Can electroconvulsive therapy attenuate glial stress in schizophrenia? Longitudinal evidence from serum GFAP and S100B

Gozde Ataov; Ozlem Devrim Balaban; Zeynep Cirakli; Umit Haluk Yesilkaya

doi:10.1016/j.schres.2026.05.015

Can electroconvulsive therapy attenuate glial stress in schizophrenia? Longitudinal evidence from serum GFAP and S100B

Schizophr Res. 2026 May 26:295:91-100. doi: 10.1016/j.schres.2026.05.015. Online ahead of print.

Authors

Gozde Ataov¹, Ozlem Devrim Balaban¹, Zeynep Cirakli², Umit Haluk Yesilkaya³

Affiliations

¹ Department of Psychiatry, Bakirkoy Prof Mazhar Osman Training and Research Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkey.
² Department of Biochemistry Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
³ Department of Neurology, Division of Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA, 02215, USA. Electronic address: uyesilka@bidmc.harvard.edu.

PMID: 42190370
DOI: 10.1016/j.schres.2026.05.015

Abstract

Background: Glial dysfunction has been implicated in schizophrenia, yet ECT's effects on glial biomarkers remain poorly understood. This study investigated longitudinal changes in serum GFAP and S100B in patients with schizophrenia treated with antipsychotic medication alone or combined with ECT.

Methods: Seventy-six patients with schizophrenia (37 ECT + medication; 39 medication alone) and 36 healthy controls were enrolled. Serum GFAP and S100B were measured at baseline, 24 h post-first ECT session, and at three-month follow-up. Symptom severity was assessed using PANSS. Longitudinal changes were analyzed using repeated measures ANOVA and paired t-tests.

Results: Both patient groups showed elevated baseline S100B compared with controls. In the ECT group, S100B increased acutely after the first session (p = 0.002) then normalized at three months. In the medication-only group, S100B significantly increased over follow-up (p = 0.047). Baseline GFAP was elevated in the ECT group with a decreasing trend at three months (p = 0.086), while remaining stable in the medication-only group. No significant correlations emerged between biomarker changes and PANSS improvement.

Conclusions: Antipsychotic monotherapy may be insufficient to modify ongoing glial stress, whereas ECT is associated with transient glial activation followed by longer-term normalization. These distinct S100B trajectories suggest that ECT's therapeutic effects may involve dynamic modulation of glial function, providing preliminary evidence for glia-related mechanisms underlying ECT in schizophrenia.

Keywords: Astrocytes; Electroconvulsive therapy; GFAP; Glial biomarkers; S100B; Schizophrenia.