Brain Changes in Severely Depressed Patients Before and After Treatment With Electroconvulsive Therapy

University Hospital, Toulouse17 enrolled

Overview

Electroconvulsive therapy (ECT) is a non-pharmacological treatment used in resistant depression whose effectiveness has been demonstrated. However, the brain mechanisms underlying this therapeutic effect remain unclear. Many animal studies show a neurotrophic action of ECT on the hippocampus: increased neurogenesis, synaptogenesis, proliferation of glial cells. In addition, functional imaging of "resting state" type have shown, among depressed patients after ECT, increased functional connectivity . These results were reinforced by the recent work of Perrin (2012). In view of this a priori contradictory, it seems appropriate to continue research neuroanatomical correlates subtending neurofunctional processes responsible at the same time improving the clinical depressive. The investigators suggest using an original technique never used in this type of population: Functional magnetic resonance imaging (fMRI) or multimodal structural-functional. This method will allow us to study the impact of ECT on brain structures involved in major depressive disorder: hippocampus.

Study Type

INTERVENTIONAL

Allocation

Purpose

BASIC_SCIENCE

Masking

NONE

Enrollment

Conditions

Severe Depression

Interventions

Four visits will be conducted during the prospective follow during which will be carried out a 3T MRI examination, assessment of assessment of depressive symptomatology and anterograde memory: within 7 days prior to the first session of ECT, within 48 hours after the first ECT session, within 48 hours after the first effective ECT session and within 10 days of the last session of ECT.

Eligibility

Sex: ALLMin age: 50 YearsMax age: 70 Years

Medical Language ↔ Plain English

Inclusion Criteria: * diagnostic and Statistical Manual of Mental Disorders-V (DSM) diagnosis of major depressive disorder * indication of ECT and signing the consent for conducting a ECT * right-handed * be of French mother tongue * belong to a social security scheme * sign an informed consent Exclusion Criteria: * against indication for MRI * against indication to anesthesia * processes brain expensive * pregnant woman * refuse to be informed of an abnormality detected during MRI * Patients holders of stimulation electrodes * presence history of neurological disease * presence history of head injury * Mini-Mental State Examination (MMSE) \<15/30 * presence of neurodegenerative disease * patients who have had ECT treatment in the last 6 months

Locations (1)

CHU Toulouse, Hôpital de psychiatrie

Toulouse, France

Outcomes

Primary Outcomes

Morphological changes in the hippocampus between baseline and after the first ECT effective session as assessed by volume measure in multimodal MRI.

Visit 3 will take place within 48 hours after the first ECT session effective.

Time frame: Within 48 hours after the first effective ECT session.

Secondary Outcomes

Functional connectivity changes of the hippocampus-related networks between baseline and after the first effective ECT session as assessed by measure of connectivity in multimodal MRI.

Visit 3 will take place within 48 hours after the first ECT session effective.

Time frame: Within 48 hours after the first effective ECT session.

Morphological changes of the hippocampus-related networks between baseline and after the first ECT session as assessed by measure of volume in multimodal MRI.

Visit 2 will take place within 48 hours after the first ECT session

Time frame: Within 48 hours after the first ECT session.

Morphological changes of the hippocampus-related networks between baseline and after the first ECT session as assessed by average diffusivity in multimodal MRI.

Visit 2 will take place within 48 hours after the first ECT session

Time frame: Within 48 hours after the first ECT session.

Functional changes of the hippocampal-related networks between baseline and after the first ECT session as assessed by measure of connectivity in multimodal MRI.

Visit 2 will take place within 48 hours after the first ECT session

Time frame: Within 48 hours after the first ECT session.

Morphological changes in the hippocampus and hippocampal-related networks related to ECT between baseline and after remission as assessed by measure of volume in multimodal MRI

Remission is defined by a score of 7 or less on Hamilton Depression Rating

Time frame: Within 10 days after remission.

Morphological changes in the hippocampus and hippocampal-related networks related to ECT between baseline and after remission as assessed by

Remission is defined by a score of 7 or less on Hamilton Depression Rating

Time frame: Within 10 days after remission.

Functional changes in the hippocampus and hippocampal-related networks related to ECT after remission as assessed by measure of connectivity in multimodal MRI.

Remission is defined by a score of 7 or less on Hamilton Depression Rating Scale (HDRS).

Time frame: Within 10 days after remission

Evolution of Real Life/Real Impact-16 (RLRI-16) score after the first ECT, after ECT first "effective" and after remission

RLRI-16 test will be realised during all visits, after ECT.

Time frame: Within 7 days before first ECT, after the first ECT, within 48 hours after the first effective ECT and within 10 days after remission

Changes in the intensity of depressive symptoms score (Hamilton Depression Rating Scale) after the first ECT, ECT first "effective" and after remission

Hamilton Depression Rating Scale will be realised during all visits, after ECT.

Time frame: Within 7 days before first ECT, after the first ECT, within 48 hours after the first effective ECT and within 10 days after remission

Data from ClinicalTrials.gov

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