Depression: Electrospasm therapy reduces hyperconnectivity in the brain
Scottish researchers have studied the use of so-called electro-spasmodic therapy (EKT) for depression in more detail. “Electro-spasm therapy reduces frontal cortical connectivity in severe depressive disorder,” wrote the researchers led by Jennifer Perrina and Ian Reida from the University of Aberdeen in the journal “Proceedings of the National Academy of Science” (PNAS).
The Scottish researchers assume that according to the so-called "hyperconnectivity hypothesis", patients with severe depression will increasingly develop connections within the cortex or between the cortex and the limbic system that play a major role in the mental illness. The Scottish scientists report that the cortical connectivity in the test subjects and the severity of their depressive symptoms have been significantly reduced due to the highly controversial electro-spasm therapy.
Reservations regarding electro-cramp therapy The controversial electro-cramp therapy became known through the film "One flew over the cuckoo's nest", in which the electric shocks were not used to heal but to punish the patient. As a result, the treatment method developed in Italy and Hungary in the 1930s had lost its reputation as an inhuman form of therapy, although to date, considerable success has been achieved with ECT. Since the treatment of depression based on medication has become possible, EKT has hardly been used. Psychiatrists usually prefer antidepressants, but their effectiveness is often limited. If the medication is not successful in treatment, ECT remains the last therapeutic option. This is used far more frequently in Great Britain than here: 4,282 EKT treatments were carried out in 2010 in the United Kingdom, according to the Scottish ECT Accreditation Network.
Effect of electro-seizure therapy examined The Scottish researchers cite one of the reasons for the rare use of electro-seizure therapy being the lack of knowledge of how it works. In the case of an ECT, an epileptic seizure is triggered with the help of current surges, which, according to Ian Reida, affects the "wiring" of the individual neurons. For this reason, brain researchers at Aberdeen University have used magnetic resonance imaging (MRI) and a “unique data-driven approach to analyze functional connectivity in the brain” to investigate the effects of EKT treatment in nine patients with severe depression. Using functional magnetic resonance imaging (fMRI), the scientists were able to draw conclusions about the connectivity of the different brain areas. The observed decline in general connectivity was associated with a significant improvement in depressive symptoms, according to the researchers.
Reduced connectivity goes hand in hand with reduced depressive symptoms Before and after treatment with ECT, depression patients should solve a simple brain teaser using fMRI to measure brain activity. Using a mathematical algorithm, the researchers then calculated the changes in functional connectivity in the subjects' brains. They found that in the area of the "left dorsolateral prefrontal cortical region (Brodmann area 44, 45 and 46)" there was a significant reduction in the "average global functional connectivity" after the EKT. This was accompanied by a "significant improvement in depressive symptoms", which was reflected in lower values on the so-called "Montgomery Asberg Depression Rating Scale", write the researchers led by Jennifer Perrina and Ian Reida. “Our results show that ECT has a lasting impact on the functional architecture of the brain,” says the scientists.
Further research on the use of ECT in depression is required, according to Ian Reida, the results of the study support the "hyperconnectivity hypothesis" for depression, whereby the increased connectivity can not only serve as a "biomarker for mood disorders", but also "a potential therapeutic target" represent. While their study does not provide clear evidence of the link between increased connectivity and the occurrence of depression, Scottish scientists believe that further research should be undertaken. The subjects of the current study should also continue to be monitored in order to check whether hyperconnectivity is again evident in the brain of the affected person if the depression reappears. In further studies, Jennifer Perrina and Ian Reida hope to be able to investigate the previous weaknesses of EKT in more detail and possibly even avoid them.
Possible side effects of electro-spasm therapy Although the EKT already shows a clear effect in 75 to 85 percent of depression patients, this is often associated with considerable side effects, the Scottish researchers explained. For example, after EKT, patients often suffer from memory disorders, which usually affect the period immediately before and after treatment. The memory problems usually go away on their own after a few hours to days, but the regression may remain incomplete. However, according to the experts, extensive damage to the brain through the use of ECT is not to be feared and memory improvements could possibly be avoided in the future, according to Ian Reida. However, due to the health risks associated with certain pre-existing conditions, such as vascular leakage in the main artery or the vessels of the brain, electro-seizure therapy is excluded, increased intracranial pressure or a survived heart attack. In addition, high blood pressure, strokes and coronary artery disease require careful consideration of the benefits of ECT against the risks of not doing therapy. (fp)
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