Qinghua Luo

Antidepressant Effects of Electroconvulsive Therapy Correlate With Subgenual Anterior Cingulate Activity and Connectivity in Depression.

AbstractThe mechanisms underlying the effects of electroconvulsive therapy (ECT) in major depressive disorder (MDD) are not fully understood. Resting-state functional magnetic resonance imaging (rs-fMRI) is a new tool to study the effects of brain stimulation interventions, particularly ECT. The authors aim to investigate the mechanisms of ECT in MDD by rs-fMRI.They used rs-fMRI to measure functional changes in the brain of first-episode, treatment-naive MDD patients (n = 23) immediately before and then following 8 ECT sessions (brief-pulse square-wave apparatus, bitemporal). They also computed voxel-wise amplitude of low-frequency fluctuation (ALFF) as a measure of regional brain activity and selected the left subgenual anterior cingulate cortex (sgACC) to evaluate functional connectivity between the sgACC and other brain regions.Increased regional brain activity measured by ALFF mainly in the left sgACC following ECT. Functional connectivity of the left sgACC increased in the ipsilateral parahippocampal gyrus, pregenual ACC, contralateral middle temporal pole, and orbitofrontal cortex. Importantly, reduction in depressive symptoms were negatively correlated with increased ALFF in the left sgACC and left hippocampus, and with distant functional connectivity between the left sgACC and contralateral middle temporal pole. That is, across subjects, as depression improved, regional brain activity in sgACC and its functional connectivity increased in the brain.Eight ECT sessions in MDD patients modulated activity in the sgACC and its networks. The antidepressant effects of ECT were negatively correlated with sgACC brain activity and connectivity. These findings suggest that sgACC-associated prefrontal-limbic structures are associated with the therapeutic effects of ECT in MDD.

Effect of Low Dose of Ketamine on Learning Memory Function in Patients Undergoing Electroconvulsive Therapy-A Randomized, Double-Blind, Controlled Clinical Study.

Objectives Converging evidence suggests that low doses of ketamine have antidepressant effects. The feasibility and safety of administering low doses of ketamine as adjunctive medication during electroconvulsive therapy (ECT) to enhance ECT efficacy and mitigate cognitive impairment has attracted much attention. This study investigated the effects of low doses of ketamine on learning and memory in patients undergoing ECT under propofol anesthesia. Methods This randomized, placebo-controlled, double-blind study recruited patients with moderate to severe depressive disorders who failed to respond to antidepressants and were scheduled to receive ECT. Participants were randomly assigned to a study group, which received an intravenous administration of 0.3 mg/kg ketamine and then underwent ECT under propofol anesthesia, and a control group, which received isovolumetric placebo (normal saline) and then underwent ECT under propofol anesthesia. The Hamilton Depression Rating Scale was used to assess the severity of depression after ECT. Before and after the ECT course, the Mini-mental State Examination and the Wechsler Memory Scale-Chinese-Revision were used to assess global cognitive and learning and memory functions, respectively. Psychotropic effects were assessed using the Brief Psychiatric Rating Scale. Vital signs and other adverse events were recorded for each ECT procedure. Results Of 132 patients recruited, 66 were assigned to each group; 63 patients in study groups and 64 patients in the control group completed the ECT course during the study. Afterward, the incidence of global cognitive impairment in the control group was higher than it was in the study group. In addition, the decline in the Wechsler Memory Scale-Chinese-Revision scale was greater in the control group than in the study group. The necessary ECT treatment times were shorter in the study group than in the control group (8 [7, 9] vs 9 [8, 10]). No significant escalations of the positive Brief Psychiatric Rating Scale scores or adverse events were observed in the study group when compared with the control group. Conclusions As adjunctive medication, ketamine can attenuate learning and memory impairment, especially for short-term memory, caused by ECT performed under propofol anesthesia. Ketamine can also reduce ECT treatment times during the therapy course without inducing significant adverse effects.

Predicting individual responses to the electroconvulsive therapy with hippocampal subfield volumes in major depression disorder

Electroconvulsive therapy (ECT) is one of the most effective treatments for major depression disorder (MDD). ECT can induce neurogenesis and synaptogenesis in hippocampus, which contains distinct subfields, e.g., the cornu ammonis (CA) subfields, a granule cell layer (GCL), a molecular layer (ML), and the subiculum. It is unclear which subfields are affected by ECT and whether we predict the future treatment response to ECT by using volumetric information of hippocampal subfields at baseline? In this study, 24 patients with severe MDD received the ECT and their structural brain images were acquired with magnetic resonance imaging before and after ECT. A state-of-the-art hippocampal segmentation algorithm from Freesurfer 6.0 was used. We found that ECT induced volume increases in CA subfields, GCL, ML and subiculum. We applied a machine learning algorithm to the hippocampal subfield volumes at baseline and were able to predict the change in depressive symptoms (r = 0.81; within remitters, r = 0.93). Receiver operating characteristic analysis also showed robust prediction of remission with an area under the curve of 0.90. Our findings provide evidence for particular hippocampal subfields having specific roles in the response to ECT. We also provide an analytic approach for generating predictions about clinical outcomes for ECT in MDD.

