Whole-Brain Functional Connectivity Dynamics Associated With Electroconvulsive Therapy Treatment Response

• Authors: Randall Espinoza, University of California Los Angeles; Jing Sui, Emory University; Katherine Narr, University of California Los Angeles; Zening Fu, Emory University; Shile Qi, Emory University; Mohammad SE Sendi, Emory University; Christopher C Abbott, University of New Mexico; Vince Calhoun, Emory University
• Journal Title: BIOLOGICAL PSYCHIATRY-COGNITIVE NEUROSCIENCE AND NEUROIMAGING
• Volume: Volume 7, Number 3
• Publisher: ELSEVIER | 2022-03-04, Pages 312-322
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.bpsc.2021.07.004
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Neurosciences; Neurosciences & Neurology; VENTROMEDIAL PREFRONTAL CORTEX; MAJOR DEPRESSIVE DISORDER; SELF-FOCUSED ATTENTION; NETWORK DYSFUNCTION; CINGULATE CORTEX; NEGATIVE AFFECT; BRIEF PULSE; MEMORY; ECT; AMYGDALA

Abstract

Background: Depressive episodes (DEPs), characterized by abnormalities in cognitive functions and mood, are a leading cause of disability. Electroconvulsive therapy (ECT), which involves a brief electrical stimulation of the anesthetized brain, is one of the most effective treatments used in patients with DEP due to its rapid efficacy. Methods: In this work, we investigated how dynamic brain functional connectivity responds to ECT and whether the dynamic responses are associated with treatment outcomes and side effects in patients. We applied a fully automated independent component analysis–based pipeline to 110 patients with DEP (including diagnosis of unipolar depression or bipolar depression) and 60 healthy control subjects. The dynamic functional connectivity was analyzed by a combination of the sliding window approach and clustering analysis. Results: Five recurring connectivity states were identified, and patients with DEPs had fewer occurrences in one brain state (state 1) with strong positive and negative connectivity. Patients with DEP changed the occupancy of two states (states 3 and 4) after ECT, resulting in significantly different occurrences of one additional state (state 3) compared with healthy control subjects. We further found that patients with DEP had diminished global metastate dynamism, two of which recovered to normal after ECT. The changes in dynamic connectivity characteristics were associated with the changes in memory recall and Hamilton Depression Rating Scale of DEP after ECT. Conclusions: These converging results extend current findings on subcortical-cortical dysfunction and dysrhythmia in DEP and demonstrate that ECT might cause remodeling of brain functional dynamics that enhance the neuroplasticity of the diseased brain.