Electroconvulsive therapy (ECT) helps people with severe depression by "pushing the reset button" on brain networks involved in creating a mental picture, according to recent Baycrest findings.

People with depression commonly become focused on the negative aspects of an experience, which also blunts their memory ability. These individuals have difficulty reframing their thoughts towards healthier interpretations of past events. Electroconvulsive therapy appeared to fight depression by "rebooting" the visualization networks, according to findings published in the journal NeuroImage: Clinical.

"ECT has long been known to be an effective treatment for patients who don't respond to other therapies," says Dr. Brian Levine, senior author on the paper and senior scientist at Baycrest's Rotman Research Institute (RRI). "But we don't know precisely how ECT affects brain function. Our study shows how ECT alters brain networks involved in memory and thinking."

Since the late 1930s, psychiatrists have used ECT as part of an overall treatment plan to help people with depression who are not benefitting from antidepressants. With ECT, electrical current is applied to the forehead to intentionally cause brief seizures, while the person is under anesthesia. Following a course of ECT, individuals proceed with medication or talk therapy to maintain their improved condition.

"Since people with depression struggle to reframe an event, their ability to cope with adverse situations is affected," says Dr. Raluca Petrican, co-first author on the paper and RRI postdoctoral fellow. "Our study suggests that ECT reconfigures brain networks that promote flexibility in how people remember events, and this may help people cope better with daily challenges."

Researchers analyzed the brain scans of 25 adults between the ages of 25 to 60 years old. Among the participants, 15 individuals were severely depressed and referred for electroconvulsive therapy at psychiatric clinics across Toronto. All participants were asked to share some notable events with researchers at the beginning of the study. Participants were cued to picture these events while they were inside the scanner. Individuals who were recommended for ECT did scans before and after all their sessions. These scans were analyzed and researchers found that before ECT, the brain networks linked to visualization appeared to function differently among individuals with depression, but after ECT, these brain networks looked similar to healthy individuals.

The results were validated in a publicly available database of more than 300 individuals who had their brains scanned as part of a separate study but did not have ECT.

Through these scans and access to the database, researchers were also able to link a person's brain networks to their resiliency or susceptibility to depression.

As next steps, the study is exploring one of the common side effects of ECT -- the amount and types of memory loss experienced by patients who undergo this treatment.

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This project was supported by the Canadian Institutes of Health Research. The research team also included Dr. Hedvig Söderlund from Uppsala University in Sweden, Dr. Zafiris Daskalakis from the Centre for Addiction and Mental Health, Dr. Alastair Flint from University Health Network and Namita Kumar from Baycrest.

About Baycrest

Baycrest is a global leader in geriatric residential living, healthcare, research, innovation and education, with a special focus on brain health and aging. Fully affiliated with the University of Toronto, Baycrest provides excellent care for older adults combined with an extensive clinical training program for the next generation of healthcare professionals and one of the world's top research institutes in cognitive neuroscience, the Rotman Research Institute. Baycrest is home to the federally and provincially-funded Centre for Aging and Brain Health Innovation, a solution accelerator focused on driving innovation in the aging and brain health sector, and is the developer of Cogniciti - a free online memory assessment for Canadians 40+ who are concerned about their memory. Founded in 1918 as the Toronto Jewish Old Folks Home, Baycrest continues to embrace the long-standing tradition of all great Jewish healthcare institutions to improve the well-being of people in their local communities and around the globe. Baycrest is helping create a world where every older adult enjoys a life of purpose, inspiration and fulfilment. For more information please visit: http://www. baycrest. org

About Baycrest's Rotman Research Institute

Now in its 30th year, the Rotman Research Institute at Baycrest is a premier international centre for the study of human brain function. Through generous support from private donors and funding agencies, the institute is helping to illuminate the causes of cognitive decline in seniors, identify promising approaches to treatment and lifestyle practices that will protect brain health longer in the lifespan.

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