​ECT and depression - understanding treatment response and blood-brain-barrier changes

As ECT is used worldwide, the development of precise methods for predicting which patients will benefit from treatment will be of paramount importance to both physicians and patients. In the current study, we have two important goals: 1) To develop easily accessible and valid methods based on MRI scans that can predict which patients will achieve the effect of ECT. 2) To conduct a potentially groundbreaking proof-of-concept study of the blood-brain barrier (BBB) ​​before and after ECT.​​

Depression is a widespread and serious illness. ECT is often used in the most severe depression, where other treatments have not had an effect or where the patient is at high risk of committing suicide. In general, approx. 5% of inpatients in psychiatric wards are treated with ECT. It is thus about several thousand people a year.

The overall purpose of the project is to better understand the mechanisms behind the effect of ECT. We do this in two different ways. In work package 1 (WP1) we will predict which patients will benefit from the treatment. ECT is an effective and safe form of treatment, but unfortunately achieves approx. 30% of patients do not have the required effect. As the treatment carries a risk of side effects, it will be of great importance to be able to predict which patients will achieve the effect of the treatment. In work packages 2 (WP2), we investigate whether ECT affects the so-called blood-brain barrier, which protects the brain's internal environment from external influences, and whether any influence can explain the changes that are often seen in a brain area hippocampus.​

WP1 studies a group of hospitalized patients with depression who receive ECT. The patients are examined clinically, with structural and functional MRI scans and with blood, urine and hair samples. The investigations take place at three times; before, immediately after the end of the ECT treatment series/just before discharge, and six months thereafter. The trial participants are recruited from the Capital Region of Denmark's psychiatric centers. WP2 is a pilot project examining 10 patients being treated with ECT. All patients are examined before and after an ECT treatment. As we expect that any effect on the blood-brain barrier is short-lived, patients are examined a few hours after treatment. We examine patients with an MRI scan with contrast, blood tests and memory tests. Subsequently, a control group of 10 patients with the same studies is examined.

Results and conclusions:
We expect that the project will shed light on the mechanisms behind ECT's effect. This will make it possible to predict which patients should be offered ECT and which should not. If the expected results are achieved, the long-term goal will be to implement the use of blood and urine samples, hair analyzes and MRI scans prior to ECT, as a practice in the Capital Region of Denmark's Psychiatry and around the rest of the world. By predicting the effect of ECT, the project will significantly improve treatment with ECT for the benefit of both patients, their relatives and healthcare professionals.​



​Foundations that supports the  project:  


Gerhart Lind Legat


Responsible editor