imaging Unit, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Glostrup, Glostrup, Denmark
| | | | | | - Henrik Bo Wiberg Larsson
- Functional Imaging Unit, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Glostrup, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Science, The University of Copenhagen, Copenhagen, Denmark
| | - Poul Videbech
- Center for Neuropsychiatric Depression Research, Mental Health Center Glostrup, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Science, The University of Copenhagen, Copenhagen, Denmark
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40
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Soda T, McLoughlin DM, Clark SR, Oltedal L, Kessler U, Haavik J, Bousman C, Smith DJ, Bioque M, Clements CC, Loo C, Vila-Rodriguez F, Minelli A, Mickey BJ, Milev R, Docherty AR, Langan Martin J, Achtyes ED, Arolt V, Redlich R, Dannlowski U, Cardoner N, Clare E, Craddock N, Di Florio A, Dmitrzak-Weglarz M, Forty L, Gordon-Smith K, Husain M, Ingram WM, Jones L, Jones I, Juruena M, Kirov G, Landén M, Müller DJ, Nordensköld A, Pålsson E, Paul M, Permoda A, Pliszka B, Rea J, Schubert KO, Sonnen JA, Soria V, Stageman W, Takamiya A, Urretavizacaya M, Watson S, Zavorotny M, Young AH, Vieta E, Rybakowski JK, Gennarelli M, Zandi PP, Sullivan PF, Baune BT. International Consortium on the Genetics of Electroconvulsive Therapy and Severe Depressive Disorders (Gen-ECT-ic). Eur Arch Psychiatry Clin Neurosci 2020; 270:921-932. [PMID: 31802253 PMCID: PMC7385979 DOI: 10.1007/s00406-019-01087-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 11/16/2019] [Indexed: 02/05/2023]
Abstract
Recent genome-wide association studies have demonstrated that the genetic burden associated with depression correlates with depression severity. Therefore, conducting genetic studies of patients at the most severe end of the depressive disorder spectrum, those with treatment-resistant depression and who are prescribed electroconvulsive therapy (ECT), could lead to a better understanding of the genetic underpinnings of depression. Despite ECT being one of the most effective forms of treatment for severe depressive disorders, it is usually placed at the end of treatment algorithms of current guidelines. This is perhaps because ECT has controlled risk and logistical demands including use of general anaesthesia and muscle relaxants and side-effects such as short-term memory impairment. Better understanding of the genetics and biology of ECT response and of cognitive side-effects could lead to more personalized treatment decisions. To enhance the understanding of the genomics of severe depression and ECT response, researchers and ECT providers from around the world and from various depression or ECT networks, but not limited to, such as the Psychiatric Genomics Consortium, the Clinical Alliance and Research in ECT, and the National Network of Depression Centers have formed the Genetics of ECT International Consortium (Gen-ECT-ic). Gen-ECT-ic will organize the largest clinical and genetic collection to date to study the genomics of severe depressive disorders and response to ECT, aiming for 30,000 patients worldwide using a GWAS approach. At this stage it will be the largest genomic study on treatment response in depression. Retrospective data abstraction and prospective data collection will be facilitated by a uniform data collection approach that is flexible and will incorporate data from many clinical practices. Gen-ECT-ic invites all ECT providers and researchers to join its efforts.
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Affiliation(s)
- Takahiro Soda
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Declan M McLoughlin
- Department of Psychiatry and Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Scott R Clark
- Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Leif Oltedal
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Radiology, Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, Bergen, Norway
| | - Ute Kessler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Haukeland University Hospital, Bergen, Norway
| | - Jan Haavik
- Haukeland University Hospital, Bergen, Norway
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Chad Bousman
- Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Daniel J Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Miquel Bioque
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | | | - Colleen Loo
- School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
- Sydney Neurostimulation Centre, Black Dog Institute, Randwick, NSW, Australia
| | - Fidel Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Alessandra Minelli
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Brian J Mickey
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Roumen Milev
- Departments of Psychiatry and Psychology, Queen's University, Kingston, ON, Canada
- Providence Care Hospital, Kingston, ON, Canada
| | - Anna R Docherty
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Eric D Achtyes
- Pine Rest Christian Mental Health Services, Grand Rapids, MI, USA
| | - Volker Arolt
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Ronny Redlich
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Udo Dannlowski
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Narcis Cardoner
- Department of Mental Health, Parc Taulí Hospital Universitari, Institut D'INVESTIGACIÓ i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Emily Clare
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nick Craddock
- Division of Psychological Medicine and Clinical Neuroscience, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Arianna Di Florio
- Division of Psychological Medicine and Clinical Neuroscience, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | | | - Liz Forty
- Division of Psychological Medicine and Clinical Neuroscience, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | | | | | - Wendy M Ingram
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lisa Jones
- Psychological Medicine, University of Worcester, Worcester, UK
| | - Ian Jones
- Division of Psychological Medicine and Clinical Neuroscience, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Mario Juruena
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - George Kirov
- Division of Psychological Medicine and Clinical Neuroscience, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Mikael Landén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the Gothenburg University, Gothenburg, Sweden
| | - Daniel J Müller
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Axel Nordensköld
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Erik Pålsson
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the Gothenburg University, Gothenburg, Sweden
| | - Meethu Paul
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Agnieszka Permoda
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Bartlomiej Pliszka
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jamie Rea
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Klaus O Schubert
- Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Northern Adelaide Mental Health Service, Salisbury, SA, Australia
| | - Joshua A Sonnen
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Virginia Soria
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Will Stageman
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
- Institute of Neuroscience, Newcastle University and NTW NHS Trust, Newcastle, UK
| | - Akihiro Takamiya
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | | | - Stuart Watson
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
- Institute of Neuroscience, Newcastle University and NTW NHS Trust, Newcastle, UK
| | - Maxim Zavorotny
- Department of Psychiatry, University of Marburg, Marburg, Germany
| | - Allan H Young
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
- Department of Psychiatric Nursing, Poznan University of Medical Sciences, Poznan, Poland
| | - Massimo Gennarelli
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
- Genetic Unit, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Peter P Zandi
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Patrick F Sullivan
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
- Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27514, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Bernhard T Baune
- Department of Psychiatry, University of Münster, Münster, Germany.
- Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Australia.
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia.
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Predicting Individual Remission After Electroconvulsive Therapy Based on Structural Magnetic Resonance Imaging: A Machine Learning Approach. J ECT 2020; 36:205-210. [PMID: 32118692 DOI: 10.1097/yct.0000000000000669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To identify important clinical or imaging features predictive of an individual's response to electroconvulsive therapy (ECT) by utilizing a machine learning approach. METHODS Twenty-seven depressed patients who received ECT were recruited. Clinical demographics and pretreatment structural magnetic resonance imaging (MRI) data were used as candidate features to build models to predict remission and post-ECT Hamilton Depression Rating Scale scores. Support vector machine and support vector regression with elastic-net regularization were used to build models using (i) only clinical features, (ii) only MRI features, and (iii) both clinical and MRI features. Consistently selected features across all individuals were identified through leave-one-out cross-validation. RESULTS Compared with models that include only clinical variables, the models including MRI data improved the prediction of ECT remission: the prediction accuracy improved from 70% to 93%. Features selected consistently across all individuals included volumes in the gyrus rectus, the right anterior lateral temporal lobe, the cuneus, and the third ventricle, as well as 2 clinical features: psychotic features and family history of mood disorder. CONCLUSIONS Pretreatment structural MRI data improved the individual predictive accuracy of ECT remission, and only a small subset of features was important for prediction.
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Volume increase in the dentate gyrus after electroconvulsive therapy in depressed patients as measured with 7T. Mol Psychiatry 2020; 25:1559-1568. [PMID: 30867562 DOI: 10.1038/s41380-019-0392-6] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 01/03/2023]
Abstract
Electroconvulsive therapy (ECT) is the most effective treatment for depression, yet its working mechanism remains unclear. In the animal analog of ECT, neurogenesis in the dentate gyrus (DG) of the hippocampus is observed. In humans, volume increase of the hippocampus has been reported, but accurately measuring the volume of subfields is limited with common MRI protocols. If the volume increase of the hippocampus in humans is attributable to neurogenesis, it is expected to be exclusively present in the DG, whereas other processes (angiogenesis, synaptogenesis) also affect other subfields. Therefore, we acquired an optimized MRI scan at 7-tesla field strength allowing sensitive investigation of hippocampal subfields. A further increase in sensitivity of the within-subjects measurements is gained by automatic placement of the field of view. Patients receive two MRI scans: at baseline and after ten bilateral ECT sessions (corresponding to a 5-week interval). Matched controls are also scanned twice, with a similar 5-week interval. A total of 31 participants (23 patients, 8 controls) completed the study. A large and significant increase in DG volume was observed after ECT (M = 75.44 mm3, std error = 9.65, p < 0.001), while other hippocampal subfields were unaffected. We note that possible type II errors may be present due to the small sample size. In controls no changes in volume were found. Furthermore, an increase in DG volume was related to a decrease in depression scores, and baseline DG volume predicted clinical response. These findings suggest that the volume change of the DG is related to the antidepressant properties of ECT, and may reflect neurogenesis.
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Tsolaki E, Narr KL, Espinoza R, Wade B, Hellemann G, Kubicki A, Vasavada M, Njau S, Pouratian N. Subcallosal Cingulate Structural Connectivity Differs in Responders and Nonresponders to Electroconvulsive Therapy. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 6:10-19. [PMID: 32741703 DOI: 10.1016/j.bpsc.2020.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/21/2020] [Accepted: 05/24/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Subcallosal cingulate (SCC) activity is associated with treatment response in major depressive disorder (MDD). Using electroconvulsive therapy (ECT) as a treatment model in this exploratory study, we addressed whether pretreatment SCC structural connectivity with corticolimbic-striatal circuitry relates to therapeutic outcome and whether these connectivity patterns change with treatment. METHODS Diffusion magnetic resonance imaging scans were acquired in 43 patients with MDD (mean [SD] age = 41 [13] years; men/women: 18/25) before and within 1 week of completing an ECT index series and in 31 healthy control subjects scanned twice (mean [SD] age = 38 [11] years; men/women: 17/18). Probabilistic tractography from subject-specific anatomically defined SCC seed regions to the ventral striatum (VS), anterior cingulate cortex (ACC), and bilateral medial prefrontal cortex (mPFC) was used to estimate structural connectivity in the target network. RESULTS SCC-mPFC connectivity was lower in responders (>50% symptom improvement) than nonresponders both before (p < .014) (difference 37%-96% left and right hemispheres) and after (p = .023) (difference 100% right hemisphere) treatment. SCC-mPFC connectivity in responders was also decreased compared with control subjects both at baseline (p = .012) and after ECT (p = .006), whereas nonresponders had SCC-right mPFC connectivity similar to that of control subjects. Subjects with MDD also showed decreased SCC-ACC connectivity compared with control subjects (baseline: p < .003, after ECT: p = .001), although SCC-ACC connectivity did not distinguish responders from nonresponders. Bilateral SCC-VS connectivity decreased (11%) with ECT (p = .021) regardless of treatment response. CONCLUSIONS While SCC-ACC connectivity may be a hallmark of MDD compared with control subjects, lower pretreatment SCC-mPFC connectivity in ECT responders (compared with nonresponders and control subjects) suggests that connectivity in this pathway may serve as a potential biomarker of therapeutic outcome and be relevant for treatment selection.
