Ask the Doctor: Electroconvulsive Therapy; Chewing Gum & Brainpower; COPD & Stroke Risk

Q: My doctor wants me to have electrocon­vulsive therapy for my severe depression. How does this procedure improve mood?

A: Electroconvulsive therapy (ECT) is a treatment in which measured pulses of electricity are applied through the skull to the brain of an anesthetized patient, causing convulsions that are intended to help improve severe depression or schizophrenia. Although scientists have long acknowledged the positive effects of ECT, it was not known how electrically inducing a seizure acts on the brain. A recent study—published in the April 3, 2012 issue of the Proceedings of the National Academy of Sciences—has shed light on the subject by suggesting that the treatment improves communication between different brain regions involved in depression. The re-searchers used functional magnetic resonance imaging to record the functioning of the brains of nine severely depressed patients before and after they underwent ECT. Using highly complex mathematical calculations, they analyzed brain connectivity to assess communication among more than 25,000 different brain areas. They found that ECT dampens overactive connections between parts of the brain responsible for mood and regions that control think-ing and concentrating. Treatment with ECT appears to normalize these overactive connections—which are thought to be a characteristic of depression—and the patients’ mood improves.

Q: I read recently that chewing gum can boost brainpower. How so?

A: A number of studies have linked the practice of chewing gum—with and without sugar—with improved alertness, increased attention, lowered stress, improved mood, and better cognitive performance. Although many studies have suggested that gum chewing improves immediate recall, delayed recall, and short-term memory, a few have found no memory advantage. The most recent findings come from a small study published March 8, 2013 in the British Journal of Psychology. Researchers asked 38 participants—half of whom chewed gum, and half of whom did not—to complete a challenging 30-minute audio memory task. Results showed that the gum chewers reacted more quickly and were more accurate than those who did not chew gum, especially toward the end of the task, suggesting that chewing helped promote vigilance. Scientists don’t know exactly how gum chewing stimulates the brain, but theories include the possibility that chewing increases blood flow and brain activity in regions associated with cognition, and may help prevent stress-induced impairment of the hippocampus, a key memory region.

Q: My husband has chronic obstructive pul­monary disease, which I understand may increase his risk for stroke. Please tell me more.

A: Chronic obstructive pulmonary disease (COPD) is a progressive condition with symptoms such as difficulty breathing, coughing, shortness of breath, and wheezing. People with COPD are known to have a higher risk for ischemic strokes (strokes caused by blockage of blood flow to brain tissue that results in brain injury), and new research published January 1, 2013 in the American Journal of Respiratory and Critical Care Medicine may help explain why. The researchers used MRI scans to look at the carotid arteries (major blood vessels in the neck that supply blood to the brain) in a group of 250 older individuals with COPD and a similar group without COPD. The research showed that participants with COPD were twice as likely as those without COPD to develop thickening of the walls of their carotid arteries and that they had a significantly greater risk of developing plaques with a fatty core that are known to rupture and block brain blood vessels, causing a stroke. It’s important that your husband and his medical care provider work together to help lower his overall risk of stroke.

—Editor-in-Chief Maurizo Fava, MD

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