Effects of ECT in treatment of major depression: A prospective neuroradiological study of acute and longitudinal effects on brain structure and function.

BACKGROUND: Major depression can be a serious and debilitating condition. For some patients in a treatment resistant depressive episode, electroconvulsive treatment (ECT) is the only treatment that is effective. Although ECT has shown efficacy in randomized controlled trials, the treatment is still controversial and stigmatized. This can in part be attributed to our lack of knowledge of the mechanisms of action. Some reports also suggest potential harmful effects of ECT treatment and memory related side effects have been documented. SAMPLE: n=40 patients in a major depressive episode (bipolar and major depressive disorder). Two control groups with n=15 in each group: age and gender matched healthy volunteers not receiving ECT and patients undergoing electrical cardioversion (ECV) for atrial fibrillation (AF). Observation time: six months. In addition to the Bergen sample, REK has approved collecting 500 subjects from international collaborators to a common Data Portal in Bergen. RESULTS: By the end of 2016, 31 ECT patients have been included in the study, as well as 35 controls. The project is still collecting data. However, the study protocol has been published and preliminary results have been submitted for both poster and oral presentation at several international Conferences. Four research track students are currently involved in the project. In addition, a large international collaboration has been established which will give a combined sample size of 345 patients. The international data is collected on a server in Bergen (SAFE) and data processing of this large sample is ongoing. Key ongoing investigations, and preliminary results are mentioned briefly: Brain GABA levels in patients receiving ECT (Erchinger). Structural brain changes after ECT (Oltedal). Hippocampal tissue properties after ECT - signs of harmful effects? (Evjenth Sørhaug). Serum lipids after ECT (Stautland): Post-treatment samples showed reduction of serum concentration in several classes of lipid metabolites, especially free fatty acids (FFA). Further investigations in larger samples should be performed to confirm these results and evaluate the clinical significance of the findings. Cognitive profile of ECT sample and effects of ECT (Hammar): International collaboration: 1) Gene activation following ECT: A Collaboration with researchers at the University of California Los Angeles. Data collection is ongoing. 2) GEMRIC: (Oltedal) An international initiative, The Global ECT-MRI Research Collaboration has been initiated. Currently 15 sites contribute in this collaboration. Our combined sample will be the largest study of ECT induced brain changes to date. References: Oltedal L, Bartsch H, Sørhaug OJE, Kessler U, Abbott C, Dols A, Stek ML, Ersland E, Emsell L, van Eijndohoven P, Argyelan M, Tendolkar I, Nordanskog P, Hamilton P, Jorgensen MB, Sommer IE, Heringa SH, Draganski B, Relich R, Dannlowski U, Kugel H, Bouckaert F, Sinaert P, Anand A, Espinoza R, Narr KL, Dale AM & Oedegaard KJ. The Global ECT-MRI Research Collaboration (GEMRIC): Establishing a multi-site investigation of the neural mechanisms underlying response to electroconvulsive therapy. Under revision for Neuroimage: Clinical.

BACKGROUND: Major depression can be a serious and debilitating condition. For some patients in a treatment resistant depressive episode, electroconvulsive treatment (ECT) is the only treatment that is effective. Although ECT has shown efficacy in randomized controlled trials, the treatment is still controversial and stigmatized. This can in part be attributed to our lack of knowledge of the mechanisms of action. Some reports also suggest potential harmful effects of ECT treatment and memory related side effects have been documented. METHODS/DESIGN: The present study will apply state of the art radiology through advanced magnetic resonance imaging (MRI) techniques to investigate structural and functional brain effects of ECT. As a multi-disciplinary collaboration, imaging findings will be correlated to psychiatric response parameters, neuropsychological functioning as well as neurochemical and genetic biomarkers that can elucidate the underlying mechanisms. The aim is to document both treatment effects and potential harmful effects of ECT. SAMPLE: n?=?40 patients in a major depressive episode (bipolar and major depressive disorder). Two control groups with n?=?15 in each group: age and gender matched healthy volunteers not receiving ECT and patients undergoing electrical cardioversion (ECV) for atrial fibrillation (AF). Observation time: six months. DISCUSSION: The study will contribute to our understanding of the pathophysiology of major depression as well as mechanisms of action for the most effective treatment for the disorder; ECT. By the end of 2015 21 ECT patients were included in the study, as well as 9 Controls. The study protocol has been published and preliminary results have been submitted for both poster and oral presentation at international Conferences in 2 Oltedal L, Kessler U, Ersland L, Grüner R, Andreassen OA, Haavik J, Hoff PI, Hammar Å,10, Dale AM, Hugdahl K, Oedegaard KJ. Effects of ECT in treatment of depression: study protocol for a prospective neuroradiological study of acute and longitudinal effects on brain structure and function.BMC Psychiatry. 2015 May 1;15:94. doi: 10.1186/s12888-015-0477-y.