Electroconvulsive Therapy-Induced Brain Structural and Functional Changes in Major Depressive Disorders: A Longitudinal Study

Background This study aimed to study the brain structural and functional changes after 8 courses of electroconvulsive therapy (ECT) on patients with major depressive disorder (MDD). Material/Methods MRI scans were performed on 12 depressive patients before and after 8 courses of ECT and compared with those of 15 normal controls. Data were analyzed by voxel-based morphometry (VBM) using SPM8 software. Functional MRI (fMRI) and regional homogeneity (ReHo) analyses were used to assess the functional changes after ECT. Results Grey matter volumes were smaller in the right cingulate gyrus of depressive patients before ECT compared with normal controls. After false discovery rate (FDR) correction, post-ECT grey matter volumes were increased in bilateral amygdala and hippocampus compared with pre-ECT. Resting-state ReHo maps showed significant differences in brain activity pre- and post-ECT. Compared with healthy controls, MDD patients treated with 8 courses of ECT showed higher ReHo values in the bilateral frontal lobe, bilateral parietal lobe, and right caudate nucleus. Decreased ReHo values were observed in the right medial temporal gyrus, right superior temporal gyrus, right cingulate gyrus, and left anterior cerebellar lobe. Conclusions Results suggested that there were both structural and functional differences between the brains of MDD patients and healthy controls. After ECT, both structural and functional changes occurred, but without complete recovery to normal. ECT may display effects through regulating other brain regions to compensate for the original defects.

Changes in Problem-Solving Capacity and Association With Spontaneous Brain Activity After a Single Electroconvulsive Treatment in Major Depressive Disorder.

Background Modified electroconvulsive therapy (MECT) has been regarded as the most effective antidepressant therapy, despite its cognitive side effects. However, how MECT influences problem-solving capacity in major depressive disorder (MDD), as well as its underlying neurobiological mechanisms, remains unclear. The present study aimed to assess alterations in problem-solving capacity after MECT and to explore spontaneous brain activity using amplitudes of low-frequency fluctuations (ALFF)/fractional ALFF. Methods Thirteen first-episode, treatment-naive MDD patients treated by MECT were recruited. We collected resting-state functional magnetic resonance imaging, and we evaluated their Modified Card Sorting Test performance before and after single-session MECT. Another 11 MDD patients without MECT were also recruited and interviewed with Modified Card Sorting Test twice as a control group. Results After a single MECT, MDD patients showed significantly decreased ALFF in the right cerebellar posterior lobe. Compared to the control group, perseverative errors significantly decreased after MECT, controlling for practice effects. Some cognitive functional changes significantly correlated to changed ALFF in several brain regions, including Brodmann areas BA9, BA19, BA 21, and BA48, right thalamus, left cerebellum, and right postcentral gyrus. Conclusions The MECT could improve problem-solving capacity, even after controlling for practice effects, and it could induce changes in spontaneous brain activity. These changes in cognitive functioning might result from changes in the cerebral functions of some regions, including frontal cortex, a key region for problem-solving capacity.

Changes in the expression of hippocampal proteins in rats with recrudescence of morphine addiction

The high recrudescence rate of drug addiction has received attention worldwide and its mechanisms remain to be elucidated. This study aimed to analyse the disparate protein expression in the hippocampal tissue of rats with recrudescence of morphine addiction, as well as to provide clues for the exploration of the recrudescence mechanism. Sixteen male adult Sprague-Dawley rats were divided equally into the morphine and physiological saline groups. Effective nose pokes were determined as the main index. The proteins were separated using the immobilised pH gradient two-dimensional polyacrylamide gel electrophoresis (2-DE). Disparate protein spots were analysed using the PDQuest 2-DE software. Peptide dactylograms were obtained using the matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry. The effective nose poke counts of the morphine group significantly increased during addiction maturation compared with the saline group (P<0.001). The post-recrudescence nose poke counts of the morphine group significantly increased compared with those before recrudescence (P<0.001). Fifteen disparate proteins were identified according to the protein electrophoresis of the morphine and physiological saline groups, including three proteins associated with energy metabolism, two ionic channel regulatory proteins, one heat shock protein and one exogenous substance metabolic enzyme. The energy metabolism and expression of cell metabolism-related proteins decreased in the hippocampus of rats with morphine recrudescence.

