Michael J Ward1, Helmet T Karim2, Zachary F Jessen3, Avniel Singh Ghuman1,2,4,5, R Mark Richardson1,4, Charles F Reynolds2, Jordan F Karp2. 1. Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA. 2. Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA. 3. Medical Scientist Training Program, Northwestern University, Chicago, IL. 4. Center for the Neural Basis of Cognition, Carnegie Mellon University and University of Pittsburgh, Pittsburgh, PA. 5. Program in Neural Computation, Center for the Neural Basis of Cognition, Carnegie Mellon University and University of Pittsburgh, Pittsburgh, PA.
Abstract
OBJECTIVES: More than half of patients with major depression who do not respond to initial antidepressants become treatment resistant (TRD), and while electroconvulsive therapy (ECT) is effective, it involves anesthesia and other medical risks that are of concern in geriatric patients. Past studies have suggested that theta cordance (TC), a correlate of cerebral metabolism measured by electroencephalography, could guide treatment decisions related to patient selection and engagement of the therapeutic target. METHODS/ DESIGN: Eight patients with late-life treatment resistant depression (LL-TRD) underwent magnetoencephalography (MEG) at baseline and following seven sessions of ECT. We tested whether the mean and regional frontal cortex TC were able to differentiate early responders from nonresponders. RESULTS: Five patients whose depression severity decreased by >30% after seven sessions were considered early responders. We found no baseline differences in mean frontal TC between early responders compared with nonresponders, but early responders exhibited a significant increase in TC following ECT. Further, we found that compared with nonresponders, early responders exhibited a greater change in TC specifically within the right prefrontal cortex. CONCLUSIONS: These results support the hypothesis that increases in frontal TC are associated with antidepressant response. We expand on previous findings by showing that this change is specific to the right prefrontal cortex. Validation of this neural marker could contribute to improved ECT outcomes, by informing early clinical decisions about the acute efficacy of this treatment.
OBJECTIVES: More than half of patients with major depression who do not respond to initial antidepressants become treatment resistant (TRD), and while electroconvulsive therapy (ECT) is effective, it involves anesthesia and other medical risks that are of concern in geriatric patients. Past studies have suggested that theta cordance (TC), a correlate of cerebral metabolism measured by electroencephalography, could guide treatment decisions related to patient selection and engagement of the therapeutic target. METHODS/ DESIGN: Eight patients with late-life treatment resistant depression (LL-TRD) underwent magnetoencephalography (MEG) at baseline and following seven sessions of ECT. We tested whether the mean and regional frontal cortex TC were able to differentiate early responders from nonresponders. RESULTS: Five patients whose depression severity decreased by >30% after seven sessions were considered early responders. We found no baseline differences in mean frontal TC between early responders compared with nonresponders, but early responders exhibited a significant increase in TC following ECT. Further, we found that compared with nonresponders, early responders exhibited a greater change in TC specifically within the right prefrontal cortex. CONCLUSIONS: These results support the hypothesis that increases in frontal TC are associated with antidepressant response. We expand on previous findings by showing that this change is specific to the right prefrontal cortex. Validation of this neural marker could contribute to improved ECT outcomes, by informing early clinical decisions about the acute efficacy of this treatment.
Authors: Jennifer I Lissemore; Benoit H Mulsant; Anthony J Bonner; Meryl A Butters; Robert Chen; Jonathan Downar; Jordan F Karp; Eric J Lenze; Tarek K Rajji; Charles F Reynolds; Reza Zomorrodi; Zafiris J Daskalakis; Daniel M Blumberger Journal: Biol Psychiatry Cogn Neurosci Neuroimaging Date: 2021-07-23