Electroconvulsive therapy (ECT) is the most effective treatment in treatment-resistant depression; it may modulate intracellular processes in such patients. This study aimed to investigate the association between changes in plasma brain-derived neurotrophic factor (BDNF) levels and the clinical improvements after ECT for patients with treatment-resistant depression. Fifty-five inpatients with treatment-resistant depression were recruited. The severity of depression was measured using the 17-item Hamilton Rating Scale for Depression (HAMD-17) and the Clinical Global Impression-Severity (CGI-S) before ECT, after every 3 sessions of ECT, and at the end of ECT. Plasma BDNF levels were measured in all subjects before and after ECT. The severity of depression was significantly reduced on the HAMD-17 (p < 0.001) and the CGI-S (p < 0.001) after the end of ECT. There were no significant differences in plasma BDNF levels after ECT (p = 0.615). No significant correlation was found between changes in plasma BDNF levels and changes in HAMD-17 scores (r = 0.188, p = 0.169). Our results do not support the hypothesis that improvements in treatment-resistant depression patients after ECT are due to changes in BDNF levels.

Fekadu A, Wooderson SC, Markopoulo K, Donaldson C, Papadopoulos A, Cleare AJ: What happens to patients with treatment-resistant depression? A systematic review of medium to long term outcome studies. J Affect Disord 2009;116:4-11.
Sackeim HA: The definition and meaning of treatment-resistant depression. J Clin Psychiatry 2001;62(suppl 16):10-17.
Fava GA, Ruini C, Sonino N: Treatment of recurrent depression: a sequential psychotherapeutic and psychopharmacological approach. CNS Drugs 2003;17:1109-1117.
Hussain F, Cochrane R: Depression in South Asian women living in the UK: a review of the literature with implications for service provision. Transcult Psychiatry 2004;41:253-270.
Laske C, Eschweiler GW: Brain-derived neurotrophic factor: from nerve growth factor to modulator of brain plasticity in cognitive processes and psychiatric diseases (in German). Nervenarzt 2006;77:523-537.
Yamamoto H, Gurney ME: Human platelets contain brain-derived neurotrophic factor. J Neurosci 1990;10:3469-3478.
Aydemir O, Deveci A, Taneli F: The effect of chronic antidepressant treatment on serum brain-derived neurotrophic factor levels in depressed patients: a preliminary study. Prog Neuropsychopharmacol Biol Psychiatry 2005;29:261-265.
Fernandes BS, Gama CS, Cereser KM, Yatham LN, Fries GR, Colpo G, de Lucena D, Kunz M, Gomes FA, Kapczinski F: Brain-derived neurotrophic factor as a state-marker of mood episodes in bipolar disorders: a systematic review and meta-regression analysis. J Psychiatr Res 2011;45:995-1004.
Huang TL, Lee CT, Liu YL: Serum brain-derived neurotrophic factor levels in patients with major depression: effects of antidepressants. J Psychiatr Res 2008;42:521-525.
Karege F, Perret G, Bondolfi G, Schwald M, Bertschy G, Aubry JM: Decreased serum brain-derived neurotrophic factor levels in major depressed patients. Psychiatry Res 2002;109:143-148.
Shimizu E, Hashimoto K, Okamura N, Koike K, Komatsu N, Kumakiri C, Nakazato M, Watanabe H, Shinoda N, Okada S, Iyo M: Alterations of serum levels of brain-derived neurotrophic factor (BDNF) in depressed patients with or without antidepressants. Biol Psychiatry 2003;54:70-75.
Lin PY: State-dependent decrease in levels of brain-derived neurotrophic factor in bipolar disorder: a meta-analytic study. Neurosci Lett 2009;466:139-143.
Molendijk ML, Bus BA, Spinhoven P, Penninx BW, Kenis G, Prickaerts J, Voshaar RC, Elzinga BM: Serum levels of brain-derived neurotrophic factor in major depressive disorder: state-trait issues, clinical features and pharmacological treatment. Mol Psychiatry 2010;16:1088-1095.
Shirayama Y, Chen AC, Nakagawa S, Russell DS, Duman RS: Brain-derived neurotrophic factor produces antidepressant effects in behavioral models of depression. J Neurosci 2002;22:3251-3261.