Reorganization of Anatomical Connectome following Electroconvulsive Therapy in Major Depressive Disorder

Objective. Electroconvulsive therapy (ECT) is considered one of the most effective and fast-acting treatment options for depressive episodes. Little is known, however, about ECTs enabling brain (neuro)plasticity effects, particular for plasticity of white matter pathway. Materials and Methods. We collected longitudinal diffusion tensor imaging in the first-episode, drug-naïve major depressive disorder (MDD) patients (n = 24) before and after a predefined time window ECT treatment. We constructed large-scale anatomical networks derived from white matter fiber tractography and evaluated the topological reorganization using graph theoretical analysis. We also assessed the relationship between topological reorganization with improvements in depressive symptoms. Results. Our investigation revealed three main findings: (1) the small-worldness was persistent after ECT series; (2) anatomical connections changes were found in limbic structure, temporal and frontal lobes, in which the connection changes between amygdala and parahippocampus correlate with depressive symptom reduction; (3) significant nodal strength changes were found in right paralimbic network. Conclusions. ECT elicits neuroplastic processes associated with improvements in depressive symptoms that act to specific local ventral frontolimbic circuits, but not small-world property. Overall, ECT induced topological reorganization in large-scale brain structural network, opening up new avenues to better understand the mode of ECT action in MDD.

Comparative efficacy and safety of Crocus sativus L. for treating mild to moderate major depressive disorder in adults: a meta-analysis of randomized controlled trials

Purpose To investigate the efficacy and safety of saffron in the treatment of major depressive disorder (MDD) in comparison to placebo and synthetic antidepressants. Patients and methods We conducted a systematic search in several electronic databases as well as manual search in bibliographies of relevant studies. We included randomized controlled trials that investigated the efficacy and safety of saffron for treating MDD in adults in comparison to either placebo or synthetic antidepressants. Primary outcome was change in scores on depressive symptoms from baseline. Secondary outcomes included remission rate, response rate, and drop-out rate for all reasons. We chose a random-effects model in order to obtain more conservative results. Standardized mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals (CIs) were estimated as the overall effect index by inverse variance models. Results Seven studies were included in this meta-analysis. Overall quality of these included studies was moderate. As for the primary outcome, saffron showed more improvements in depression symptoms when compared with placebo, with an SMD of −1.22 (95% CI −1.94, −0.49, P=0.001). Meanwhile, saffron was as effective as synthetic antidepressants, with an SMD of 0.16 (95% CI −0.25, 0.57, P=0.44). Moderate heterogeneity existed in our analysis. Through subgroup analyses, we found that treatment dosage and duration, types of synthetic antidepressants administered in the comparison group, and outcome measures could explain most of the variance. No differences were found in remission rate, response rate, or drop-out rate. Conclusion Saffron was effective in the treatment of MDD and had comparable efficacy to synthetic antidepressants. Saffron was also a safe drug without serious adverse events reported.

P-1375 - Longitudinal assessment of ect-induced brain structure changeslongitudinal assessment of ect-induced brain structure changes

Introduction Many MRI studies have cited major depression, with or without anti-depressive treatment, associated with structural plasticity changing in several brain regions. Few of these studies researched the effect of the anti-depressive treatment, electroconvulsive therapy (ECT), on depression. Objective To assess the influence of ECT on the brain structure change during the treatment process by utilizing the voxel-based morphometry (VBM) analysis. Aims To determine whether ECT alter brain structure. Methods We performed HAMD ratings and MRI scans on 12 depressive patients during ECT, analyzing the data by VBM with SPM8 softwares family-wise error correction (FWE). Results The researchers found volumes changes in white matter in 37 regions between pre-ECT and post-ECT1, but only one region changing between pre-ECT and post-ECT8. Seven regions changing in grey matter between pre-ECT and post-ECT 1⌧but none regions changing between pre-ECT and post-ECT8. Conclusions The density changes in several brain regions after a single ECT stimuli, but return to the original level after completing the eighth ECT. Our finding supports that ECT may play a temporary role in treating major depression but do not permanently alter the structures of brain.

The Construction and Prospects of the Chongqing Twin Children Database

Twins could play a crucial role in our understanding of genetic contributions to numerous etiologically complex disorders. In China, although adult twins are relatively rare, twins will become increasingly available due to increasing twin birth rates. Thus, child twin data will be a valuable resource to contribute to the field of child and adolescent psychopathology. The first twin database of children aged from 6 to 16 was established in Chongqing, R.P., China. In this article, we will discuss our experiences in establishing the twin database, completed in three steps--the first step being to search and identify twins, the second being to keep contact with the twins and the final being to seek cooperation with the twin families, and its future prospects. Our twin database has proven to be an efficient method for the investigation and data collection of twin children in China. The results of our present study suggest that the inclusion of twin information in the residence registration of the public security bureaus in the future may ensure a smooth run of research based on the demographic resources. We propose that school networks may be adopted as the preferred method of collection of twin records for future studies.