Background

Electroconvulsive therapy (ECT) is the most effective treatment for severe depression. Recent neuroimaging studies have consistently reported that ECT induces volume increases in widely distributed brain regions. However, it still remains unclear about ECT-induced volume changes associated with clinical improvement.

Methods

Longitudinal assessments of structural magnetic resonance imaging were conducted in 48 participants. Twenty-seven elderly melancholic depressed individuals (mean 67.5 ± 8.1 years old; 19 female) were scanned before (TP1) and after (TP2) ECT. Twenty-one healthy controls were also scanned twice. Whole-brain gray matter volume (GMV) was analyzed via group (remitters, nonremitters, and controls) by time (TP1 and TP2) analysis of covariance to identify ECT-related GMV changes and GMV changes specific to remitters. Within-subject and between-subjects correlation analyses were conducted to investigate the associations between clinical improvement and GMV changes. Depressive symptoms were evaluated using the 17-item Hamilton Depression Rating Scale (HAM-D), and remission was defined as HAM-D total score ≤ 7.

Results

Bilateral ECT increased GMV in multiple brain regions bilaterally regardless of clinical improvement. Remitters showed a larger GMV increase in the right-lateralized frontolimbic brain regions compared to nonremitters and healthy controls. GMV changes in the right hippocampus/amygdala and right middle frontal gyrus showed correlations with clinical improvement in within−/between-subjects correlation analyses.

Conclusions

ECT-induced GMV increase in the right frontolimbic regions was associated with clinical remission.

中文翻译：

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电休克疗法诱导的结构可塑性与临床缓解的关系

背景

电休克疗法（ECT）是治疗重度抑郁症最有效的方法。最近的神经影像学研究一致报道，ECT 会导致广泛分布的大脑区域的体积增加。然而，ECT 引起的与临床改善相关的体积变化仍不清楚。

方法

对 48 名参与者进行了结构磁共振成像的纵向评估。在 ECT 之前 (TP1) 和之后 (TP2) 扫描了 27 名老年忧郁症患者（平均 67.5 ± 8.1 岁；19 名女性）。还对 21 名健康对照者进行了两次扫描。全脑灰质体积 (GMV) 通过组（汇款人、非汇款人和对照组）按时间（TP1 和 TP2）协方差分析进行分析，以识别 ECT 相关的 GMV 变化和汇款人特有的 GMV 变化。进行了受试者内和受试者间的相关性分析，以研究临床改善与 GMV 变化之间的关联。使用 17 项汉密尔顿抑郁评定量表 (HAM-D) 评估抑郁症状，缓解定义为 HAM-D 总分≤7。

结果

无论临床改善如何，双侧 ECT 双侧多个脑区的 GMV 增加。与非汇款者和健康对照组相比，汇款者在右侧额叶边缘大脑区域显示出更大的 GMV 增加。右侧海马/杏仁核和右侧额中回的 GMV 变化显示与受试者内/受试者间相关性分析中的临床改善相关。

结论

ECT 诱导的右额边缘区 GMV 增加与临床缓解有关。