ECT & CRP, quo vadis? - A retrospective study of low-grade inflammation in patients with depression undergoing electroconvulsive therapy
Introduction: Electroconvulsive therapy (ECT) is the most effective treatment for severe depression. Depression has been associated with low-grade inflammation (LGI), as indicated by elevated C-reactive protein (CRP) levels compared to healthy individuals. While the effect of ECT on inflammation mar...
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Elsevier
2025-06-01
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| Series: | Biomarkers in Neuropsychiatry |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666144624000339 |
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| author | Moritz Spangemacher Sebastian Karl Suna Su Aksay Eva Kathrin Lamadé Jana Plemper Alexander Sartorius Bruno Pedraz-Petrozzi |
| author_facet | Moritz Spangemacher Sebastian Karl Suna Su Aksay Eva Kathrin Lamadé Jana Plemper Alexander Sartorius Bruno Pedraz-Petrozzi |
| author_sort | Moritz Spangemacher |
| collection | DOAJ |
| description | Introduction: Electroconvulsive therapy (ECT) is the most effective treatment for severe depression. Depression has been associated with low-grade inflammation (LGI), as indicated by elevated C-reactive protein (CRP) levels compared to healthy individuals. While the effect of ECT on inflammation markers remains unclear, some evidence suggests that higher baseline CRP levels may predict remission in ECT. Additionally, LGI could influence the seizure threshold and thus the required stimulation dose. Materials and methods: This retrospective study examined the potential link between LGI and treatment outcomes as well as stimulation doses across multiple ECT sessions, controlling for age and interparticipant variability. The hypothesis of this study was that LGI was associated with ECT remission as well as with ECT dosing in people with depression. Two groups were defined, depending on CRP levels, those with LGI (CRP 3–10 mg/L) and those without (CRP < 3 mg/L). Generalized linear models were used to analyze maximum ECT doses, while linear mixed models were applied to assess changes in ECT doses over time. Results: After 10 ECT sessions, we found no significant difference in remission rates between patients with (n = 52) and without LGI (n = 143). However, patients with baseline LGI had higher maximum ECT doses. A linear mixed model revealed that the number of sessions and baseline LGI significantly influenced ECT doses, with patients with baseline LGI needing higher doses, particularly at the seventh session. Age also was associated with both maximum doses and dose adjustments throughout the ECT series, but the influence of LGI on ECT dose was independent of age, since no age differences were observed between groups. Conclusions: Baseline inflammation was not associated with remission rates, but it had a significant association with ECT dosing. Therefore, while CRP may not be a reliable biomarker for predicting ECT response in depression, baseline inflammation could indicate the need for a higher stimulation dose. |
| format | Article |
| id | doaj-art-54f7cbfc38b24fd0ad40a9bd394eef61 |
| institution | OA Journals |
| issn | 2666-1446 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
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| series | Biomarkers in Neuropsychiatry |
| spelling | doaj-art-54f7cbfc38b24fd0ad40a9bd394eef612025-08-20T01:57:58ZengElsevierBiomarkers in Neuropsychiatry2666-14462025-06-011210011510.1016/j.bionps.2024.100115ECT & CRP, quo vadis? - A retrospective study of low-grade inflammation in patients with depression undergoing electroconvulsive therapyMoritz Spangemacher0Sebastian Karl1Suna Su Aksay2Eva Kathrin Lamadé3Jana Plemper4Alexander Sartorius5Bruno Pedraz-Petrozzi6Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, J5, 68159 Mannheim, Medical Faculty Mannheim - University of Heidelberg, Mannheim, Germany; Department of Molecular Neuroimaging, Central Institute of Mental Health, Clinical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; German Center for Mental Health (DZPG), partner site Mannheim, Germany; Research Group Brain Stimulation, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Clinical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Corresponding author at: Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, J5, 68159 Mannheim, Medical Faculty Mannheim - University of Heidelberg, Mannheim, GermanyDepartment of Psychiatry and Psychotherapy, Central Institute of Mental Health, J5, 68159 Mannheim, Medical Faculty Mannheim - University of Heidelberg, Mannheim, Germany; German Center for Mental Health (DZPG), partner site Mannheim, Germany; Research Group Brain Stimulation, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Clinical Faculty Mannheim, University of Heidelberg, Mannheim, GermanyDepartment of Psychiatry and Psychotherapy, Central Institute of Mental Health, J5, 68159 Mannheim, Medical Faculty Mannheim - University of Heidelberg, Mannheim, Germany; German Center for Mental Health (DZPG), partner site Mannheim, Germany; Research Group Brain Stimulation, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Clinical Faculty Mannheim, University of Heidelberg, Mannheim, GermanyDepartment of Psychiatry and Psychotherapy, Central Institute of Mental Health, J5, 68159 Mannheim, Medical Faculty Mannheim - University of Heidelberg, Mannheim, Germany; German