Is successful electroconvulsive therapy related to stimulation of the vagal system?
BACKGROUND
Electroconvulsive therapy (ECT) has been shown to exhibit strong beneficial effects in the treatment of major depressive disorder (MDD). While the exact underlying mechanisms are under debate, a role for the sympathetic response upon ECT has been suggested. When assessing patients with MDD for autonomic function, however, a loss of vagal function is prominent.


OBJECTIVE
Here, we aimed to assess the immediate effects of ECT on vagal activity and to test the hypothesis that surrogates of the latter correlate with therapeutic outcome.


METHODS
Twenty patients with MDD who underwent ECT treatment were assessed regarding their vagal function using electrophysiological measures and determination of pancreatic polypeptide (PP), which is known to be released upon vagal stimulation. Parameters were correlated to the improvement of disease severity upon ECT treatment.


RESULTS
Patients showed a significant increase of PP shortly after ECT which correlated with clinical improvement. Furthermore, the described association with the sympathetic phase after ECT could be verified.


CONCLUSIONS
ECT increases vagal activity which might be associated with the beneficial effect seen following this treatment. PP elevation after administration of ECT might be a useful parameter to estimate the degree of such vagal stimulation after treatment.
Bär
Karl-Jürgen
KJ
Department of Psychiatry and Psychotherapy, University Hospital, Jena, Germany. Karl-Juergen.Baer@med.uni-jena.de
Ebert
Andreas
A
Boettger
Michael Karl
MK
Merz
Sebastian
S
Kiehntopf
Michael
M
Jochum
Thomas
T
Juckel
Georg
G
Agelink
Marcus Willi
MW
D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D003865:Major Depressive Disorder / Q000503:physiopathology* / Q000628:therapy*; D004565:Electroconvulsive Therapy; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010191:Pancreatic Polypeptide / Q000097:blood; D010555:Personality Inventory / Q000706:statistics & numerical data; D011594:Psychometrics; D019233:Retreatment; D013223:Statistics as Topic; D013564:Sympathetic Nervous System / Q000503:physiopathology; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000503:physiopathology*; D055536:Vagus Nerve Stimulation
D010191:Pancreatic Polypeptide