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

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Kamilla Woznica Miskowiak, Julian Macoveanu, Merete Barker Jørgensen, Caroline Vintergaard Ott, M M Støttrup, Hannah Malene Jensen, A Jørgensen, Catherine J Harmer, Olaf B. Paulson, Hartwig Roman Siebner, Lars Vedel Kessing

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.

Original languageEnglish
JournalEuropean Neuropsychopharmacology
Issue number8
Pages (from-to)915-924
Number of pages10
Publication statusPublished - Aug 2018

    Research areas

  • Depression, ECT, Magnetic resonance imaging, Neurocognition, Prefrontal cortex

ID: 203247426