title: Modulation of Limbic and Prefrontal Connectivity by Electroconvulsive Therapy in Treatment-resistant Depression: A Preliminary Study.
abstract: BACKGROUND
  Although current models of depression suggest that a sequential modulation of limbic and prefrontal connectivity is needed for illness recovery, neuroimaging studies of electroconvulsive therapy (ECT) have focused on assessing functional connectivity (FC) before and after an ECT course, without characterizing functional changes occurring at early treatment phases.
  
  
  OBJECTIVE
  To assess sequential changes in limbic and prefrontal FC during the course of ECT and their impact on clinical response.
  
  
  METHODS
  Longitudinal intralimbic and limbic-prefrontal networks connectivity study. We assessed 15 patients with treatment-resistant depression at four different time-points throughout the entire course of an ECT protocol and 10 healthy participants at two functional neuroimaging examinations. Furthermore, a path analysis to test direct and indirect predictive effects of limbic and prefrontal FC changes on clinical response measured with the Hamilton Rating Scale for Depression was also performed.
  
  
  RESULTS
  An early significant intralimbic FC decrease significantly predicted a later increase in limbic-prefrontal FC, which in turn significantly predicted clinical improvement at the end of an ECT course.
  
  
  CONCLUSIONS
  Our data support that treatment response involves sequential changes in FC within regions of the intralimbic and limbic-prefrontal networks. This approach may help in identifying potential early biomarkers of treatment response.
authors.affiliation: Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Cano
authors.affiliation: Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain; Carlos III Health Institute, CIBERSAM, Spain; Mental Health Department, Parc Taulí Sabadell, Universitat Autònoma de Barcelona, Barcelona, Spain. Electronic address: ncardoner@tauli.cat.
authors.forename: Narcís
authors.initials: N
authors.lastname: Cardoner
authors.affiliation: Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain; Carlos III Health Institute, CIBERSAM, Spain.
authors.forename: Mikel
authors.initials: M
authors.lastname: Urretavizcaya
authors.affiliation: Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Martínez-Zalacaín
authors.affiliation: Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain; Carlos III Health Institute, CIBERSAM, Spain.
authors.forename: Ximena
authors.initials: X
authors.lastname: Goldberg
authors.affiliation: Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Via
authors.affiliation: Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain; Carlos III Health Institute, CIBERSAM, Spain.
authors.forename: Oren
authors.initials: O
authors.lastname: Contreras-Rodríguez
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Joan
authors.initials: J
authors.lastname: Camprodon
authors.affiliation: Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Aida
authors.initials: A
authors.lastname: de Arriba-Arnau
authors.affiliation: Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain; Carlos III Health Institute, CIBERSAM, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Hernández-Ribas
authors.affiliation: Carlos III Health Institute, CIBERSAM, Spain; MRI Research Unit, Hospital del Mar, Barcelona, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Pujol
authors.affiliation: Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain; Carlos III Health Institute, CIBERSAM, Spain; Department of Psychobiology and Methodology in Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain. Electronic address: csoriano@idibell.cat.
authors.forename: Carles
authors.initials: C
authors.lastname: Soriano-Mas
authors.affiliation: Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain; Carlos III Health Institute, CIBERSAM, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Menchón
mesh_terms: D000328:Adult; D000368:Aged; D061218:Depressive Disorder, Treatment-Resistant / Q000503:physiopathology / Q000628:therapy*; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D008032:Limbic System / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D017397:Prefrontal Cortex / Q000503:physiopathology*
keywords: Electroconvulsive therapy; Intralimbic modulation; Limbic–prefrontal modulation; Treatment early biomarkers; Treatment-resistant depression