{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:28:10Z","timestamp":1787027290952,"version":"build-2736575974"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,7,12]],"date-time":"2023-07-12T00:00:00Z","timestamp":1689120000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Suicidality is commonly observed in patients with depressive episodes, and electroconvulsive therapy (ECT) has been found to be effective in treating these patients. However, the role of ECT in suicidality remains unclear. This study used resting-state functional magnetic resonance imaging (rs-fMRI) to explore the changes in brain function before and after ECT in depressed patients with suicidality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In total, 26 depressed patients with suicidality underwent rs-fMRI at baseline and after 8\u201312 sessions of ECT. In addition, 32 healthy controls (HCs) matched for age, gender, and educational level underwent rs-fMRI once. The amplitude of low-frequency fluctuations (ALFF), the fractional amplitude of low-frequency fluctuations (fALFF), and regional homogeneity (ReHo) were measured to evaluate whole brain function. Differences between the groups and time points (before and after ECT) were compared. Clinical symptoms were assessed using the 17-item Hamilton Depression Scale (HAMD-17) and Beck Scale for Suicide Ideation (BSSI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      At baseline, patients exhibited decreased ALFF in the right postcentral and precentral gyrus and decreased fALFF in the right supramarginal and postcentral gyrus, left superior frontal gyrus (SFG), as well as the superior and middle temporal gyrus compared to HCs. Patients also had lower ReHo in the left amygdala, anterior cingulate, and postcentral gyrus, and in the right thalamus, insula, and postcentral gyrus. They also exhibited higher ALFF in the bilateral temporal gyrus and insula as well as higher fALFF in the cerebellum. Following ECT, fALFF in the left SFG and orbital frontal cortex (OFC) significantly increased and was inversely correlated with the reduction of BSSI scores (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009\u22120.416,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.048), whereas no correlation was found with changes in HAMD-17scores.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our findings suggest that the left SFG and OFC may play a key role in the mechanism of ECT for suicidality. The decrease of fALFF in the left SFG and OFC may represent a potential mechanism through which ECT effectively treats suicidality in depressed patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2023.1224914","type":"journal-article","created":{"date-parts":[[2023,7,12]],"date-time":"2023-07-12T07:48:17Z","timestamp":1689148097000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":12,"title":["Reduced suicidality after electroconvulsive therapy is linked to increased frontal brain activity in depressed patients: a resting-state fMRI 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disorder and personality factors associated with suicide in older people: a descriptive and case-control study","volume":"16","author":"Harwood","year":"2001","journal-title":"Int J Geriatr Psychiatry"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1016\/j.jad.2020.03.093","article-title":"Prevalence and related factors of suicide attempts in first-episode and untreated Chinese Han outpatients with psychotic major depression","volume":"270","author":"Li","year":"2020","journal-title":"J Affect Disord"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1186\/s12916-015-0325-4","article-title":"Depression sum-scores don't add up: why analyzing specific depression symptoms is essential","volume":"13","author":"Fried","year":"2015","journal-title":"BMC Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1097\/YCT.0000000000000562","article-title":"Acute phase treatment outcomes of electroconvulsive therapy in adolescents and young adults","volume":"35","author":"Benson","year":"2019","journal-title":"J ECT"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"466","DOI":"10.1038\/nature04271","article-title":"Empathic neural responses are modulated by the perceived fairness of others","volume":"439","author":"Singer","year":"2006","journal-title":"Nature"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"977","DOI":"10.1176\/appi.ajp.162.5.977","article-title":"Relief of expressed suicidal intent by ECT: a consortium for research in ECT study","volume":"162","author":"Kellner","year":"2005","journal-title":"Am J Psychiatry"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"12589","DOI":"10.1111\/bdi.12589","article-title":"Superior anti-suicidal effects of electroconvulsive therapy in unipolar disorder and bipolar depression","volume":"20","author":"Liang","year":"2018","journal-title":"Bipolar Disord"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"762343","DOI":"10.3389\/fnhum.2021.762343","article-title":"Alteration of whole brain ALFF\/fALFF and degree centrality in adolescents with depression and suicidal ideation after electroconvulsive therapy: a resting-state fMRI study","volume":"15","author":"Li","year":"2021","journal-title":"Front Hum Neurosci"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"944520","DOI":"10.3389\/fpsyt.2022.1058572","article-title":"Changes in gray matter volume following electroconvulsive therapy in adolescent depression with suicidal ideation: a longitudinal structural magnetic resonance imaging study","volume":"13","author":"Li","year":"2022","journal-title":"Front Psych"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"12091121","DOI":"10.3390\/brainsci12091121","article-title":"Altered regional homogeneity and amplitude of low-frequency fluctuations induced by electroconvulsive therapy for adolescents with 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Psychol"},{"key":"ref14","first-page":"138","article-title":"The half-age stimulation strategy for ECT dosing","volume":"12","author":"Petrides","year":"1996","journal-title":"Convuls Ther"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1007\/s12021-016-9299-4","article-title":"DPABI: Data Processing & Analysis for (resting-state) brain imaging","volume":"14","author":"Yan","year":"2016","journal-title":"Neuroinformatics"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1111\/acps.13425","article-title":"Suicidal ideation and ECT, ECT and suicidal ideation: a register study","volume":"1","author":"Sienaert","year":"2022","journal-title":"Acta Psychiatr Scand"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1097\/00000542-199203000-00003","article-title":"Context-sensitive half-time in multicompartment pharmacokinetic models for intravenous anesthetic 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decision-making and social threat in patients with a history of suicidal attempt: a neuroimaging replication study","volume":"234","author":"Oli\u00e9","year":"2015","journal-title":"Psychiatry Res"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1016\/j.jpsychires.2016.06.020","article-title":"Suicide attempters with borderline personality disorder show differential orbitofrontal and parietal recruitment when reflecting on aversive memories","volume":"81","author":"Silvers","year":"2016","journal-title":"J Psychiatr Res"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1176\/appi.ajp.2016.15050652","article-title":"Multimodal neuroimaging of Frontolimbic structure and function associated with suicide attempts in adolescents and young adults with bipolar disorder","volume":"174","author":"Johnston","year":"2017","journal-title":"Am J 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Psychiatry"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1016\/j.neulet.2012.11.032","article-title":"Abnormal baseline brain activity in suicidal and non-suicidal patients with major depressive disorder","volume":"534","author":"Fan","year":"2013","journal-title":"Neurosci Lett"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"571532","DOI":"10.3389\/fpsyt.2021.802513","article-title":"Disruption of neural activity and functional connectivity in adolescents with major depressive disorder who engage in non-suicidal self-injury: a resting-state fMRI study","volume":"12","author":"Huang","year":"2021","journal-title":"Front Psych"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1016\/S0959-4388(03)00090-4","article-title":"Interoception: the sense of the physiological condition of the body","volume":"13","author":"Craig","year":"2003","journal-title":"Curr Opin Neurobiol"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"754","DOI":"10.1037\/abn0000074","article-title":"(dis)connected: an examination of Interoception in individuals with suicidality","volume":"124","author":"Forrest","year":"2015","journal-title":"J Abnorm Psychol"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1016\/j.jad.2011.04.004","article-title":"The insular cortex and the neuroanatomy of major depression","volume":"133","author":"Sprengelmeyer","year":"2011","journal-title":"J Affect Disord"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/j.pscychresns.2014.02.006","article-title":"Impulsivity, aggression and brain structure in high and low lethality suicide attempters with borderline personality disorder","volume":"222","author":"Soloff","year":"2014","journal-title":"Psychiatry 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