Center for Mental Health (DZPG), partner site Mannheim, Germany; Research Group of Stress-related Disorders, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Clinical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Research Group Brain Stimulation, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Clinical Faculty Mannheim, University of Heidelberg, Mannheim, GermanyDepartment of Psychiatry and Psychotherapy, Central Institute of Mental Health, J5, 68159 Mannheim, Medical Faculty Mannheim - University of Heidelberg, Mannheim, Germany; Research Group Brain Stimulation, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Clinical Faculty Mannheim, University of Heidelberg, Mannheim, GermanyDepartment of Psychiatry and Psychotherapy, Central Institute of Mental Health, J5, 68159 Mannheim, Medical Faculty Mannheim - University of Heidelberg, Mannheim, Germany; German Center for Mental Health (DZPG), partner site Mannheim, Germany; Research Group Brain Stimulation, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Clinical Faculty Mannheim, University of Heidelberg, Mannheim, GermanyDepartment of Psychiatry and Psychotherapy, Central Institute of Mental Health, J5, 68159 Mannheim, Medical Faculty Mannheim - University of Heidelberg, Mannheim, Germany; German Center for Mental Health (DZPG), partner site Mannheim, Germany; Research Group of Stress-related Disorders, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Clinical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Research Group Brain Stimulation, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Clinical Faculty Mannheim, University of Heidelberg, Mannheim, GermanyIntroduction: Electroconvulsive therapy (ECT) is the most effective treatment for severe depression. Depression has been associated with low-grade inflammation (LGI), as indicated by elevated C-reactive protein (CRP) levels compared to healthy individuals. While the effect of ECT on inflammation markers remains unclear, some evidence suggests that higher baseline CRP levels may predict remission in ECT. Additionally, LGI could influence the seizure threshold and thus the required stimulation dose. Materials and methods: This retrospective study examined the potential link between LGI and treatment outcomes as well as stimulation doses across multiple ECT sessions, controlling for age and interparticipant variability. The hypothesis of this study was that LGI was associated with ECT remission as well as with ECT dosing in people with depression. Two groups were defined, depending on CRP levels, those with LGI (CRP 3–10 mg/L) and those without (CRP < 3 mg/L). Generalized linear models were used to analyze maximum ECT doses, while linear mixed models were applied to assess changes in ECT doses over time. Results: After 10 ECT sessions, we found no significant difference in remission rates between patients with (n = 52) and without LGI (n = 143). However, patients with baseline LGI had higher maximum ECT doses. A linear mixed model revealed that the number of sessions and baseline LGI significantly influenced ECT doses, with patients with baseline LGI needing higher doses, particularly at the seventh session. Age also was associated with both maximum doses and dose adjustments throughout the ECT series, but the influence of LGI on ECT dose was independent of age, since no age differences were observed between groups. Conclusions: Baseline inflammation was not associated with remission rates, but it had a significant association with ECT dosing. Therefore, while CRP may not be a reliable biomarker for predicting ECT response in depression, baseline inflammation could indicate the need for a higher stimulation dose.http://www.sciencedirect.com/science/article/pii/S2666144624000339Electroconvulsive therapyTreatment responseDepressionC-reactive proteinLow-grade inflammation |
| spellingShingle | Moritz Spangemacher Sebastian Karl Suna Su Aksay Eva Kathrin Lamadé Jana Plemper Alexander Sartorius Bruno Pedraz-Petrozzi ECT & CRP, quo vadis? - A retrospective study of low-grade inflammation in patients with depression undergoing electroconvulsive therapy Biomarkers in Neuropsychiatry Electroconvulsive therapy Treatment response Depression C-reactive protein Low-grade inflammation |
| title | ECT & CRP, quo vadis? - A retrospective study of low-grade inflammation in patients with depression undergoing electroconvulsive therapy |
| title_full | ECT & CRP, quo vadis? - A retrospective study of low-grade inflammation in patients with depression undergoing electroconvulsive therapy |
| title_fullStr | ECT & CRP, quo vadis? - A retrospective study of low-grade inflammation in patients with depression undergoing electroconvulsive therapy |
| title_full_unstemmed | ECT & CRP, quo vadis? - A retrospective study of low-grade inflammation in patients with depression undergoing electroconvulsive therapy |
| title_short | ECT & CRP, quo vadis? - A retrospective study of low-grade inflammation in patients with depression undergoing electroconvulsive therapy |
| title_sort | ect amp crp quo vadis a retrospective study of low grade inflammation in patients with depression undergoing electroconvulsive therapy |
| topic | Electroconvulsive therapy Treatment response Depression C-reactive protein Low-grade inflammation |
| url | http://www.sciencedirect.com/science/article/pii/S2666144624000339 |
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