Effect of electroconvulsive therapy on neural response to affective pictures: A randomized, sham-controlled fMRI study

• Published in: European neuropsychopharmacology Vol. 28; no. 8; pp. 915 - 924
• Main Authors: Miskowiak, KW, Macoveanu, J, Jørgensen, MB, Ott, CV, Støttrup, MM, Jensen, HM, Jørgensen, A, Harmer, CJ, Paulson, OB, Siebner, HR, Kessing, LV
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.08.2018
• Subjects: Depression; ECT; Magnetic resonance imaging; Neurocognition; Prefrontal cortex; Depression; Prefrontal cortex; Magnetic resonance imaging; Neurocognition; ECT
• ISSN: 0924-977X; 1873-7862
• DOI: 10.1016/j.euroneuro.2018.05.013

Electroconvulsive therapy (ECT) is the most effective treatment for severe depression but its neurocognitive mechanisms are unclear. This randomized, sham-controlled functional magnetic resonance imaging (fMRI) study explored the effects of a single ECT on neural response to affective pictures. Twenty-seven patients with major depressive disorder were randomized to a single active ECT (N = 15) or sham (N = 12) session in a double-blind, parallel-group design. On the following day, patients underwent fMRI during which they viewed pleasant, unpleasant and neutral pictures and performed a free recall test after the scan. Mood symptoms were assessed before ECT/sham and at the time of fMRI. Subsequently, all patients continued active ECT as usual. Mood symptoms were reassessed after six active ECT sessions. A single ECT vs. sham session reduced neural response to unpleasant vs. pleasant pictures in the medial prefrontal cortex, a region showing greater response in the more depressed patients. This effect occurred in the absence of between-group differences in picture recall, mood symptoms or concomitant medication. In conclusion, modulation of medial prefrontal hyper-activity during encoding of negative affective information may be a common mechanism of distinct biological depression treatments.