title: Effects of electroconvulsive therapy on brain functional activation and connectivity in depression.
abstract: OBJECTIVE
  Past neuroimaging work has suggested that increased activation to cognitive and emotional tasks and decreased connectivity in frontal regions are related to cognitive inefficiency in depression; normalization of these relationships has been associated with successful treatment. The present study investigated brain function before and after electroconvulsive therapy (ECT) in patients with major depressive disorder (MDD) and demonstrated the effect of treatment on cortical activation patterns.
  
  
  METHODS
  Six ECT-naive patients with depression (mean ± SD age, 39.0 ± 5.4 years) were treated with ECT. Within 1 week before and 1 to 3 weeks after ECT, the patients underwent a magnetic resonance imaging session with functional magnetic resonance image scanning during working memory and affective tasks and during rest. Changes in voxelwise statistical maps of brain response to each task in regions identified to be relevant from past studies of depression were compared with changes in depression severity as measured by the Hamilton Depression Rating Score. Changes in functional connectivity between brain regions were also compared with changes in depression severity.
  
  
  RESULTS
  Activation during both tasks was generally found to be decreased after ECT. Remission of depression was significantly associated with reduced affective deactivation after ECT in the orbitofrontal cortex (P = 0.03). Whole-brain functional connectivity of the anterior cingulate cortex showed a consistent increase in connectivity to the right dorsolateral prefrontal cortex and posterior cingulate cortex after ECT.
  
  
  CONCLUSIONS
  These results suggest that successful ECT for MDD is associated with decreased activation to cognitive and emotional tasks and an increase in resting connectivity.
authors: Cleveland Clinic, Cleveland, OH 44195, USA. ebeall@gmail.com
authors: Erik B
authors: EB
authors: Beall
authors: Donald A
authors: DA
authors: Malone
authors: Roman M
authors: RM
authors: Dale
authors: David J
authors: DJ
authors: Muzina
authors: Katherine A
authors: KA
authors: Koenig
authors: Pallab K
authors: PK
authors: Bhattacharrya
authors: Stephen E
authors: SE
authors: Jones
authors: Michael D
authors: MD
authors: Phillips
authors: Mark J
authors: MJ
authors: Lowe
mesh_terms: D000328:Adult; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping; D003863:Depression / Q000503:physiopathology* / Q000628:therapy*; D003865:Major Depressive Disorder / Q000503:physiopathology / Q000523:psychology; D004565:Electroconvulsive Therapy; D004644:Emotions / Q000502:physiology; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009434:Neural Pathways / Q000502:physiology; D009483:Neuropsychological Tests; D017397:Prefrontal Cortex / Q000502:physiology / Q000503:physiopathology; D011569:Psychiatric Status Rating Scales