Electroconvulsive Therapy Response Unaffected by Age-Related Brain Changes in Treating Late-Life Depression

There is no evidence of a relationship between response to electroconvulsive therapy (ECT) and age-related structural or molecular brain changes, according to research findings published in the Journal of Affective Disorders. This result implies that ECT could be effectively used to treat depressed patients regardless of accumulating age-related brain changes.

Researchers examined 34 elderly patients with severe late life depression in order to determine whether the accumulation of age-related brain changes negatively affects the outcome of ECT in late-life depression. The patients underwent ECT treatment twice weekly until remission and had 3T structural magnetic resonance imaging (MRI) and β-amyloid PET imaging using 18F-flutemetamol at baseline. Montgomery-Åsberg

Depression Rating Scale and Mini-Mental State Examination results were obtained weekly from 1 week prior to ECT through 6 months after final ECT. Researchers conducted a multiple logistic regression analysis and a survival analysis with neuroimaging measures as predictors and response, remission, and relapse as outcome variables.

The study was limited by its small sample size and exploratory nature. The study was focused on hippocampal volume and did not investigate the predictive value of other cortical and subcortical regions. Future studies should incorporate larger samples and explore other gray matter regions.

There were no associations detected between baseline hippocampal volume, white matter hyperintensity volume, and total amyloid load and response or remission at 1 and 4 weeks after ECT. The researchers stated, “Our study shows no evidence of [a] relationship between response to ECT and age-related structural or molecular brain changes, implying that ECT can be applied effectively in depressed patients irrespective of accumulating age-related brain changes.” They also noted that this should influence clinical decision-making.

Reference

Bouckaert F, Emsell L, Vansteelandt K, et al. Electroconvulsive therapy response in late-life depression unaffected by age-related brain changes. J Affect Disord. 2019;251:114-120.