Effect of electroconvulsive therapy on neural response to affective pictures: A randomized, sham-controlled fMRI study.

Eur Neuropsychopharmacol. 2018 Jun 08;:

Authors: Miskowiak KW, Macoveanu J, Jørgensen MB, Ott CV, Støttrup MM, Jensen HM, Jørgensen A, Harmer CJ, Paulson OB, Siebner HR, Kessing LV

Abstract
Electroconvulsive therapy (ECT) is the most effective treatment for severe depression but its neurocognitive mechanisms are unclear. This randomized, sham-controlled functional magnetic resonance imaging (fMRI) study explored the effects of a single ECT on neural response to affective pictures. Twenty-seven patients with major depressive disorder were randomized to a single active ECT (N = 15) or sham (N = 12) session in a double-blind, parallel-group design. On the following day, patients underwent fMRI during which they viewed pleasant, unpleasant and neutral pictures and performed a free recall test after the scan. Mood symptoms were assessed before ECT/sham and at the time of fMRI. Subsequently, all patients continued active ECT as usual. Mood symptoms were reassessed after six active ECT sessions. A single ECT vs. sham session reduced neural response to unpleasant vs. pleasant pictures in the medial prefrontal cortex, a region showing greater response in the more depressed patients. This effect occurred in the absence of between-group differences in picture recall, mood symptoms or concomitant medication. In conclusion, modulation of medial prefrontal hyper-activity during encoding of negative affective information may be a common mechanism of distinct biological depression treatments.

PMID: 29891215 [PubMed - as supplied by publisher]