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An Electrophysiological Biomarker That May Predict Treatment Response to ECT

Scangos, Katherine W., MD, PhD*; Weiner, Richard D., MD, PhD; Coffey, Edward C., MD; Krystal, Andrew D., MD, MS*

doi: 10.1097/YCT.0000000000000557
Original Studies

Objective Electroconvulsive therapy (ECT) is the most effective treatment for major depression but also carries risk of cognitive side effects. The ability to predict whether treatment will be effective before initiation of treatment could significantly improve quality of care, reduce suffering, and diminish costs. We sought to carry out a comprehensive and definitive study of the relationship between the background electroencephalography (EEG) and therapeutic response to ECT.

Methods Twenty-one channel resting EEG was collected pre-ECT and 2 to 3 days after ECT course from 2 separate data sets, one to develop an EEG model of therapeutic response (n = 30) and a second to test this model (n = 40). A 3-way principal components analysis was applied and coherence and spectral amplitude across 6 frequency bands were examined. The primary outcome measure was the Montgomery-Asberg Rating Scale (MADRS).

Results Four patterns of amplitude and coherence along with baseline MADRS score accounted for 85% of the variance in posttreatment course MADRS score in study 1 (R2 = 0.85, F = 11.7, P < 0.0002) and 53% of the variance in MADRS score in study 2 (R2 = 0.53, F = 5.5, P < 0.003). Greater pre-ECT course anterior delta coherence accounted for the majority of variance in therapeutic response (study 1: R2 = 0.44, P = 0.01; study 2: R2 = 0.16, P = 0.008).

Conclusions These results suggest a putative electrophysiological biomarker that can predict therapeutic response before a course of ECT. Greater baseline anterior delta coherence is significantly associated with a better subsequent therapeutic response and could be indicative of intact circuitry allowing for improved seizure propagation.

From the *Department of Psychiatry, University of California, San Francisco, San Francisco, CA;

Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC; and

Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX.

Received for publication June 22, 2018; accepted September 10, 2018.

Reprints: Katherine Scangos, MD, PhD, Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA 94143 (e-mail:

Supported by MH40159 (R.D.W. and C.E.C.) and MH41803 (C.E.C.).

A.D.K. is a consultant for Ferring, Galderma, Jazz, Janssen, Takeda, Merck, Neurocrine, Otsuka, Pfizer, Lundbeck, Pernix, Idorsia, Adare, and Harmony Biosciences. The other authors report no conflicts of interest.

Online date: December 10, 2018

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