TY - JOUR
T1 - The relationship between electric field strength induced by electroconvulsive therapy and cognitive and antidepressant outcomes
AU - Loef, Dore
AU - Argyelan, Miklos
AU - Ruhé, Henricus G.
AU - Scheepens, Dominique S.
AU - Schoevers, Robert A.
AU - Tendolkar, Indira
AU - van Exel, Eric
AU - van Waarde, Jeroen A.
AU - van Wingen, Guido A.
AU - Verdijk, Joey P.A.J.
AU - Verwijk, Esmée
AU - Dols, Annemiek
AU - van Eijndhoven, Philip F.P.
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to American College of Neuropsychopharmacology 2025.
PY - 2025
Y1 - 2025
N2 - Electroconvulsive therapy (ECT) is an effective treatment for depression but is often associated with cognitive side effects. In patients, ECT-induced electric field (E-field) strength across brain regions varies significantly due to anatomical differences, which may explain individual differences in cognitive side effects. We examined the relationship between regional E-field strength and change in verbal fluency score (i.e., category fluency animals score from pre- to 1 week post-ECT; as key proxy of cognitive side effects) across different electrode placements in depressed patients. Secondary, we examined the relationship between regional E-field strength and depression outcome. Using T1 magnetic resonance imaging, we performed E-field modeling in a total of 109 patients. Linear mixed models were executed to analyze the relationship between E-field strength across all 118 brain regions and both cognitive and depression outcomes, while correcting for nuisance variables (e.g., age, total number of ECT sessions, and study cohort). We found that a higher E-field strength was significantly associated with a higher decline in verbal fluency (n = 71, false discovery rate [FDR] corrected p < 0.01) in several brain regions in the left hemisphere (e.g., temporal gyrus and operculum cortex). Moreover, numerous significant associations were found only in the 24 patients treated with right unilateral ECT. No significant relationships were found between regional E-field strength and depression outcome. In conclusion, significant associations between verbal fluency and E-field strength were found in areas crucial for linguistic processing and semantic memory. Our findings underscore the importance of considering individualized dosing strategies to optimize cognitive outcome in ECT, while maintaining its antidepressant efficacy.
AB - Electroconvulsive therapy (ECT) is an effective treatment for depression but is often associated with cognitive side effects. In patients, ECT-induced electric field (E-field) strength across brain regions varies significantly due to anatomical differences, which may explain individual differences in cognitive side effects. We examined the relationship between regional E-field strength and change in verbal fluency score (i.e., category fluency animals score from pre- to 1 week post-ECT; as key proxy of cognitive side effects) across different electrode placements in depressed patients. Secondary, we examined the relationship between regional E-field strength and depression outcome. Using T1 magnetic resonance imaging, we performed E-field modeling in a total of 109 patients. Linear mixed models were executed to analyze the relationship between E-field strength across all 118 brain regions and both cognitive and depression outcomes, while correcting for nuisance variables (e.g., age, total number of ECT sessions, and study cohort). We found that a higher E-field strength was significantly associated with a higher decline in verbal fluency (n = 71, false discovery rate [FDR] corrected p < 0.01) in several brain regions in the left hemisphere (e.g., temporal gyrus and operculum cortex). Moreover, numerous significant associations were found only in the 24 patients treated with right unilateral ECT. No significant relationships were found between regional E-field strength and depression outcome. In conclusion, significant associations between verbal fluency and E-field strength were found in areas crucial for linguistic processing and semantic memory. Our findings underscore the importance of considering individualized dosing strategies to optimize cognitive outcome in ECT, while maintaining its antidepressant efficacy.
KW - n/a OA procedure
UR - http://www.scopus.com/inward/record.url?scp=85214135962&partnerID=8YFLogxK
U2 - 10.1038/s41386-024-02050-7
DO - 10.1038/s41386-024-02050-7
M3 - Article
AN - SCOPUS:85214135962
SN - 0893-133X
JO - Neuropsychopharmacology
JF - Neuropsychopharmacology
M1 - e40
ER -