Poster No:
693
Submission Type:
Abstract Submission
Authors:
Noor Al-Sharif1, Artemis Zavaliangos-Petropulu1, Brandon Taraku1, Randall Espinoza2, Katherine Narr1
Institutions:
1Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Los Angeles, CA, 2Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
First Author:
Noor Al-Sharif
Ahmanson-Lovelace Brain Mapping Center, Department of Neurology
Los Angeles, CA
Co-Author(s):
Brandon Taraku
Ahmanson-Lovelace Brain Mapping Center, Department of Neurology
Los Angeles, CA
Randall Espinoza
Jane and Terry Semel Institute for Neuroscience and Human Behavior
Los Angeles, CA
Katherine Narr
Ahmanson-Lovelace Brain Mapping Center, Department of Neurology
Los Angeles, CA
Introduction:
Electroconvulsive therapy (ECT) is an effective treatment for individuals with major depressive disorder (MDD), particularly those whose symptoms have failed to respond to first-line antidepressant treatments(Li et al., 2020). Such individuals are categorized as having treatment resistant depression (TRD)(Rush et al., 2019). The precise mechanisms underlying the antidepressant efficacy of ECT remain unclear, however, the application of resting-state functional magnetic resonance imaging (fMRI) shows potential for identifying its therapeutic effects. Prior studies suggest that ECT disrupts functional connectivity within the default mode network (DMN)(Sinha et al., 2020), a large-scale network involved in introspection frequently found to be overactive in patients with depression(Kaiser et al., 2015). In this study, we compared pre-treatment within-DMN connectivity in patients with TRD and HC, and investigated long term changes in these networks after ECT treatment.
Methods:
Participants included N=42 patients (age=39.8土14.8, 27 female) with TRD (defined as no response to at least two antidepressant treatments) and N=54 HC (age=32.2土12.0, 31 female). All TRD patients underwent ECT at UCLA Resnick Neuropsychiatric Hospital. Mood assessments (Hamilton Depression Rating Scale; HDRS(Hamilton, 1960)) and resting-state fMRI were collected at baseline (pre-treatment) and at follow-up (3 months post treatment). Human Connectome Project (HCP) protocol was used on a 3T Siemens Prisma to collect structural MRI (T1 and T2, voxel size (VS)=0.8mm3) and resting-state fMRI (VS=2mm3). Data were preprocessed with the HCP minimal preprocessing pipeline(Glasser et al., 2013), ICA + FIX(Salimi-Khorshidi et al., 2014), and MSMALL alignment(Robinson et al., 2018). The Schaefer 100 Yeo 17 Network atlas(Schaefer et al., 2018) was used to parcellate fMRI data to generate z-scored correlation matrices. Only within-DMN nodes were analyzed. A paired t-test was used to test for changes in HDRS. Linear regression was used to compare within-DMN connectivity between HC and TRD patients at baseline, adjusting for age, sex, and global signal average (GSA) as fixed effects, correcting for multiple comparisons with FDR. In a follow-up analysis, a mixed effect model tested for changes in connectivity after ECT, adjusting for age, sex, and GSA. We also performed a linear regression testing for associations between change in HDRS and change in connectivity, adjusting for age, sex, and GSA and correcting for multiple comparisons with FDR.
Results:
Patients showed significant improvements in HDRS post-ECT (p-value=6.223e-05, t-value=5.1). When comparing baseline HC to TRD, 190 nodes showed significant differences in resting state connectivity, with 121 presenting greater connectivity and 69 presenting less connectivity. Of the nodes that differed by diagnosis, 27 significantly changed following ECT (p-value<0.05), with 15 nodes normalizing towards connectivity levels observed in HC. Changes in HDRS scores showed trending associations (p-value<0.05) to change in connectivity patterns in 112 nodes (17 increasing, 95 decreasing), but did not pass FDR.
Conclusions:
In this study, we showed mood symptoms significantly improved in patients with TRD after 3 months following ECT. Pre-treatment, patients with TRD showed distinct connectivity patterns within the DMN compared to HC. Several nodes that were hyperactive at baseline in TRD normalized in the direction of HC at follow up, 3 months post-ECT treatment. Trending associations between improvements in mood and changes in connectivity were observed. Overall, these findings suggest that the antidepressant mechanisms of ECT may act long-term on the aberrant DMN in patients with TRD.
Disorders of the Nervous System:
Psychiatric (eg. Depression, Anxiety, Schizophrenia) 1
Modeling and Analysis Methods:
fMRI Connectivity and Network Modeling 2
Keywords:
FUNCTIONAL MRI
Treatment
Other - Major Depressive Disorder; Electroconvulsive therapy;
1|2Indicates the priority used for review
Provide references using author date format
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