Structural changes in amygdala nuclei, hippocampal subfields and cortical thickness following electroconvulsive therapy in treatment-resistant depression: longitudinal analysis

BackgroundElectroconvulsive therapy (ECT) is the treatment of choice for severe mental illness including treatment-resistant depression (TRD). Increases in volume of the hippocampus and amygdala following ECT have consistently been reported.AimsTo investigate neuroplastic changes after ECT in specific hippocampal subfields and amygdala nuclei using high-resolution structural magnetic resonance imaging (MRI) (trial registration: clinicaltrials.gov – NCT02379767).MethodMRI scans were carried out in 14 patients (11 women, 46.9 years (s.d. = 8.1)) with unipolar TRD twice before and once after a series of right unilateral ECT in a pre–post study design. Volumes of subcortical structures, including subfields of the hippocampus and amygdala, and cortical thickness were extracted using FreeSurfer. The effect of ECT was tested using repeated-measures ANOVA. Correlations of imaging and clinical parameters were explored.ResultsIncreases in volume of the right hippocampus by 139.4 mm3 (s.d. = 34.9), right amygdala by 82.3 mm3 (s.d. = 43.9) and right putamen by 73.9 mm3 (s.d. = 77.0) were observed. These changes were localised in the basal and lateral nuclei, and the corticoamygdaloid transition area of the amygdala, the hippocampal–amygdaloid transition area and the granule cell and molecular layer of the dentate gyrus. Cortical thickness increased in the temporal, parietal and insular cortices of the right hemisphere.ConclusionsFollowing ECT structural changes were observed in hippocampal subfields and amygdala nuclei that are specifically implicated in the pathophysiology of depression and stress-related disorders and retain a high potential for neuroplasticity in adulthood.Declaration of interestS.K. has received grants/research support, consulting fees and/or honoraria within the past 3 years from Angelini, AOP Orphan Pharmaceuticals AG, AstraZeneca, Celegne GmbH, Eli Lilly, Janssen-Cilag Pharma GmbH, KRKA-Pharma, Lundbeck A/S, Neuraxpharm, Pfizer, Pierre Fabre, Schwabe and Servier. R.L. received travel grants and/or conference speaker honoraria from Shire, AstraZeneca, Lundbeck A/S, Dr. Willmar Schwabe GmbH, Orphan Pharmaceuticals AG, Janssen-Cilag Pharma GmbH, and Roche Austria GmbH.

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Elektroconvulsietherapie bij een patiënte met een bipolaire stoornis en voorgeschiedenis van ischemisch cerebrovasculair accident

Tijdschrift voor Geneeskunde ◽

10.47671/tvg.77.21.163 ◽

2021 ◽

Author(s):

A. GOOSSENS ◽

F. VAN DEN EEDE ◽

D. SCHRIJVERS ◽

P. CRAS ◽

L. YPERZEELE ◽

...

Keyword(s):

Ischemic Stroke ◽

Electroconvulsive Therapy ◽

Recurrent Stroke ◽

Careful Consideration ◽

Treatment Resistant Depression ◽

Treatment Resistant ◽

Bipolaire Stoornis ◽

History Of ◽

Resistant Depression ◽

The Right

Electroconvulsive therapy in a patient with bipolar disorder and a history of ischemic stroke This article is a case-report of a 35 year old female patient with a history of ischemic stroke who, after careful consideration and additional investigations, received a treatment with electroconvulsive therapy (ECT) for a treatment-resistant depression in a rapid cycling bipolar 1 disorder. A thorough neurological evaluation in patients with a history of stroke is important as stated by the guidelines. As the patient was clinically and neurologically stable since her stroke 2 years prior, the risk of complications due to ECT was estimated to be low. The literature shows that ECT is not associated with a higher risk of a recurrent stroke, when taking the right indications and monitoring into account.

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Changes in White Matter Microstructure After Electroconvulsive Therapy for Treatment-Resistant Depression

The International Journal of Neuropsychopharmacology ◽

10.1093/ijnp/pyz059 ◽

2019 ◽

Vol 23 (1) ◽

pp. 20-25

Author(s):

Gregor Gryglewski ◽

René Seiger ◽

Pia Baldinger-Melich ◽

Jakob Unterholzner ◽

Benjamin Spurny ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

White Matter ◽

Electroconvulsive Therapy ◽

Electrode Placement ◽

Treatment Resistant Depression ◽

Resonance Imaging ◽

Treatment Resistant ◽

White Matter Microstructure ◽

Resistant Depression ◽

The Right

Abstract Background Treatment-resistant depression is among the most debilitating conditions in psychiatry. Recent studies have associated alterations in white matter microstructure measured with magnetic resonance imaging with poor antidepressant response. Therefore, the extent to which electroconvulsive therapy, the most effective therapeutic option for treatment-resistant depression, affects white matter microstructure warrants investigation. Methods A total 13 patients suffering from severe unipolar treatment-resistant depression underwent magnetic resonance imaging with a diffusion tensor imaging sequence before and after undergoing a series of right unilateral electroconvulsive therapy. Diffusivity metrics were compared voxel-wise using tract-based spatial statistics and repeated-measures ANOVA. Results A total 12 patients responded to electroconvulsive therapy and 9 were classified as remitters. An increase in axial diffusivity was observed in the posterior limb of the internal capsule of the right hemisphere (PFWE ≤ .05). The increase in this area was higher in the right compared with the left hemisphere (P < .05). No correlation of this effect with treatment response could be found. Conclusions The strong lateralization of effects to the hemisphere of electrical stimulation suggests an effect of electroconvulsive therapy on diffusivity metrics which is dependent of electrode placement. Investigation in controlled studies is necessary to reveal to what extent the effects of electroconvulsive therapy on white matter microstructure are related to clinical outcomes and electrode placement.

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