Magnetic seizure therapy and electroconvulsive therapy increase aperiodic activity

Sydney E Smith; Eena L Kosik; Quirine van Engen; Jordan Kohn; Aron T Hill; Reza Zomorrodi; Daniel M Blumberger; Zafiris J Daskalakis; Itay Hadas; Bradley Voytek

doi:10.1038/s41398-023-02631-y

Magnetic seizure therapy and electroconvulsive therapy increase aperiodic activity

Transl Psychiatry. 2023 Nov 16;13(1):347. doi: 10.1038/s41398-023-02631-y.

Authors

Sydney E Smith^#¹, Eena L Kosik^#², Quirine van Engen^#², Jordan Kohn^{3

4}, Aron T Hill^{5

6}, Reza Zomorrodi⁷, Daniel M Blumberger⁷, Zafiris J Daskalakis⁴, Itay Hadas^#⁴, Bradley Voytek^#^{8

2

9

10}

Affiliations

¹ Neurosciences Graduate Program, University of California, San Diego, La Jolla, CA, USA. s1smith@health.ucsd.edu.
² Department of Cognitive Science, University of California, San Diego, La Jolla, CA, USA.
³ Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA.
⁴ Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA.
⁵ Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, VIC, Australia.
⁶ Department of Psychiatry, Central Clinical School, Monash University, Melbourne, VIC, Australia.
⁷ Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.
⁸ Neurosciences Graduate Program, University of California, San Diego, La Jolla, CA, USA.
⁹ Halıcıoğlu Data Science Institute, University of California, San Diego, La Jolla, CA, USA.
¹⁰ Kavli Institute for Brain and Mind, University of California, San Diego, La Jolla, CA, USA.

^# Contributed equally.

Abstract

Major depressive disorder (MDD) is a leading cause of disability worldwide. One of the most efficacious treatments for treatment-resistant MDD is electroconvulsive therapy (ECT). Recently, magnetic seizure therapy (MST) was developed as an alternative to ECT due to its more favorable side effect profile. While these approaches have been very successful clinically, the neural mechanisms underlying their therapeutic effects are unknown. For example, clinical "slowing" of the electroencephalogram beginning in the postictal state and extending days to weeks post-treatment has been observed in both treatment modalities. However, a recent longitudinal study of a small cohort of ECT patients revealed that, rather than delta oscillations, clinical slowing was better explained by increases in aperiodic activity, an emerging EEG signal linked to neural inhibition. Here we investigate the role of aperiodic activity in a cohort of patients who received ECT and a cohort of patients who received MST treatment. We find that aperiodic neural activity increases significantly in patients receiving either ECT or MST. Although not directly related to clinical efficacy in this dataset, increased aperiodic activity is linked to greater amounts of neural inhibition, which is suggestive of a potential shared neural mechanism of action across ECT and MST.

MeSH terms

Depressive Disorder, Major* / complications
Depressive Disorder, Treatment-Resistant* / therapy
Electroconvulsive Therapy*
Humans
Seizures / therapy
Transcranial Magnetic Stimulation / adverse effects

Grants and funding

R01 GM134363/GM/NIGMS NIH HHS/United States