Iraj SalehiSeyed Mohammad HosseiniMohammad HaghighiLeila JahangardHafez BajoghliMarkus GerberUwe PühseRoumen KirovEdith Holsboer-TrachslerSerge BrandHamedan University of Medical SciencesTehran University of Medical SciencesMahidol UniversityUniversitat BaselBulgarian Academy of SciencesUniversitaren Psychiatrischen Kliniken Basel2018-11-092018-11-092014-01-01Journal of Psychiatric Research. Vol.57, No.1 (2014), 117-12418791379002239562-s2.0-84905567865https://repository.li.mahidol.ac.th/handle/20.500.14594/34806Background: To treat patients suffering from treatment-resistant major depressive disorder (TR-MDD), research has focused on electroconvulsive therapy (ECT) and aerobic exercise training (AET). Brain derived neurotrophic factor (BDNF) seems to be key in MDD. The aims of the present study were therefore two-fold, to investigate in a three-arm interventional study the differential effects of ECT, ECT plus AET, and AET alone in patients suffering from TR-MDD on 1. depressive symptoms and 2. BDNF. Methods: 60 patients with TR-MDD (mean age: 31 years; 31.6% female patients) were randomly assigned either to the ECT, ECT + AET, or AET condition. The AET condition consisted of treadmill exercise for 30 min, three times a week. Both depression severity and BDNF levels were assessed at baseline and 4 weeks later. All patients were further treated with an SSRI standard medication. Results: BDNF levels increased over time in all three study conditions. After completion of the intervention program, the ECT group showed significantly higher BDNF levels compared to the ECT + AET and the AET conditions. Depressive symptoms decreased in all three conditions over time. The combination of ECT + AET led to a significantly greater decrease than in either the ECT or AET alone conditions. BDNF levels were not associated with symptoms of depression. Conclusions: The pattern of results suggests that ECT, AET and particularly their combination are promising directions for treatment patients suffering from TR-MDD, and that it remains unclear to what extent BDNF is key and a reliable biomarker for TR-MDD. © 2014 Elsevier Ltd.Mahidol UniversityMedicineNeuroscienceArticleSCOPUS10.1016/j.jpsychires.2014.06.018