Understanding the mechanisms of treatment response in depression, focus on electro-convulsive therapy
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EDITORIAL
Understanding the mechanisms of treatment response in depression, focus on electro‑convulsive therapy Elisabeth B. Binder1 Published online: 31 August 2020 © The Author(s) 2020
Major depressive disorders are among the most common psychiatric disorders, with a lifetime prevalence of up to 20% [1]. While there are a number of effective treatment approaches, including pharmacological, psychotherapeutic or treatments based on invasive or non-invasive brain stimulation, rates of chronic depression and treatment-resistant forms are high. These chronic disease trajectories are not only an enormous burden for the patients and their families, but also for societies, accounting for among the highest years lived with disability [2]. Currently, in the absence of biology-based diagnoses and clinically relevant biomarkers, treatment choices have to remain trial and error, further increasing the time to response for patients. Biomarkers predicting likely response to treatment overall or a specific treatment would be a clinically important advance for psychiatry and are thus a topic of intense research. The largest number of studies to date have explored biomarkers for predicting or tracking response to antidepressant medication, either overall or to specific classes of antidepressant drugs, with genetic, neuroimaging, or peripheral bloodbased biomarkers being the most commonly investigated. Overall, no predictors actually used in clinical routine have yet emerged, including pharmacogenetic markers. Even for genotypes of genes involved in the pharmacokinetics of antidepressant drug, such as the cytochrome P450 gene family, data have remained controversial [3]. Beyond pharmacotherapy, biomarker studies have been scarce, especially for differential response to different treatment modalities, although such biomarkers would be of great value, possibly also allowing to identify biological subtypes of depression. For instance, functional magnetic resonance imaging (fMRI) resting-state functional * Elisabeth B. Binder [email protected] 1
Dept. Of Translational Research in Psychiatry, Max-Planck Institute of Psychiatry, Kraepelinstr. 2‑10, 80804 Munich, Germany
connectivity analyses with a bilateral subcallosal cingulate cortex seed could predict treatment remission or failure to cognitive behavioral therapy vs. antidepressant drug treatment with over 70% accuracy. Patients with higher summed connectivity with this brain region preferentially remitted to behavioral therapy and did not response to pharmacological treatment. Such differential predictors would not only be on high clinical relevance, but could also shed light on different brain circuit dysfunction in depression relevant for treatment response [4]. In addition to understanding differential treatment response, focusing on the factors underlying treatment response to electroconvulsive therapy (ECT) could also reveal important insight into mechanisms of depression treatment response. ECT is among the most effective forms of treatment for severe depressive disorde
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