October 8, 2012
Christopher Abbott, M.D, M.S., will be the principal investigator on a three-year $200,000 grant from the Dana Foundation as part of The David Mahoney Neuroimaging Program.
Dr. Abbott proposes to answer this question: Can imaging reveal how ECT improves major depression and identify those at risk for relapse?
The study will employ resting state fMRI to determine how electroconvulsive therapy exerts a therapeutic effect in patients with major depressive disorder, and to identify biomarkers that predict which patients are likely to relapse following ECT treatment.
According to Dr. Abbott, major depressive disorder (MDD) tends to be resistant to current therapies. Electroconvulsive therapy (ECT) can be effective for patients with this form of depression. The success rate is impressive. About 75 percent of patients improve, and the improvements can be striking: during a three to four week course of ECT treatment, most depressive episodes will remit and previously suicidal or psychotically depressed patients will completely recover. But, about 40 percent of patients then relapse within two months.
His study is designed to answer two questions to improve outcomes: 1) How does ECT therapy work - how does it change brain function during therapy? Learning this could lead to improvements in ECT, also in the non-invasive treatment called “transcranial magnetic stimulation” (in which a magnet is placed over the patient’s head to alter electrical activity) and in drug treatments.
2) Are there biomarkers that can identify those patients who are at risk of relapse following ECT therapy, so that more aggressive therapy can be provided following ECT treatment to prevent relapse?
Researchers hypothesize that successful ECT response is associated with normalizing brain activity within and between an overactive limbic/paralimbic network and that sustained ECT response may be contingent upon diminishing signaling between the paralimbic and cortical brain networks. They will test this by comparing resting state fMRI in 20 healthy volunteers and 20 patients with MDD. Resting state fMRI identifies regional network connectivity that occurs in the absence of performing a specific task. Volunteers will be imaged to establish “healthy” resting state network activity levels. Patients’ clinical state and brain imaging will be assessed prior to and after ECT treatment. Investigators will determine whether patients’ post-treatment images more closely resemble those of the healthy volunteers, whether the changes in network activity correlate with their clinical outcomes, and what changes in the network are associated with improved outcomes. Patients will be imaged again at the time of relapse or after three months with no relapse, to identify potential biomarkers that differentiate those who relapse from those who do not.
Significance: The study findings may lead to a better understanding of processes involved in MDD and lead to improved treatment and relapse prevention in at-risk patients.
Grand Rounds: Juan Bustillo, MD, Professor, presents
November 18, 2013