Low tumor necrosis factor-α levels predict symptom reduction during electroconvulsive therapy in major depressive disorder

Brain Behav. 2018 Feb 22;8(4):e00933. doi: 10.1002/brb3.933. eCollection 2018 Apr.


Objective: Changes in the tumor necrosis factor-α (TNFα) have been associated with major depressive disorder (MDD). Findings concerning the effects of electroconvulsive therapy (ECT) on the TNFα level have been contradictory. The aim was to examine the immediate and long-term changes in the TNFα level and their associations with symptom reduction in patients with MDD during ECT.

Method: The study included 30 patients with MDD. Their TNFα levels were measured at baseline and 2 and 4 hr after the first, fifth and last ECT session. Depressive symptoms were assessed with the Montgomery-Asberg Depression Rating Scale (MADRS).

Results: The TNFα level decreased from baseline to the 2- and 4-hr measurements. There was a correlation between the first ECT session TNFα levels and the relative symptom reduction according to the MADRS score after the ECT series. Both the first (baseline) ECT and 4-hr TNFα levels were lower in responders than in nonresponders.

Conclusion: ECT consistently induced a decrease in the TNFα level after each studied session. A low TNFα level at the first ECT appeared to predict a symptom reduction. These findings suggest that TNFα might have a role in the pathogenesis in MDD and in the mechanism of action of ECT.

Keywords: cytokine; electroconvulsive therapy; major depressive disorder; seizure.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Depressive Disorder, Major / blood
  • Depressive Disorder, Major / psychology
  • Depressive Disorder, Major / therapy*
  • Electroconvulsive Therapy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / blood*


  • Tumor Necrosis Factor-alpha