Effects of electroconvulsive therapy and repetitive transcranial magnetic stimulation on serum brain-derived neurotrophic factor levels in patients with depression

Abstract

Objective: Brain-derived neurotrophic factor (BDNF) levels are decreased in individuals with depression and increase following antidepressant treatment. The objective of this study is to compare pre- and post-treatment serum BDNF levels in patients with drug-resistant major depressive disorder (MDD) who received either electroconvulsive therapy (ECT) or repetitive transcranial magnetic stimulation (rTMS). It is hypothesized that non-pharmacological treatments also increase serum BDNF levels.

Methods: This was a prospective, single-blind study comparing pre- and post-treatment serum BDNF levels of 29 patients with drug-resistant MDD who received ECT or rTMS treatment. Serum BDNF levels were measured 1 week prior to and 1 week after treatment using the sandwich ELISA technique. Depression severity was measured 1 week before and 1 week after treatment using the Hamilton Depression Rating Scale. Two-sided normal distribution paired t-test analysis was used to compare pre- and post-treatment BDNF concentration and illness severity. Bivariate correlations using Pearson's coefficient assessed the relationship between post-treatment BDNF levels and post-treatment depression severity.

Results: There was no significant difference in serum BDNF levels before and after ECT, although concentrations tended to increase from a baseline mean of 9.95-12.29 ng/ml after treatment (p = 0.137). Treatment with rTMS did not significantly alter BDNF concentrations (p = 0.282). Depression severity significantly decreased following both ECT (p = 0.003) and rTMS (p < 0.001). Post-treatment BDNF concentration was not significantly correlated with post-treatment depression severity in patients who received either ECT (r = -0.133, p = 0.697) or rTMS (r = 0.374, p = 0.126). It is important to note that these results are based on the small number of patients included in this study.

Conclusion: This study suggests that ECT and rTMS may not exert their clinical effects by altering serum BDNF levels in patients with drug-resistant MDD. Serum BDNF concentration may not be a biomarker of ECT or rTMS treatment response.

Keywords: brain-derived neurotrophic factor; depression; electroconvulsive therapy; repetitive transcranial magnetic stimulation.

Figure 1

Change in serum brain-derived neurotrophic factor (BDNF) concentration from pre- to post-treatment in patients with major depressive disorder treated with electroconvulsive therapy (ECT). Serum BDNF was determined 1 week prior to and 1 week following ECT. There was no significant difference between pre- and post-treatment BDNF levels (p = 0.137). Values are mean ± SE.

Figure 2

Change in Hamilton Depression Rating Scale (HDRS) score from pre- to post-treatment in patients with major depressive disorder treated with electroconvulsive therapy (ECT). HDRS scores were determined 1 week prior to and 1 week following ECT. HDRS scores significantly decreased following ECT (p = 0.003). Values are mean ± SE.

Figure 3

Change in serum brain-derived neurotrophic factor (BDNF) concentration from pre- to post-treatment in patients with major depressive disorder treated with repetitive transcranial magnetic stimulation (rTMS). Serum BDNF was determined 1 week prior to and 1 week following rTMS. There was no significant difference between pre- and post-treatment BDNF levels (p = 0.282). Values are mean ± SE.

Figure 4

Change in mean Hamilton Depression Rating Scale (HDRS) score from pre- to post-treatment in patients with major depressive disorder treated with repetitive transcranial magnetic stimulation (rTMS). HDRS scores were determined 1 week prior to and 1 week following rTMS. HDRS scores significantly decreased following rTMS (p < 0.001). Values are mean ± SE.