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Affiliation(s)
- Evangelia Tsolaki
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California.
| | - Katherine L Narr
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California; Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, Los Angeles, California
| | - Randall Espinoza
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Benjamin Wade
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California; Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, Los Angeles, California
| | - Gerhard Hellemann
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Antoni Kubicki
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California; Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, Los Angeles, California
| | - Megha Vasavada
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California; Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, Los Angeles, California
| | - Stephanie Njau
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California; Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, Los Angeles, California
| | - Nader Pouratian
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California
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44
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Depressive Symptom Dimensions in Treatment-Resistant Major Depression and Their Modulation With Electroconvulsive Therapy. J ECT 2020; 36:123-129. [PMID: 31464814 PMCID: PMC7044066 DOI: 10.1097/yct.0000000000000623] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Symptom heterogeneity in major depressive disorder obscures diagnostic and treatment-responsive biomarker identification. Whether symptom constellations are differentially changed by electroconvulsive therapy (ECT) remains unknown. We investigate the clustering of depressive symptoms over the ECT index and whether ECT differentially influences symptom clusters. METHODS The 17-item Hamilton Depression Rating Scale (HDRS-17) was collected from 111 patients with current depressive episode before and after ECT from 4 independent participating sites of the Global ECT-MRI Research Collaboration. Exploratory factor analysis of HDRS-17 items pre- and post-ECT treatment identified depressive symptom dimensions before and after ECT. A 2-way analysis of covariance was used to determine whether baseline symptom clusters were differentially changed by ECT between treatment remitters (defined as patients with posttreatment HDRS-17 total score ≤8) and nonremitters while controlling for pulse width, titration method, concurrent antidepressant treatment, use of benzodiazepine, and demographic variables. RESULTS A 3-factor solution grouped pretreatment HDRS-17 items into core mood/anhedonia, somatic, and insomnia dimensions. A 2-factor solution best described the symptoms at posttreatment despite poorer separation of items. Among remitters, core mood/anhedonia symptoms were significantly more reduced than somatic and insomnia dimensions. No differences in symptom dimension trajectories were observed among nonremitting patients. CONCLUSIONS Electroconvulsive therapy targets the underlying source of depressive symptomatology and may confer differential degrees of improvement in certain core depressive symptoms. Our findings of differential trajectories of symptom clusters over the ECT index might help related predictive biomarker studies to refine their approaches by identifying predictors of change along each latent symptom dimension.
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45
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Borrione L, Bellini H, Razza LB, Avila AG, Baeken C, Brem AK, Busatto G, Carvalho AF, Chekroud A, Daskalakis ZJ, Deng ZD, Downar J, Gattaz W, Loo C, Lotufo PA, Martin MDGM, McClintock SM, O'Shea J, Padberg F, Passos IC, Salum GA, Vanderhasselt MA, Fraguas R, Benseñor I, Valiengo L, Brunoni AR. Precision non-implantable neuromodulation therapies: a perspective for the depressed brain. ACTA ACUST UNITED AC 2020; 42:403-419. [PMID: 32187319 PMCID: PMC7430385 DOI: 10.1590/1516-4446-2019-0741] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/10/2019] [Indexed: 12/13/2022]
Abstract
Current first-line treatments for major depressive disorder (MDD) include pharmacotherapy and cognitive-behavioral therapy. However, one-third of depressed patients do not achieve remission after multiple medication trials, and psychotherapy can be costly and time-consuming. Although non-implantable neuromodulation (NIN) techniques such as transcranial magnetic stimulation, transcranial direct current stimulation, electroconvulsive therapy, and magnetic seizure therapy are gaining momentum for treating MDD, the efficacy of non-convulsive techniques is still modest, whereas use of convulsive modalities is limited by their cognitive side effects. In this context, we propose that NIN techniques could benefit from a precision-oriented approach. In this review, we discuss the challenges and opportunities in implementing such a framework, focusing on enhancing NIN effects via a combination of individualized cognitive interventions, using closed-loop approaches, identifying multimodal biomarkers, using computer electric field modeling to guide targeting and quantify dosage, and using machine learning algorithms to integrate data collected at multiple biological levels and identify clinical responders. Though promising, this framework is currently limited, as previous studies have employed small samples and did not sufficiently explore pathophysiological mechanisms associated with NIN response and side effects. Moreover, cost-effectiveness analyses have not been performed. Nevertheless, further advancements in clinical trials of NIN could shift the field toward a more “precision-oriented” practice.
