Electroconvulsive therapy, electric field, neuroplasticity, and clinical outcomes.
Journal
Molecular psychiatry
ISSN: 1476-5578
Titre abrégé: Mol Psychiatry
Pays: England
ID NLM: 9607835
Informations de publication
Date de publication:
03 2022
03 2022
Historique:
received:
07
07
2021
accepted:
26
10
2021
revised:
20
10
2021
pubmed:
3
12
2021
medline:
18
5
2022
entrez:
2
12
2021
Statut:
ppublish
Résumé
Electroconvulsive therapy (ECT) remains the gold-standard treatment for patients with depressive episodes, but the underlying mechanisms for antidepressant response and procedure-induced cognitive side effects have yet to be elucidated. Such mechanisms may be complex and involve certain ECT parameters and brain regions. Regarding parameters, the electrode placement (right unilateral or bitemporal) determines the geometric shape of the electric field (E-field), and amplitude determines the E-field magnitude in select brain regions (e.g., hippocampus). Here, we aim to determine the relationships between hippocampal E-field strength, hippocampal neuroplasticity, and antidepressant and cognitive outcomes. We used hippocampal E-fields and volumes generated from a randomized clinical trial that compared right unilateral electrode placement with different pulse amplitudes (600, 700, and 800 mA). Hippocampal E-field strength was variable but increased with each amplitude arm. We demonstrated a linear relationship between right hippocampal E-field and right hippocampal neuroplasticity. Right hippocampal neuroplasticity mediated right hippocampal E-field and antidepressant outcomes. In contrast, right hippocampal E-field was directly related to cognitive outcomes as measured by phonemic fluency. We used receiver operating characteristic curves to determine that the maximal right hippocampal E-field associated with cognitive safety was 112.5 V/m. Right hippocampal E-field strength was related to the whole-brain ratio of E-field strength per unit of stimulation current, but this whole-brain ratio was unrelated to antidepressant or cognitive outcomes. We discuss the implications of optimal hippocampal E-field dosing to maximize antidepressant outcomes and cognitive safety with individualized amplitudes.
Identifiants
pubmed: 34853404
doi: 10.1038/s41380-021-01380-y
pii: 10.1038/s41380-021-01380-y
pmc: PMC9095458
doi:
Substances chimiques
Antidepressive Agents
0
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
1676-1682Subventions
Organisme : NIMH NIH HHS
ID : U01 MH111826
Pays : United States
Organisme : Intramural NIH HHS
ID : ZIA MH002955
Pays : United States
Organisme : NIMH NIH HHS
ID : K23 MH120504
Pays : United States
Organisme : NIMH NIH HHS
ID : R01 MH119285
Pays : United States
Organisme : NIMH NIH HHS
ID : R61 MH125126
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021. The Author(s).
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