Multi-modal imaging investigation of electroconvulsive therapy response in depre

电休克治疗（ECT）仍然是治疗严重的，难治性的金标准。 抑郁发作的患者。在典型的4周ECT系列中，大多数抑郁发作缓解， 以前有自杀倾向或精神抑郁症的患者将恢复其发病前的功能水平。机冷却液温度 精神病学最具侵入性的治疗方法之一，仍然局限于学术医疗中心或更大的大都市。 医院的尽管ECT已有80年的历史，但由于缺乏对神经生物学的了解， ECT反应的作用机制限制了更安全、更容易获得的治疗的发展。的 本研究的总体目的是鉴定ECT应答的生物标志物。病例对照纵向设计 和静息状态功能性磁共振成像（fMRI）将同时评估（目的 1)以及与ECT响应相关的网络内变化（目标2）。我们的初步数据支持我们的假设 ECT反应在正面和默认模式网络中的网络关系之间增加， 并且降低了在胼胝体下扣带回中的网络内低频功率（0.01至0.1赫兹（Hz））。 ECT系列与癫痫发作阈值增加和癫痫发作持续时间缩短相关。这些 ECT的抗惊厥特性可能与功能网络内光谱功率的降低有关。 在目标3中，质子光谱（H-MRS）将测量γ-氨基丁酸浓度的变化 GABA是与ECT反应相关的主要抑制性神经递质。这种多模式的方面 研究将把GABA浓度的变化与ECT反应的fMRI生物标志物的变化联系起来 (Aims 1和2）。具体地说，我们假设后扣带回中GABA浓度的增加将 与边缘系统和旁边缘系统网络内降低的低频频谱功率（0.01和0.1 Hz）相关。 这项研究将影响该领域更好地了解ECT的功能神经相关性 响应，这将有助于优化ECT治疗参数（例如，脉冲宽度，刺激传递方法， 治疗次数），并扩展到治疗难治性抑郁症的其他治疗干预措施。

Electroconvulsive therapy (ECT) remains the gold-standard treatment for severe, treatment-resistant patients with depressive episodes. During a typical 4-week ECT series, most depressive episodes remit, and formerly suicidal or psychotically depressed patients will resume their premorbid levels of functioning. ECT is one of psychiatry's most invasive treatments and remains limited to academic medical centers or larger, metropolitan hospitals. Despite ECT's 80-year history, the lack of understanding regarding the neurobiology and the mechanism of action of ECT response limit the development of safer, more accessible treatments. The overall aim of this investigation is to identify the biomarkers of ECT response. A case-control longitudinal design and resting state functional magnetic resonance imaging (fMRI) will simultaneously assess between (Aim 1) and within network changes (Aim 2) associated with ECT response. Our preliminary data supports our hypothesis that ECT response increases between network relationships amid frontal and default mode networks and reduces within network low frequency power (0.01 to 0.1 hertz (Hz)) in the subcallosal cingulate gyrus. The ECT series is associated with increased seizure threshold and reduced seizure duration. These anticonvulsant properties of ECT may be related to the reduction in spectral power within functional networks. In Aim 3, proton spectroscopy (H-MRS) will measure changes in concentrations of gamma-aminobutyric acid (GABA), the main inhibitory neurotransmitter, associated with ECT response. The multi-modal aspect of this investigation will link changes in GABA concentrations with changes in the fMRI biomarkers of ECT response (Aims 1 and 2). Specifically, we hypothesize that increased GABA concentrations in the posterior cingulate will correlate with reduced low frequency spectral power (0.01 and 0.1 Hz) within limbic and para-limbic networks. This research will impact the field with a better understanding of the functional neural correlates of ECT response, which will help to optimize ECT treatment parameters (e.g., pulse width, stimulus delivery method, number of treatments) and extend to other therapeutic interventions for treatment-resistant depression.