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Affiliation(s)
- Lucas Borrione
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Helena Bellini
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Lais Boralli Razza
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Ana G Avila
- Centro de Neuropsicologia e Intervenção Cognitivo-Comportamental, Faculdade de Psicologia e Ciências da Educação, Universidade de Coimbra, Coimbra, Portugal
| | - Chris Baeken
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Psychiatry, University Hospital (UZ Brussel), Brussels, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Anna-Katharine Brem
- Max Planck Institute of Psychiatry, Munich, Germany.,Division of Interventional Cognitive Neurology, Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Geraldo Busatto
- Laboratório de Neuroimagem em Psiquiatria (LIM-21), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Adam Chekroud
- Spring Health, New York, NY, USA.,Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutic & Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.,Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Jonathan Downar
- Department of Psychiatry and Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Centre for Mental Health and Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Wagner Gattaz
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas,
Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Colleen Loo
- School of Psychiatry and Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Paulo A Lotufo
- Estudo Longitudinal de Saúde do Adulto (ELSA), Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, USP, São Paulo, SP, Brazil
| | - Maria da Graça M Martin
- Laboratório de Ressonância Magnética em Neurorradiologia (LIM-44) and Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Shawn M McClintock
- Neurocognitive Research Laboratory, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jacinta O'Shea
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Ives C Passos
- Laboratório de Psiquiatria Molecular e Programa de
Transtorno Bipolar, Hospital de Clínicas de Porto Alegre (HCPA), Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Giovanni A Salum
- Departamento de Psiquiatria, Seção de Afeto Negativo e Processos Sociais (SANPS), HCPA, UFRGS, Porto Alegre, RS, Brazil
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium.,Department of Experimental Clinical and Health Psychology, Psychopathology and Affective Neuroscience Lab, Ghent University, Ghent, Belgium
| | - Renerio Fraguas
- Laboratório de Neuroimagem em Psiquiatria (LIM-21), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Hospital Universitário, USP, São Paulo, SP, Brazil
| | - Isabela Benseñor
- Estudo Longitudinal de Saúde do Adulto (ELSA), Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, USP, São Paulo, SP, Brazil
| | - Leandro Valiengo
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Andre R Brunoni
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas,
Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Hospital Universitário, USP, São Paulo, SP, Brazil
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Ousdal OT, Argyelan M, Narr KL, Abbott C, Wade B, Vandenbulcke M, Urretavizcaya M, Tendolkar I, Takamiya A, Stek ML, Soriano-Mas C, Redlich R, Paulson OB, Oudega ML, Opel N, Nordanskog P, Kishimoto T, Kampe R, Jorgensen A, Hanson LG, Hamilton JP, Espinoza R, Emsell L, van Eijndhoven P, Dols A, Dannlowski U, Cardoner N, Bouckaert F, Anand A, Bartsch H, Kessler U, Oedegaard KJ, Dale AM, Oltedal L. Brain Changes Induced by Electroconvulsive Therapy Are Broadly Distributed. Biol Psychiatry 2020; 87:451-461. [PMID: 31561859 DOI: 10.1016/j.biopsych.2019.07.010] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/14/2019] [Accepted: 07/15/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is associated with volumetric enlargements of corticolimbic brain regions. However, the pattern of whole-brain structural alterations following ECT remains unresolved. Here, we examined the longitudinal effects of ECT on global and local variations in gray matter, white matter, and ventricle volumes in patients with major depressive disorder as well as predictors of ECT-related clinical response. METHODS Longitudinal magnetic resonance imaging and clinical data from the Global ECT-MRI Research Collaboration (GEMRIC) were used to investigate changes in white matter, gray matter, and ventricle volumes before and after ECT in 328 patients experiencing a major depressive episode. In addition, 95 nondepressed control subjects were scanned twice. We performed a mega-analysis of single subject data from 14 independent GEMRIC sites. RESULTS Volumetric increases occurred in 79 of 84 gray matter regions of interest. In total, the cortical volume increased by mean ± SD of 1.04 ± 1.03% (Cohen's d = 1.01, p < .001) and the subcortical gray matter volume increased by 1.47 ± 1.05% (d = 1.40, p < .001) in patients. The subcortical gray matter increase was negatively associated with total ventricle volume (Spearman's rank correlation ρ = -.44, p < .001), while total white matter volume remained unchanged (d = -0.05, p = .41). The changes were modulated by number of ECTs and mode of electrode placements. However, the gray matter volumetric enlargements were not associated with clinical outcome. CONCLUSIONS The findings suggest that ECT induces gray matter volumetric increases that are broadly distributed. However, gross volumetric increases of specific anatomically defined regions may not serve as feasible biomarkers of clinical response.
