Brain-derived neurotrophic factor as a possible predictor of electroconvulsive therapy outcome

Elisabeth Maria Van Zutphen,Filip Bouckaert,Annemieke Dols,Eric Van Exel,Didi Rhebergen,Pascal Sienaert,Matthieu Vandenbulcke,Mardien Leoniek Oudega,Max Stek

doi:10.1038/s41398-019-0491-9

Abstract

While brain-derived neurotrophic factor (BDNF) has been shown to predict response to pharmacotherapy in depression, studies in electroconvulsive therapy (ECT) are small and report conflicting results. This study assesses the association between pre-treatment BDNF levels and ECT outcome in severe late-life unipolar depression (LLD). The potential of BDNF as a clinical predictor of ECT outcome was subsequently evaluated. Characteristics associated with low and high BDNF subgroups were determined as well. Ninety-four patients diagnosed with LDD referred for ECT were included. Fasting serum BDNF levels were determined before ECT. Remission and response, measured with the Montgomery–Åsberg Depression Rating Scale, were the outcomes. The association between BDNF and ECT outcome was analysed with logistic regression and Cox regression. The clinical usefulness of BDNF was evaluated using the receiver operating characteristic (ROC) curve. Associations between clinical characteristics and low versus high BDNF levels were examined with T tests, chi-squared tests and Mann−Whitney tests. The odds of remission decreased with 33% for every five units increase of BDNF levels (OR 0.67, 95% confidence interval 0.47–0.96; p = 0.03); however, neither the association with time to remission nor the associations with response nor the adjusted models were significant. The area under the ROC (0.66) implied a poor accuracy of BDNF as a clinical test. Clinical characteristics associated with BDNF were inclusion site, physical comorbidities and duration of the index episode. To conclude, although there is an association between pre-treatment BDNF levels and ECT outcome, BDNF cannot be considered an eligible biomarker for ECT outcome in clinical practice.

Highlights

Depression is the leading cause of disability worldwide[1].To avoid long trajectories ending with treatment failure, predictors of treatment effect in depressed patients are needed
A third aim of this paper is to examine the association of low and high Brain-derived neurotrophic factor (BDNF) levels with a wide variety of features, including sociodemographics, physical health characteristics, clinical features and magnetic resonance imaging (MRI) characteristics, as BDNF levels have been linked to clinical features other than the effect of electroconvulsive therapy (ECT)
Logistic regression showed a significant relation between BDNF and remission (OR: 0.67, 95% CI: 0.47–0.96, p = 0.03), but not between BDNF and response (OR: 0.70, 95% CI: 0.47–1.05, p = 0.08)

Summary

Introduction

To avoid long trajectories ending with treatment failure, predictors of treatment effect in depressed patients are needed. Brain-derived neurotrophic factor (BDNF) is a protein that has received considerable attention in the field of depression. Stress could induce a change in neurotrophic factors such as BDNF, which has a negative effect on neuronal plasticity[9]. Neuronal cell loss and atrophy, especially in the hippocampi, have been linked to depression and treatment outcome[10,11,12]. A change in factors as BDNF van Zutphen et al Translational Psychiatry (2019)9:155 levels might impel depression. It has been suggested that the effectiveness of antidepressant treatment could be explained by a normalization of neurotrophic factors and, subsequently, neuronal plasticity[9]

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