BACKGROUND In treatment-resistant major depressive disorder (MDD), electroconvulsive therapy (ECT) is a treatment with high efficacy. While knowledge regarding changes in brain structure following ECT is growing, the effects of ECT on brain function during emotional processing are largely unknown. OBJECTIVE We investigated the effects of ECT on the activity of the anterior cingulate cortex (ACC) and amygdala during negative emotional stimuli processing and its association with clinical response. METHODS In this non-randomized longitudinal study, patients with MDD (n = 37) were assessed before and after treatment with ECT. Healthy controls (n = 37) were matched regarding age and gender. Functional magnetic resonance imaging (fMRI) was obtained twice, at baseline and after six weeks using a supraliminal face-matching paradigm. In order to evaluate effects of clinical response, additional post-hoc analyses were performed comparing responders to non-responders. RESULTS After ECT, patients with MDD showed a statistically significant increase in ACC activity during processing of negative emotional stimuli (pFWE = .039). This effect was driven by responders (pFWE = .023), while non-responders showed no increase. Responders also had lower pre-treatment ACC activity compared to non-responders (pFWE = .025). No significant effects in the amygdala could be observed. CONCLUSIONS ECT leads to brain functional changes in the ACC, a relevant region for emotional regulation during processing of negative stimuli. Furthermore, baseline ACC activity might serve as a biomarker for treatment response. Findings are in accordance with recent studies highlighting properties of pre-treatment ACC to be associated with general antidepressive treatment response.

中文翻译：

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电休克疗法对重度抑郁症情绪处理过程中脑功能的影响

背景技术在难治性重度抑郁症（MDD）中，电休克疗法（ECT）是一种高效的治疗方法。虽然关于 ECT 后大脑结构变化的知识正在增长，但 ECT 在情绪处理过程中对大脑功能的影响在很大程度上是未知的。目的 我们研究了 ECT 在负面情绪刺激处理过程中对前扣带回皮层 (ACC) 和杏仁核活动的影响及其与临床反应的关联。方法 在这项非随机纵向研究中，对 ECT 治疗前后的 MDD 患者（n = 37）进行了评估。健康对照（n = 37）在年龄和性别方面匹配。功能磁共振成像 (fMRI) 在基线和六周后使用超阈值面部匹配范例获得两次。为了评估临床反应的效果，进行了额外的事后分​​析，比较了反应者与非反应者。结果 ECT 后，MDD 患者在处理负面情绪刺激期间表现出统计学上显着的 ACC 活动增加 (pFWE = .039)。这种效应是由响应者驱动的 (pFWE = .023)，而无响应者则没有增加。与无反应者相比，有反应者的治疗前 ACC 活性也较低 (pFWE = .025)。在杏仁核中没有观察到显着影响。结论 ECT 导致 ACC 的大脑功能变化，ACC 是处理负面刺激过程中情绪调节的相关区域。此外，基线 ACC 活动可能作为治疗反应的生物标志物。