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Affiliation(s)
| | - Miklos Argyelan
- Center for Psychiatric Neuroscience at the Feinstein Institute for Medical Research, New York, New York
| | - Katherine L Narr
- Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles
| | - Christopher Abbott
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Benjamin Wade
- Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles
| | - Mathieu Vandenbulcke
- Department of Geriatric Psychiatry, University Psychiatric Center Katholieke Universiteit Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Mikel Urretavizcaya
- Department of Psychiatry, Bellvitge University Hospital-Bellvitge Biomedical Research Institute; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Carlos III Health Institute, Madrid, Spain
| | - Indira Tendolkar
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands; Donders Institute for Brain Cognition and Behavior, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands; Faculty of Medicine and Landschaftsverband Rheinland Clinic for Psychiatry and Psychotherapy, University of Duisburg-Essen, Duisburg-Essen, Germany
| | - Akihiro Takamiya
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Center for Psychiatry and Behavioral Science, Komagino Hospital, Tokyo, Japan
| | - Max L Stek
- Geestelijke GezondheidsZorg inGeest Specialized Mental Health Care, Amsterdam, The Netherlands; Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Carles Soriano-Mas
- Department of Psychiatry, Bellvitge University Hospital-Bellvitge Biomedical Research Institute; Department of Psychobiology and Methodology in Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Carlos III Health Institute, Madrid, Spain
| | - Ronny Redlich
- Department of Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany
| | - Olaf B Paulson
- Neurobiology Research Unit, Department of Neurology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mardien L Oudega
- Geestelijke GezondheidsZorg inGeest Specialized Mental Health Care, Amsterdam, The Netherlands; Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Nils Opel
- Department of Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany; Interdisciplinary Centre for Clinical Research (IZKF), University of Muenster, Muenster, Germany
| | - Pia Nordanskog
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Taishiro Kishimoto
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Robin Kampe
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Anders Jorgensen
- Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark
| | - Lars G Hanson
- Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark; Danish Research Centre for Magnetic Resonance, Center for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Hvidovre, Denmark
| | - J Paul Hamilton
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Randall Espinoza
- Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles
| | - Louise Emsell
- Department of Geriatric Psychiatry, University Psychiatric Center Katholieke Universiteit Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Philip van Eijndhoven
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands; Donders Institute for Brain Cognition and Behavior, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands
| | - Annemieke Dols
- Geestelijke GezondheidsZorg inGeest Specialized Mental Health Care, Amsterdam, The Netherlands; Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Udo Dannlowski
- Department of Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany
| | - Narcis Cardoner
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Carlos III Health Institute, Madrid, Spain; Department of Mental Health, University Hospital Parc Taulí-I3PT, Sabadell, Spain
| | - Filip Bouckaert
- Department of Geriatric Psychiatry, University Psychiatric Center Katholieke Universiteit Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Amit Anand
- Cleveland Clinic, Center for Behavioral Health, Cleveland, Ohio
| | - Hauke Bartsch
- Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California; Department of Radiology, University of California, San Diego, La Jolla, California
| | - Ute Kessler
- Norwegian Centre for Mental Disorders Research, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ketil J Oedegaard
- Norwegian Centre for Mental Disorders Research, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Anders M Dale
- Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California; Department of Radiology, University of California, San Diego, La Jolla, California; Department of Neurosciences, University of California, San Diego, La Jolla, California
| | - Leif Oltedal
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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47
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Mulders PCR, Llera A, Beckmann CF, Vandenbulcke M, Stek M, Sienaert P, Redlich R, Petrides G, Oudega ML, Oltedal L, Oedegaard KJ, Narr KL, Magnusson PO, Kessler U, Jorgensen A, Espinoza R, Enneking V, Emsell L, Dols A, Dannlowski U, Bolwig TG, Bartsch H, Argyelan M, Anand A, Abbott CC, van Eijndhoven PFP, Tendolkar I. Structural changes induced by electroconvulsive therapy are associated with clinical outcome. Brain Stimul 2020; 13:696-704. [PMID: 32289700 DOI: 10.1016/j.brs.2020.02.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/30/2020] [Accepted: 02/17/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is the most effective treatment option for major depressive disorder, so understanding whether its clinical effect relates to structural brain changes is vital for current and future antidepressant research. OBJECTIVE To determine whether clinical response to ECT is related to structural volumetric changes in the brain as measured by structural magnetic resonance imaging (MRI) and, if so, which regions are related to this clinical effect. We also determine whether a similar model can be used to identify regions associated with electrode placement (unilateral versus bilateral ECT). METHODS Longitudinal MRI and clinical data (Hamilton Depression Rating Scale) was collected from 10 sites as part of the Global ECT-MRI research collaboration (GEMRIC). From 192 subjects, relative changes in 80 (sub)cortical areas were used as potential features for classifying treatment response. We used recursive feature elimination to extract relevant features, which were subsequently used to train a linear classifier. As a validation, the same was done for electrode placement. We report accuracy as well as the structural coefficients of regions included in the discriminative spatial patterns obtained. RESULTS A pattern of structural changes in cortical midline, striatal and lateral prefrontal areas discriminates responders from non-responders (75% accuracy, p < 0.001) while left-sided mediotemporal changes discriminate unilateral from bilateral electrode placement (81% accuracy, p < 0.001). CONCLUSIONS The identification of a multivariate discriminative pattern shows that structural change is relevant for clinical response to ECT, but this pattern does not include mediotemporal regions that have been the focus of electroconvulsive therapy research so far.
