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Electro convulsive therapy (ECT) has proven to be one of the most effective treatments for this condition. Although several studies have investigated individually the clinical factors associated with the DTD response, the role of their interplay in the clinical response to ECT remains unknown. In the present study, we aimed to characterize the network of symptoms in DTD, evaluate the effects of ECT on the interrelationship of depressive symptoms, and identify the network characteristics that could predict the clinical response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0924933825100527_sec2\" sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A network analysis of clinical and demographic data from 154 patients with DTD was performed to compare longitudinally the patterns of relationships among depressive symptoms after ECT treatment. Furthermore, we estimated the network structure at baseline associated with a greater clinical improvement (\u226580% reduction at Montgomery\u2013\u00c5sberg Depression Rating Scale total score).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0924933825100527_sec3\" sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      ECT modulated the network of depressive symptoms, with increased strength of the global network (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.03, Cohen\u2019s\n                      <jats:italic>d<\/jats:italic>\n                      \u00a0= \u22120.98, 95% confidence interval = [\u22121.07, \u22120.88]). The strength of the edges between somatic symptoms (appetite and sleep) and cognitive-emotional symptoms (tension, lassitude, and pessimistic thoughts) was also increased. A stronger negative relationship between insomnia and pessimistic thoughts was associated with a greater improvement after ECT. Concentration difficulties and apparent sadness showed the greatest centrality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0924933825100527_sec4\" sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In conclusion, ECT treatment may affect not only the severity of the symptoms but also their relationship; this may contribute to the response in DTD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1192\/j.eurpsy.2025.10052","type":"journal-article","created":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T02:16:19Z","timestamp":1750040179000},"source":"Crossref","is-referenced-by-count":1,"title":["Electroconvulsive therapy modulates the interplay between depressive symptoms in difficult-to-treat depression: A longitudinal network 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