Reduced suicidality after electroconvulsive therapy is linked to increased frontal brain activity in depressed patients: a resting-state fMRI study

• Type of Material: Article
• Authors: Xue Wang, Capital Medical University; Han Wu, Capital Medical University; Dan Wang, Capital Medical University; Wei Wang, Capital Medical University; Wen Wang, Capital Medical University; Wen-qing Jin, Capital Medical University; Jiong Luo, Capital Medical University; Wei Jiang, Capital Medical University; Yilang Tang, Emory University; Yan-ping Ren, Capital Medical University; Chun-lin Yang, Capital Medical University; Xin Ma, Capital Medical University; Rena Li, Capital Medical University
• Language: English
• Date: 2023-07-12
• Publisher: FRONTIERS MEDIA SA
• Publication Version: Final Published Version
• Copyright Statement: © 2023 Wang, Wu, Wang, Wang, Wang, Jin, Luo, Jiang, Tang, Ren, Yang, Ma and Li.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3389/fpsyt.2023.1224914
• Title of Journal or Parent Work: FRONTIERS IN PSYCHIATRY
• Volume: 14
• Start Page: 1224914
• End Page: 1224914
• Grant/Funding Information: The research conducted by RL was supported by the National Key Research and Development Program of China (no: 2020YFC2005300), and that conducted by Y-pR was supported by the Capital Health Research and Development of Special Projects (2018–3-1171).
• Keywords: depressed patients; ECT; SCALE; INTEROCEPTION; frontal regions; ATTEMPTERS; PREFRONTAL CORTEX; electroconvulsive therapy; suicidality; IDEATION; Life Sciences & Biomedicine; Psychiatry; functional MRI; Science & Technology; DISORDER
• Research Categories: Engineering, Biomedical; Psychology, Behavioral; Biology, Neuroscience; Health Sciences, Medicine and Surgery

Abstract

Objective: Suicidality is commonly observed in patients with depressive episodes, and electroconvulsive therapy (ECT) has been found to be effective in treating these patients. However, the role of ECT in suicidality remains unclear. This study used resting-state functional magnetic resonance imaging (rs-fMRI) to explore the changes in brain function before and after ECT in depressed patients with suicidality. Methods: In total, 26 depressed patients with suicidality underwent rs-fMRI at baseline and after 8–12 sessions of ECT. In addition, 32 healthy controls (HCs) matched for age, gender, and educational level underwent rs-fMRI once. The amplitude of low-frequency fluctuations (ALFF), the fractional amplitude of low-frequency fluctuations (fALFF), and regional homogeneity (ReHo) were measured to evaluate whole brain function. Differences between the groups and time points (before and after ECT) were compared. Clinical symptoms were assessed using the 17-item Hamilton Depression Scale (HAMD-17) and Beck Scale for Suicide Ideation (BSSI). Results: At baseline, patients exhibited decreased ALFF in the right postcentral and precentral gyrus and decreased fALFF in the right supramarginal and postcentral gyrus, left superior frontal gyrus (SFG), as well as the superior and middle temporal gyrus compared to HCs. Patients also had lower ReHo in the left amygdala, anterior cingulate, and postcentral gyrus, and in the right thalamus, insula, and postcentral gyrus. They also exhibited higher ALFF in the bilateral temporal gyrus and insula as well as higher fALFF in the cerebellum. Following ECT, fALFF in the left SFG and orbital frontal cortex (OFC) significantly increased and was inversely correlated with the reduction of BSSI scores (r = −0.416, p = 0.048), whereas no correlation was found with changes in HAMD-17scores. Conclusion: Our findings suggest that the left SFG and OFC may play a key role in the mechanism of ECT for suicidality. The decrease of fALFF in the left SFG and OFC may represent a potential mechanism through which ECT effectively treats suicidality in depressed patients.