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Affiliation(s)
- Peter C R Mulders
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behavior, Centre for Cognitive Neuroimaging, Nijmegen, the Netherlands.
| | - Alberto Llera
- Donders Institute for Brain, Cognition and Behavior, Centre for Cognitive Neuroimaging, Nijmegen, the Netherlands; Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Christian F Beckmann
- Donders Institute for Brain, Cognition and Behavior, Centre for Cognitive Neuroimaging, Nijmegen, the Netherlands; Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), University of Oxford, Oxford, United Kingdom
| | - Mathieu Vandenbulcke
- Department of Geriatric Psychiatry, University Psychiatric Center (UPC), KU Leuven, Leuven, Belgium
| | - Max Stek
- GGZ InGeest Specialized Mental Health Care, Amsterdam, Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Pascal Sienaert
- Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC) - KU Leuven, Kortenberg, Belgium
| | - Ronny Redlich
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Georgios Petrides
- - Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, USA; Center for Neuroscience, Feinstein Institute for Medical Research, Manhasset, USA; Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry, Hempstead, USA
| | - Mardien Leoniek Oudega
- GGZ InGeest Specialized Mental Health Care, Amsterdam, Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Leif Oltedal
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Ketil J Oedegaard
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Katherine L Narr
- Departments of Neurology Psychiatry, Biobehavioral Sciences, Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Peter O Magnusson
- Lund University, Box 118, SE-221 00, Lund, Sweden; Previous: Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Hvidovre, Denmark
| | - Ute Kessler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Anders Jorgensen
- Psychiatric Center Copenhagen & University of Copenhagen, Copenhagen, Denmark
| | - Randall Espinoza
- Departments of Neurology Psychiatry, Biobehavioral Sciences, Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Verena Enneking
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Louise Emsell
- Department of Geriatric Psychiatry, University Psychiatric Center (UPC), KU Leuven, Leuven, Belgium
| | - Annemieke Dols
- GGZ InGeest Specialized Mental Health Care, Amsterdam, Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Udo Dannlowski
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Tom G Bolwig
- Previous: Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Hvidovre, Denmark
| | - Hauke Bartsch
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway; Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, USA
| | - Miklos Argyelan
- - Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, USA; Center for Neuroscience, Feinstein Institute for Medical Research, Manhasset, USA; Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry, Hempstead, USA
| | - Amit Anand
- Center of Behavioral Health, Cleveland Clinic, Cleveland, OH, USA
| | | | - Philip F P van Eijndhoven
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behavior, Centre for Cognitive Neuroimaging, Nijmegen, the Netherlands
| | - Indira Tendolkar
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behavior, Centre for Cognitive Neuroimaging, Nijmegen, the Netherlands; Department of Psychiatry and Psychotherapy, University Hospital Essen, Essen, Germany
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48
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Common increased hippocampal volume but specific changes in functional connectivity in schizophrenia patients in remission and non-remission following electroconvulsive therapy: A preliminary study. NEUROIMAGE-CLINICAL 2019; 24:102081. [PMID: 31734526 PMCID: PMC6861644 DOI: 10.1016/j.nicl.2019.102081] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/10/2019] [Accepted: 11/06/2019] [Indexed: 01/21/2023]
Abstract
Electroconvulsive therapy (ECT) is considered a treatment option in patients with drug-resistant schizophrenia (SZ). However, approximately one-third of patients do not benefit from ECT in the clinic. Thus, it is critical to investigate differences between ECT responders and non-responders. Accumulated evidence has indicated that one region of ECT action is the hippocampus, which also plays an important role in SZ pathophysiology. To date, no studies have investigated differences in ECT effects in the hippocampus between treatment responders and non-responders. This study recruited twenty-one SZ patients treated for four weeks with ECT (MSZ, n = 21) and twenty-one SZ patients who received pharmaceutical therapy (DSZ, n = 21). The MSZ group was further categorized into responders (MSR, n = 10) or non-responders (MNR, n = 11) based on treatment outcomes by the criterion of a 50% reduction in the Positive and Negative Syndrome Scale total scores. Using structural and resting-state functional MRI, we measured the hippocampal volume and functional connectivity (FC) in all SZ patients (before and after treatment) and 23 healthy controls. In contrast to pharmaceutical therapy, ECT induced bilateral hippocampal volume increases in the MSZ. Both the MSR and MNR exhibited hippocampal expansion after ECT, whereas a lower baseline volume in one of hippocampal subfield (hippocampus-amygdala transition area) was found in the MNR. After ECT, increased FC between the hippocampus and brain networks associated with cognitive function was only observed in the MSR. The mechanism of action of ECT in schizophrenia is complex. A combination of baseline impairment level, ECT-introduced morphological changes and post-ECT FC increases in the hippocampus may jointly contribute to the post-ECT symptom improvements in patients with SZ.