Sen S, Duman R, Sanacora G: Serum brain-derived neurotrophic factor, depression, and antidepressant medications: meta-analyses and implications. Biol Psychiatry 2008;64:527-532.
APA: Practice Guideline for the Treatment of Patients with Major Depressive Disorder, ed 3. Arlington, American Psychiatric Association. 2010, pp 1-152.
Altar CA, Whitehead RE, Chen R, Wortwein G, Madsen TM: Effects of electroconvulsive seizures and antidepressant drugs on brain-derived neurotrophic factor protein in rat brain. Biol Psychiatry 2003;54:703-709.
Rosa DV, Souza RP, Souza BR, Motta BS, Caetano F, Jornada LK, Feier G, Jeromin A, Gomez MV, Quevedo J, Romano-Silva MA: NCS-1 expression in rat brain after electroconvulsive stimulation. Neurochem Res 2007;32:81-85.
Rosa DV, Souza RP, Souza BR, Motta BS, Caetano F, Jornada LK, Feier G, Gomez MV, Quevedo J, Romano-Silva MA: DARPP-32 expression in rat brain after electroconvulsive stimulation. Brain Res 2007;1179:35-41.
Okamoto T, Yoshimura R, Ikenouchi-Sugita A, Hori H, Umene-Nakano W, Inoue Y, Ueda N, Nakamura J: Efficacy of electroconvulsive therapy is associated with changing blood levels of homovanillic acid and brain-derived neurotrophic factor (BDNF) in refractory depressed patients: a pilot study. Prog Neuropsychopharmacol Biol Psychiatry 2008;32:1185-1190.
Bocchio-Chiavetto L, Zanardini R, Bortolomasi M, Abate M, Segala M, Giacopuzzi M, Riva MA, Marchina E, Pasqualetti P, Perez J, Gennarelli M: Electroconvulsive therapy (ECT) increases serum brain derived neurotrophic factor (BDNF) in drug resistant depressed patients. Eur Neuropsychopharmacol 2006;16:620-624.
Marano CM, Phatak P, Vemulapalli UR, Sasan A, Nalbandyan MR, Ramanujam S, Soekadar S, Demosthenous M, Regenold WT: Increased plasma concentration of brain-derived neurotrophic factor with electroconvulsive therapy: a pilot study in patients with major depression. J Clin Psychiatry 2007;68:512-517.
Hu Y, Yu X, Yang F, Si T, Wang W, Tan Y, Zhou D, Wang H, Chen D: The level of serum brain-derived neurotrophic factor is associated with the therapeutic efficacy of modified electroconvulsive therapy in Chinese patients with depression. J ECT 2010;26:121-125.
Piccinni A, Del Debbio A, Medda P, Bianchi C, Roncaglia I, Veltri A, Zanello S, Massimetti E, Origlia N, Domenici L, Marazziti D, Dell'Osso L: Plasma brain-derived neurotrophic factor in treatment-resistant depressed patients receiving electroconvulsive therapy. Eur Neuropsychopharmacol 2009;19:349-355.
Fernandes B, Gama CS, Massuda R, Torres M, Camargo D, Kunz M, Belmonte-de-Abreu PS, Kapczinski F, de Almeida Fleck MP, Ines Lobato M: Serum brain-derived neurotrophic factor (BDNF) is not associated with response to electroconvulsive therapy (ECT): a pilot study in drug resistant depressed patients. Neurosci Lett 2009;453:195-198.
Gedge L, Beaudoin A, Lazowski L, du Toit R, Jokic R, Milev R: Effects of electroconvulsive therapy and repetitive transcranial magnetic stimulation on serum brain-derived neurotrophic factor levels in patients with depression. Front Psychiatry 2012;3:12.
Gronli O, Stensland GO, Wynn R, Olstad R: Neurotrophic factors in serum following ECT: a pilot study. World J Biol Psychiatry 2009;10:295-301.
APA: Structured clinical interview for DSM-IV. Washington, American Psychiatric Press, 1994.
Souery D, Amsterdam J, de Montigny C, Lecrubier Y, Montgomery S, Lipp O, Racagni G, Zohar J, Mendlewicz J: Treatment resistant depression: methodological overview and operational criteria. Eur Neuropsychopharmacol 1999;9:83-91.
