Biomarkers and electroconvulsive therapy in late-life depression

Overall conclusions The main objective of this thesis was to expand current knowledge on biomarkers in ECT-treatment to contribute to future personalized treatment of late-life depression. The first part aimed to explore biomarkers and treatment outcome. The second part aimed to explore biomarkers and cognitive functioning. We can conclude that older depressed patients with a profile of low-grade inflammation or intermediate levels of S100B who receive ECT have higher chances of remission of depression. However, we also conclude that both CRP and S100B are not eligible biomarkers for ECT outcome as their sensitivity and specificity were low. In general, a useful biomarker should have a sensitivity (for detecting therapy outcome) and a specificity (for discriminating between outcomes) of at least 80%.49 Vascular brain changes, that is, white matter hyperintensities, are not associated with persistent apathy after ECT. Higher levels of inflammation before start of ECT are associated with lower cognitive functioning. This association remains during and after ECT, however, it seems that patients with inflammation and white matter hyperintensities are in particular vulnerable to developing lower cognitive functioning after ECT.