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49
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Yrondi A, Nemmi F, Billoux S, Giron A, Sporer M, Taib S, Salles J, Pierre D, Thalamas C, Rigal E, Danet L, Pariente J, Schmitt L, Arbus C, Péran P. Grey Matter changes in treatment-resistant depression during electroconvulsive therapy. J Affect Disord 2019; 258:42-49. [PMID: 31382103 DOI: 10.1016/j.jad.2019.07.075] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/08/2019] [Accepted: 07/29/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION 20-30% of depressed patients experience Treatment Resistant Depression (TRD). Electroconvulsive Therapy (ECT) remains the treatment of choice for TRD. However, the exact mechanism of ECT remains unclear. We aim to assess grey matter changes in patients with TRD undergoing bilateral ECT treatment at different points during and after treatment. METHODS Patients are recruited at the University Hospital of Toulouse. Eligibility criteria include a diagnosis of TRD and an age between 50 and 70 years old. Patients received clinical assessments (Hamilton Depression Rating Scale) and structural scans (MRI) at three points: baseline (within 48 h before the first ECT); V2 (after the first ECT considered effective); and V3 (within 1 week of completing ECT). RESULTS At baseline, controls had significantly higher cortical thickness than patients in the fusiform gyrus, the inferior, middle and superior temporal gyrus, the parahippocampal gyrus and the transverse temporal gyrus (respectively: t(35)=2.7, p = 0.02; t(35)=2.89, p = 0.017; t(35)=3.1, p = 0.015; t(35)=3.6, p = 0.009; t(35)=2.37, p = 0.031; t(35)=2.46, p = 0.03). This difference was no longer significant after ECT. We showed an increase in cortical thickness in superior temporal gyrus between (i) baseline and V3 (t(62)=-3.43 p = 0.009) and (ii) V2 and V3 (t(62)=-3.42 p = 0.009). We showed an increase in hippocampal volume between (i) baseline and V3 (t(62)=-5.23 p < 0.001) and (ii) V2 and V3 (t(62)=-5.3 p < 0.001). CONCLUSION We highlight that there are grey matter changes during ECT treatment in a population with TRD compared to a healthy control population. These changes seem to occur after several rounds of ECT.
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Affiliation(s)
- Antoine Yrondi
- Service de Psychiatrie et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU Toulouse, Hospital Purpan, ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.
| | - Federico Nemmi
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Sophie Billoux
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France; Service de medicine légale, CHU Toulouse, Toulouse, France
| | - Aurélie Giron
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France; Service de Psychiatrie et de Psychologie Médicale, CHU de Toulouse, Hospital Purpan, Toulouse, France
| | - Marie Sporer
- Service de Psychiatrie et de Psychologie Médicale, CHU de Toulouse, Hospital Purpan, Toulouse, France
| | - Simon Taib
- Service de Psychiatrie et de Psychologie Médicale, CHU Toulouse, Hospital Purpan, ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Juliette Salles
- Service de Psychiatrie et de Psychologie Médicale, CHU de Toulouse, Hospital Purpan, Toulouse, France
| | - Damien Pierre
- Service de Psychiatrie et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU Toulouse, Hospital Purpan, Toulouse, France
| | - Claire Thalamas
- CIC 1436, Service de Pharmacologie Clinique, CHU de Toulouse, INSERM, Université de Toulouse, UPS, Toulouse, France
| | - Emilie Rigal
- Department of Neurology, University Hospital of Toulouse, Toulouse, France
| | - Lola Danet
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France; Department of Neurology, University Hospital of Toulouse, Toulouse, France
| | - Jérémie Pariente
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France; Department of Neurology, University Hospital of Toulouse, Toulouse, France
| | - Laurent Schmitt
- Service de Psychiatrie et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU Toulouse, Hospital Purpan, Toulouse, France
| | - Christophe Arbus
- Service de Psychiatrie et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU Toulouse, Hospital Purpan, ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Patrice Péran
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France
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50
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Argyelan M, Oltedal L, Deng ZD, Wade B, Bikson M, Joanlanne A, Sanghani S, Bartsch H, Cano M, Dale AM, Dannlowski U, Dols A, Enneking V, Espinoza R, Kessler U, Narr KL, Oedegaard KJ, Oudega ML, Redlich R, Stek ML, Takamiya A, Emsell L, Bouckaert F, Sienaert P, Pujol J, Tendolkar I, van Eijndhoven P, Petrides G, Malhotra AK, Abbott C. Electric field causes volumetric changes in the human brain. eLife 2019; 8:49115. [PMID: 31644424 PMCID: PMC6874416 DOI: 10.7554/elife.49115] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 10/22/2019] [Indexed: 12/13/2022] Open
Abstract
Recent longitudinal neuroimaging studies in patients with electroconvulsive therapy (ECT) suggest local effects of electric stimulation (lateralized) occur in tandem with global seizure activity (generalized). We used electric field (EF) modeling in 151 ECT treated patients with depression to determine the regional relationships between EF, unbiased longitudinal volume change, and antidepressant response across 85 brain regions. The majority of regional volumes increased significantly, and volumetric changes correlated with regional electric field (t = 3.77, df = 83, r = 0.38, p=0.0003). After controlling for nuisance variables (age, treatment number, and study site), we identified two regions (left amygdala and left hippocampus) with a strong relationship between EF and volume change (FDR corrected p<0.01). However, neither structural volume changes nor electric field was associated with antidepressant response. In summary, we showed that high electrical fields are strongly associated with robust volume changes in a dose-dependent fashion. Electroconvulsive therapy, or ECT for short, can be an effective treatment for severe depression. Many patients who do not respond to medication find that their symptoms improve after ECT. During an ECT session, the patient is placed under general anesthesia and two electrodes are attached to the scalp to produce an electric field that generates currents within the brain. These currents activate neurons and make them fire, causing a seizure, but it remains unclear how this reduces symptoms of depression. For many years, researchers thought that the induced seizure must be key to the beneficial effects of ECT, but recent studies have cast doubt on this idea. They show that increasing the strength of the electric field alters the clinical effects of ECT, without affecting the seizure. This suggests that the benefits of ECT depend on the electric field itself. Argyelan et al. now show that electric fields affect the brain by making a part of the brain known as the gray matter expand. In a large multinational study, 151 patients with severe depression underwent brain scans before and after a course of ECT. The scans revealed that the gray matter of the patients’ brains expanded during the treatment. The patients who experienced the strongest electric fields showed the largest increase in brain volume, and individual brain areas expanded if the electric field within them exceeded a certain threshold. This effect was particularly striking in two areas, the hippocampus and the amygdala. Both of these areas are critical for mood and memory. Further studies are needed to determine why the brain expands after ECT, and how long the effect lasts. Another puzzle is why the improvements in depression that the patients reported after their treatment did not correlate with changes in brain volume. Disentangling the relationships between ECT, brain volume and depression will ultimately help develop more robust treatments for this disabling condition.
