title: Does a single session of electroconvulsive therapy alter the neural response to emotional faces in depression? A randomised sham-controlled functional magnetic resonance imaging study.
abstract: Negative neurocognitive bias is a core feature of major depressive disorder that is reversed by pharmacological and psychological treatments. This double-blind functional magnetic resonance imaging study investigated for the first time whether electroconvulsive therapy modulates negative neurocognitive bias in major depressive disorder. Patients with major depressive disorder were randomised to one active ( n=15) or sham electroconvulsive therapy ( n=12). The following day they underwent whole-brain functional magnetic resonance imaging at 3T while viewing emotional faces and performed facial expression recognition and dot-probe tasks. A single electroconvulsive therapy session had no effect on amygdala response to emotional faces. Whole-brain analysis revealed no effects of electroconvulsive therapy versus sham therapy after family-wise error correction at the cluster level, using a cluster-forming threshold of Z>3.1 ( p<0.001) to secure family-wise error <5%. Groups showed no differences in behavioural measures, mood and medication. Exploratory cluster-corrected whole-brain analysis ( Z>2.3; p<0.01) revealed electroconvulsive therapy-induced changes in parahippocampal and superior frontal responses to fearful versus happy faces as well as in fear-specific functional connectivity between amygdala and occipito-temporal regions. Across all patients, greater fear-specific amygdala - occipital coupling correlated with lower fear vigilance. Despite no statistically significant shift in neural response to faces after a single electroconvulsive therapy session, the observed trend changes after a single electroconvulsive therapy session point to an early shift in emotional processing that may contribute to antidepressant effects of electroconvulsive therapy.
authors.affiliation: 1 Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.|2 Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
authors.forename: Kamilla W
authors.initials: KW
authors.lastname: Miskowiak
authors.affiliation: 1 Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Lars V
authors.initials: LV
authors.lastname: Kessing
authors.affiliation: 1 Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Caroline V
authors.initials: CV
authors.lastname: Ott
authors.affiliation: 1 Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.|3 Center for Integrated Molecular Brain Imaging, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Julian
authors.initials: J
authors.lastname: Macoveanu
authors.affiliation: 4 Department of Psychiatry, University of Oxford, Oxford, UK.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Harmer
authors.affiliation: 1 Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Anders
authors.initials: A
authors.lastname: Jørgensen
authors.affiliation: 1 Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Revsbech
authors.affiliation: 5 Psychiatric Centre Copenhagen, Gentofte Hospital, Denmark.
authors.forename: Hans M
authors.initials: HM
authors.lastname: Jensen
authors.affiliation: 2 Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.|3 Center for Integrated Molecular Brain Imaging, Rigshospitalet, Copenhagen, Denmark.|6 Neurobiology Research Unit, Copenhagen University Hospital, Denmark.
authors.forename: Olaf B
authors.initials: OB
authors.lastname: Paulson
authors.affiliation: 2 Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.|3 Center for Integrated Molecular Brain Imaging, Rigshospitalet, Copenhagen, Denmark.|7 Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark.
authors.forename: Hartwig R
authors.initials: HR
authors.lastname: Siebner
authors.affiliation: 1 Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Martin B
authors.initials: MB
authors.lastname: Jørgensen
mesh_terms: D000328:Adult; D000339:Affect / Q000187:drug effects; D000679:Amygdala / Q000187:drug effects; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000188:drug therapy / Q000628:therapy; D001921:Brain / Q000187:drug effects; D001931:Brain Mapping / Q000379:methods; D003863:Depression / Q000188:drug therapy* / Q000628:therapy*; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000628:therapy*; D004311:Double-Blind Method; D004565:Electroconvulsive Therapy / Q000379:methods; D004644:Emotions / Q000187:drug effects* / Q000502:physiology; D005145:Face / Q000503:physiopathology; D005149:Facial Expression; D005239:Fear / Q000187:drug effects; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male
chemical_list: D000928:Antidepressive Agents
keywords: Electroconvulsive therapy; functional magnetic resonance imaging; major depressive disorder; negative bias