Pacchiarotti I, Mazzarini L, Colom F, Sanchez-Moreno J, Girardi P, Kotzalidis GD, Vieta E: Treatment-resistant bipolar depression: towards a new definition. Acta Psychiatr Scand 2009;120:429-440.
Thase ME, Rush AJ: When at first you don't succeed: sequential strategies for antidepressant nonresponders. J Clin Psychiatry 1997;58(suppl 13):23-29.
Hamilton M: A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56-62.
Guy W: Ecdeu Assessment Manual for Psychopharmacology. DHEW Publication 76338. Washington, National Institute of Mental Health, 1976.
American Psychiatric Association Committee on Electroconvulsive Therapy, Weiner RD (eds): The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging: A Task Force Report of the American Psychiatric Association, ed 2. Washington, American Psychiatric Association, 2001.
Abrams R, Swartz CM: ECT Instruction Manual for the Thymatron™ System IV, ed 7. Lake Bluff, Somatics Inc, 2002.
Petrides G, Fink M: The ‘half-age' stimulation strategy for ECT dosing. Convuls Ther 1996;12:138-146.
Vickers AJ: The use of percentage change from baseline as an outcome in a controlled trial is statistically inefficient: a simulation study. BMC Med Res Methodol 2001;1:6.
Lommatzsch M, Zingler D, Schuhbaeck K, Schloetcke K, Zingler C, Schuff-Werner P, Virchow JC: The impact of age, weight and gender on BDNF levels in human platelets and plasma. Neurobiol Aging 2005;26:115-123.
Thase ME: Treatment of severe depression. J Clin Psychiatry 2000;61(suppl 1):17-25.
Gonul AS, Akdeniz F, Taneli F, Donat O, Eker C, Vahip S: Effect of treatment on serum brain-derived neurotrophic factor levels in depressed patients. Eur Arch Psychiatry Clin Neurosci 2005;255:381-386.
Scott A: Electroconvulsive therapy and brain-derived neurotrophic factor. J ECT 2011;27:92, author reply 92-93.
Trajkovska V, Marcussen AB, Vinberg M, Hartvig P, Aznar S, Knudsen GM: Measurements of brain-derived neurotrophic factor: methodological aspects and demographical data. Brain Res Bull 2007;73:143-149.
Brunoni AR, Lopes M, Fregni F: A systematic review and meta-analysis of clinical studies on major depression and BDNF levels: implications for the role of neuroplasticity in depression. Int J Neuropsychopharmacol 2008;11:1169-1180.
Piccinni A, Marazziti D, Catena M, Domenici L, Del Debbio A, Bianchi C, Mannari C, Martini C, Da Pozzo E, Schiavi E, Mariotti A, Roncaglia I, Palla A, Consoli G, Giovannini L, Massimetti G, Dell'Osso L: Plasma and serum brain-derived neurotrophic factor (BDNF) in depressed patients during 1 year of antidepressant treatments. J Affect Disord 2008;105:279-283.
Piccinni A, Marazziti D, Del Debbio A, Bianchi C, Roncaglia I, Mannari C, Origlia N, Catena Dell'Osso M, Massimetti G, Domenici L, Dell'Osso L: Diurnal variation of plasma brain-derived neurotrophic factor (BDNF) in humans: an analysis of sex differences. Chronobiol Int 2008;25:819-826.
Yoshimura R, Ikenouchi-Sugita A, Hori H, Umene-Nakano W, Katsuki A, Hayashi K, Ueda N, Nakamura J: Adding a low dose atypical antipsychotic drug to an antidepressant induced a rapid increase of plasma brain-derived neurotrophic factor levels in patients with treatment-resistant depression. Prog Neuropsychopharmacol Biol Psychiatry 2010;34:308-312.
Karege F, Schwald M, Cisse M: Postnatal developmental profile of brain-derived neurotrophic factor in rat brain and platelets. Neurosci Lett 2002;328:261-264.
Blier P, Ward HE, Tremblay P, Laberge L, Hebert C, Bergeron R: Combination of antidepressant medications from treatment initiation for major depressive disorder: a double-blind randomized study. Am J Psychiatry 2010;167:281-288.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.