Cerebral metabolic rate of oxygen is correlated to treatment effect of electroconvulsive therapy in patients with depression
Background: Neurobiological understanding of the antidepressant mechanisms of electroconvulsive therapy (ECT) is important to advance the treatment. ECT may work by improving depression-related alterations in the cerebral oxygen metabolism. Methods: 21 in-patients with depression treated with an ECT...
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Elsevier
2025-09-01
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| Series: | Brain Stimulation |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1935861X25002736 |
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| author | Christoffer Cramer Lundsgaard André Beyer Mathiassen Henrik Bo Wiberg Larsson Poul Videbech Krzysztof Gbyl Mark Bitsch Vestergaard |
| author_facet | Christoffer Cramer Lundsgaard André Beyer Mathiassen Henrik Bo Wiberg Larsson Poul Videbech Krzysztof Gbyl Mark Bitsch Vestergaard |
| author_sort | Christoffer Cramer Lundsgaard |
| collection | DOAJ |
| description | Background: Neurobiological understanding of the antidepressant mechanisms of electroconvulsive therapy (ECT) is important to advance the treatment. ECT may work by improving depression-related alterations in the cerebral oxygen metabolism. Methods: 21 in-patients with depression treated with an ECT series were examined 1) within two days before, and 2) a few days (median = 4 days) after the last ECT session. Depression severity was assessed by the six-item Hamilton Depression Rating Scale (HDRS-6). Magnetic resonance imaging (MRI) was used to measure 1) global cerebral blood flow (CBF) by phase contrast mapping technique and 2) global cerebral metabolic rate of oxygen (CMRO2) by measuring cerebral extraction of oxygen (A-V.O2) using susceptibility-based oximetry. Statistical analyses were performed using multiple linear regression, adjusting for age and gender. Results: ECT relieved depressive symptoms from HDRS-6 = 13.9 to 5.2 (p < 0.001), as expected. A larger increase in CMRO2 after ECT was correlated with a better treatment effect (0.5 % reduction in HDRS-6 per 1 % increase in CMRO2, adjusted R2 = 0.24, p = 0.026). The effect was driven by both higher A-V.O2 and increased CBF. Before ECT, an abnormal decoupling between CMRO2 and CBF was observed, which was normalized after the treatment (adjusted R2 = 0.17, p = 0.03). Conclusions: The treatment effect of ECT for depression was associated with increased CMRO2. Furthermore, ECT restored the normal coupling between CBF and CMRO2. The results suggest that the cerebral oxygen metabolism may be abnormally altered in patients with depression and ECT restores such dysfunction. |
| format | Article |
| id | doaj-art-e8eb6393a68d48abb033a94dac070175 |
| institution | DOAJ |
| issn | 1935-861X |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brain Stimulation |
| spelling | doaj-art-e8eb6393a68d48abb033a94dac0701752025-08-20T03:04:50ZengElsevierBrain Stimulation1935-861X2025-09-011851470147810.1016/j.brs.2025.07.005Cerebral metabolic rate of oxygen is correlated to treatment effect of electroconvulsive therapy in patients with depressionChristoffer Cramer Lundsgaard0André Beyer Mathiassen1Henrik Bo Wiberg Larsson2Poul Videbech3Krzysztof Gbyl4Mark Bitsch Vestergaard5Center for Neuropsychiatric Depression Research, Mental Health Center Glostrup, Copenhagen University Hospital – Mental Health Services CPH, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark; Corresponding author. Center for Neuropsychiatric Depression Research, Mental Health Center Glostrup, Nordstjernevej 41, 2600 Glostrup, Denmark.Center for Neuropsychiatric Depression Research, Mental Health Center Glostrup, Copenhagen University Hospital – Mental Health Services CPH, Denmark; Department of Clinical Medicine, University of Copenhagen, DenmarkDepartment of Clinical Medicine, University of Copenhagen, Denmark; Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital – Rigshospitalet, Copenhagen, DenmarkCenter for Neuropsychiatric Depression Research, Mental Health Center Glostrup, Copenhagen University Hospital – Mental Health Services CPH, Denmark; Department of Clinical Medicine, University of Copenhagen, DenmarkCenter for Neuropsychiatric Depression Research, Mental Health Center Glostrup, Copenhagen University Hospital – Mental Health Services CPH, Denmark; Department of Clinical Medicine, University of Copenhagen, DenmarkFunctional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark; Corresponding author. Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine, 2600 Glostrup, Denmark.Background: Neurobiological understanding of the antidepressant mechanisms of electroconvulsive therapy (ECT) is important to advance the treatment. ECT may work by improving depression-related alterations in the cerebral oxygen metabolism. Methods: 21 in-patients with depression treated with an ECT series were examined 1) within two days before, and 2) a few days (median = 4 days) after the last ECT session. Depression severity was assessed by the six-item Hamilton Depression Rating Scale (HDRS-6). Magnetic resonance imaging (MRI) was used to measure 1) global cerebral blood flow (CBF) by phase contrast mapping technique and 2) global cerebral metabolic rate of oxygen (CMRO2) by measuring cerebral extraction of oxygen (A-V.O2) using susceptibility-based oximetry. Statistical analyses were performed using multiple linear regression, adjusting for age and gender. Results: ECT relieved depressive symptoms from HDRS-6 = 13.9 to 5.2 (p < 0.001), as expected. A larger increase in CMRO2 after ECT was correlated with a better treatment effect (0.5 % reduction in HDRS-6 per 1 % increase in CMRO2, adjusted R2 = 0.24, p = 0.026). The effect was driven by both higher A-V.O2 and increased CBF. Before ECT, an abnormal decoupling between CMRO2 and CBF was observed, which was normalized after the treatment (adjusted R2 = 0.17, p = 0.03). Conclusions: The treatment effect of ECT for depression was associated with increased CMRO2. Furthermore, ECT restored the normal coupling between CBF and CMRO2. The results suggest that the cerebral oxygen metabolism may be abnormally altered in patients with depression and ECT restores such dysfunction.http://www.sciencedirect.com/science/article/pii/S1935861X25002736Electroconvulsive therapyMajor depressive disorderCerebral metabolic rate of oxygenCerebral blood flowCerebral oxygen extractionMRI |
| spellingShingle | Christoffer Cramer Lundsgaard André Beyer Mathiassen Henrik Bo Wiberg Larsson Poul Videbech Krzysztof Gbyl Mark Bitsch Vestergaard Cerebral metabolic rate of oxygen is correlated to treatment effect of electroconvulsive therapy in patients with depression Brain Stimulation Electroconvulsive therapy Major depressive disorder Cerebral metabolic rate of oxygen Cerebral blood flow Cerebral oxygen extraction MRI |
| title | Cerebral metabolic rate of oxygen is correlated to treatment effect of electroconvulsive therapy in patients with depression |
| title_full | Cerebral metabolic rate of oxygen is correlated to treatment effect of electroconvulsive therapy in patients with depression |
| title_fullStr | Cerebral metabolic rate of oxygen is correlated to treatment effect of electroconvulsive therapy in patients with depression |
| title_full_unstemmed | Cerebral metabolic rate of oxygen is correlated to treatment effect of electroconvulsive therapy in patients with depression |
| title_short | Cerebral metabolic rate of oxygen is correlated to treatment effect of electroconvulsive therapy in patients with depression |
| title_sort | cerebral metabolic rate of oxygen is correlated to treatment effect of electroconvulsive therapy in patients with depression |
| topic | Electroconvulsive therapy Major depressive disorder Cerebral metabolic rate of oxygen Cerebral blood flow Cerebral oxygen extraction MRI |
| url | http://www.sciencedirect.com/science/article/pii/S1935861X25002736 |
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