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MDD: BDNF may be a potential indicator of treatment response after ECT

Key clinical point: Brain-derived neurotrophic factor (BDNF) may be a potential short-term indicator of treatment response after one or more weeks of electroconvulsive therapy (ECT) in patients with major depressive disorder (MDD).

Major finding: Plasma BDNF levels showed a significant difference before and after ECT (standardized mean difference [SMD], 0.695; P = .000). In the subgroup analysis, serum BDNF levels increased in the first week (SMD = 0.491; P = .005) and first month (SMD = 0.812; P = .001) after ECT completion.

Study details: Systematic review and meta-analysis of 22 studies (4 randomized controlled studies; 18 case-control studies) including 574 patients with MDD.

Disclosures: No study sponsor was identified. The authors declared no conflicts of interest.

Commentary

“This metanalysis of 22 studies, including 4 RCTs and 18 case-control studies, sought to answer 2 questions:

  1. Does ECT treatment for major depression change BDNF levels?
  1. Does the presence of a post-ECT increase in BDNF levels differentiate treatment responders from non-responders?

Of note, serum BDNF and plasma BDNF were studied separately.

Plasma BDNF increased overall after ECT. Serum BDNF did not increase overall. However, subgroup analysis revealed that serum BDNF levels increased after one week after starting ECT, and one month after completing an ECT course, but not on the same day of the first ECT.

An increase in post-ECT BDNF levels did not differentiate treatment responders from non-responders. However, as noted by the authors:

  1. A prior study (Piccini et al, 2009) reported increased post-ECT BDNF levels among treatment responders, in whom major depression responded to ECT.
  2. In this part of the meta-analysis, BNDF levels were not stratified by time after ECT. Future research should examine whether BDNF levels, measured after a particular time period after ECT, would identify treatment responders.”

Gita Ramamurthy, MD

Director, Psychiatry Consultation-Liaison Service

Citation:

Luan S et al. Asian J Psychiatr. 2020 Feb 26. doi: 10.1016/j.ajp.2020.101983.