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Affiliation(s)
- Miklos Argyelan
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, United States.,Center for Neuroscience, Feinstein Institute for Medical Research, Manhasset, United States.,Department of Psychiatry, Zucker School of Medicine, Hempstead, United States
| | - Leif Oltedal
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Radiology, Haukeland University Hospital, Mohn Medical Imaging and Visualization Centre, Bergen, Norway
| | - Zhi-De Deng
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, United States
| | - Benjamin Wade
- Department of Neurology, Ahmanson-Lovelace Brain Mapping Center, University of California, Los Angeles, Los Angeles, United States
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of the City University of New York, New York, United States
| | - Andrea Joanlanne
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, United States
| | - Sohag Sanghani
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, United States
| | - Hauke Bartsch
- Department of Radiology, Haukeland University Hospital, Mohn Medical Imaging and Visualization Centre, Bergen, Norway.,Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, United States
| | - Marta Cano
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,CIBERSAM, Carlos III Health Institute, Barcelona, Spain
| | - Anders M Dale
- Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, United States.,Department of Radiology, University of California, San Diego, San Diego, United States.,Department of Neurosciences, University of California, San Diego, San Diego, United States
| | - Udo Dannlowski
- Department of Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany
| | - Annemiek Dols
- Department of Psychiatry, Amsterdam UMC, location VUmc, GGZinGeest, Old Age Psychiatry, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Verena Enneking
- Department of Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany
| | - Randall Espinoza
- Department of Neurology, University of California, Los Angeles, Los Angeles, United States.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, United States
| | - Ute Kessler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Katherine L Narr
- Department of Neurology, University of California, Los Angeles, Los Angeles, United States.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, United States
| | - Ketil J Oedegaard
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Mardien L Oudega
- Department of Psychiatry, Amsterdam UMC, location VUmc, GGZinGeest, Old Age Psychiatry, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Ronny Redlich
- Department of Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany
| | - Max L Stek
- Department of Psychiatry, Amsterdam UMC, location VUmc, GGZinGeest, Old Age Psychiatry, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Akihiro Takamiya
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Center for Psychiatry and Behavioral Science, Komagino Hospital, Tokyo, Japan
| | - Louise Emsell
- Department of Geriatric Psychiatry, University Psychiatric Center, KU Leuven, Leuven, Belgium
| | - Filip Bouckaert
- Department of Geriatric Psychiatry, University Psychiatric Center, KU Leuven, Leuven, Belgium.,Academic center for ECT and Neurostimulation (AcCENT), University Psychiatric Center, KU Leuven, Kortenberg, Belgium
| | - Pascal Sienaert
- Academic center for ECT and Neurostimulation (AcCENT), University Psychiatric Center, KU Leuven, Kortenberg, Belgium
| | - Jesus Pujol
- CIBERSAM, Carlos III Health Institute, Barcelona, Spain.,MRI Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain
| | - Indira Tendolkar
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands.,Donders Institute for Brain Cognition and Behavior, Centre for Cognitive Neuroimaging, Nijmegen, Netherlands.,Faculty of Medicine and LVR Clinic for Psychiatry and Psychotherapy, University of Duisburg-Essen, Essen, Germany
| | - Philip van Eijndhoven
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands.,Donders Institute for Brain Cognition and Behavior, Centre for Cognitive Neuroimaging, Nijmegen, Netherlands
| | - Georgios Petrides
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, United States.,Center for Neuroscience, Feinstein Institute for Medical Research, Manhasset, United States.,Department of Psychiatry, Zucker School of Medicine, Hempstead, United States
| | - Anil K Malhotra
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, United States.,Center for Neuroscience, Feinstein Institute for Medical Research, Manhasset, United States.,Department of Psychiatry, Zucker School of Medicine, Hempstead, United States
| | - Christopher Abbott
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, United States
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