Electroconvulsive therapy induced rapid, transient subcortical gray matter volume increases and mean diffusivity decreases in depressed adults, with longer-lasting white matter diffusivity increases; cognitive declines were transient and unrelated to brain structural changes.
RCT (n=72)
Yes
Does electroconvulsive therapy induce rapid microstructural and macrostructural brain changes in depressed patients?
ECT induces rapid, transient macrostructural brain changes and longer-lasting microstructural changes, which are not directly associated with transient cognitive side-effects or clinical efficacy.
p-value: p=<0.05 for volume and diffusivity changes; cognitive declines with pbonferroni=0.02 to 0.04; no association between brain changes and cognitive or efficacy outcomes
Electroconvulsive therapy (ECT) is an effective treatment for major depressive episodes, though its mechanisms remain unclear. Its use is limited by stigma and potential cognitive side-effects. Repeated magnetic resonance imaging (MRI) may provide further insights into brain changes related to ECT’s efficacy and cognitive outcomes. We analyzed cognitive, efficacy, and MRI data from depressed patients undergoing ECT in two prospective longitudinal trials (NCT04028596, NL-OMON43040), using 26 matched healthy controls (2020-BC-12375) to control for test-retest effects. All participants were scanned on the same MRI system. Structural and diffusion tensor imaging (DTI) scans were acquired at baseline, after the initial ECT sessions, within two weeks post-treatment, and at three-month follow-up. Linear and nonlinear changes in grey matter (GM) volume, white matter (WM) volume, mean diffusivity (MD), and fractional anisotropy (FA) were assessed. Early brain changes were examined in relation to clinical outcomes. After the 3rd ECT session (n = 19), subcortical GM volume increased with a right-lateralized MD decrease. Two weeks post-ECT (n = 30), cortical GM volume increased, returning to baseline by three months. In WM, MD increased linearly post-ECT and remained elevated at follow-up, with no widespread FA changes (n = 30). ECT transiently impaired verbal learning (n = 23, pbonferroni = 0.04), letter fluency (n = 22, pbonferroni = 0.04), and animal fluency (n = 62, pbonferroni = 0.02). Early brain changes were not associated with cognitive or efficacy outcomes. These results suggest that ECT induces rapid changes in brain macrostructure and microstructure. While macrostructural increases are temporary, microstructural changes in brain structure are longer-lasting.
Verdijk et al. (Mon,) conducted a rct in Adults (>17 years) with treatment-resistant major depressive disorder, bipolar disorder or schizoaffective disorder undergoing ECT (n=72). Electroconvulsive therapy (ECT) vs. Healthy controls (no ECT) was evaluated on Change in brain structure (gray matter volume, white matter volume, mean diffusivity, fractional anisotropy) and cognitive outcomes after ECT (p=<0.05 for volume and diffusivity changes; cognitive declines with pbonferroni=0.02 to 0.04; no association between brain changes and cognitive or efficacy outcomes). Electroconvulsive therapy induced rapid, transient subcortical gray matter volume increases and mean diffusivity decreases in depressed adults, with longer-lasting white matter diffusivity increases; cognitive declines were transient and unrelated to brain structural changes.