Subgenual cingulate cortical activity predicts the efficacy of electroconvulsive therapy.
Electroconvulsive therapy (ECT) is the most effective treatment for depression, yet its mechanism of action is unknown. Our goal was to investigate the neurobiological underpinnings of ECT response using longitudinally collected resting-state functional magnetic resonance imaging (rs-fMRI) in 16 patients with treatment-resistant depression and 10 healthy controls. Patients received bifrontal ECT 3 times a week under general anesthesia. We acquired rs-fMRI at three time points: at baseline, after the 1st ECT administration and after the course of the ECT treatment; depression was assessed with the Hamilton Depression Rating Scale (HAM-D). The primary measure derived from rs-fMRI was fractional amplitude of low frequency fluctuation (fALFF), which provides an unbiased voxel-wise estimation of brain activity. We also conducted seed-based functional connectivity analysis based on our primary findings. We compared treatment-related changes in HAM-D scores with pre- and post-treatment fALFF and connectivity measures. Subcallosal cingulate cortex (SCC) demonstrated higher BOLD signal fluctuations (fALFF) at baseline in depressed patients, and SCC fALFF decreased over the course of treatment. The baseline level of fALFF of SCC predicted response to ECT. In addition, connectivity of SCC with bilateral hippocampus, bilateral temporal pole, and ventromedial prefrontal cortex was significantly reduced over the course of treatment. These results suggest that the antidepressant effect of ECT may be mediated by downregulation of SCC activity and connectivity. SCC function may serve as an important biomarker of target engagement in the development of novel therapies for depression that is resistant to treatment with standard medications.
Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA.|Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.
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Argyelan
Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA.|Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.|Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, NY, USA.
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Lencz
Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA.|Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.
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Kaliora
Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA.|Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.
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Sarpal
Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.
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Weissman
Department of Radiology, North Shore University Hospital, Northwell Health, Manhasset, NY, USA.
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Kingsley
Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA.|Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.|Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, NY, USA.
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Malhotra
Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA.|Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.|Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, NY, USA.
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Petrides
D000293:Adolescent; D000328:Adult; D000368:Aged; D061218:Depressive Disorder, Treatment-Resistant / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D004565:Electroconvulsive Therapy; D005260:Female; D006179:Gyrus Cinguli / Q000502:physiology*; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult