Early and late effects of electroconvulsive therapy associated with different temporal lobe structures

Abstract

Recent studies examining electroconvulsive therapy (ECT) have reported that early sessions can induce rapid antidepressant and antipsychotic effects, and the early termination of ECT was reported to increase the risk of relapse. We hypothesized that different neural mechanisms associated with the therapeutic effects of ECT may be involved in the different responses observed during the early and late periods of ECT treatment. We investigated whether these antidepressant and antipsychotic effects were associated with temporally and spatially different regional gray matter volume (GMV) changes during ECT. Fourteen patients with major depressive disorder, with or without psychotic features, underwent 3-Tesla structural magnetic resonance imaging scans before (time point [Tp] 1), after the fifth or sixth ECT session (Tp2), and after ECT completion (Tp3). We investigated the regions in which GMV changed between Tp1 and Tp2, Tp2 and Tp3, and Tp1 and Tp3 using voxel-based morphometry. In addition, we investigated the association between regional GMV changes and improvement in depressive or psychotic symptoms. GMV increase in the left superior and inferior temporal gyrus during Tp1–Tp2 was associated with improvement in psychotic symptoms (P < 0.025). GMV increase in the left hippocampus was associated with improvement of depressive symptoms in Tp2–Tp3 (P < 0.05). Our findings suggest that different temporal lobe structures are associated with early antipsychotic and late antidepressant effects of ECT.

Commonalities and differences in ECT-induced gray matter volume change between depression and schizophrenia

“…, Ota et al, 2015 , Bouckaert et al, 2016 , Jorgensen et al, 2016 , Pirnia et al, 2016 , Cano et al, 2017 ) that demonstrated significant GMV increases after ECT for patients with depression. In the present study, the GMV percent change was not associated with the HDRS percent change; however, our previous study, ( Yamasaki et al, 2020 ) which included 14 patients with MDD, reported that the GMV increase in the left hippocampus was associated with an improvement in depressive symptoms. Results from previous studies investigating the association between GMV changes and symptom improvement have also been inconsistent.…”

Multimodal multi-center analysis of electroconvulsive therapy effects in depression: Brainwide gray matter increase without functional changes

“…Many studies over the past years have attempted to get better insight into the working mechanism of ECT for depressive symptoms on the structural, functional, and clinical level. Both animaland human studies point to an effect of ECT on structural gray matter increases in many regions [8,33,34], but other studies have not always been able to find relations between this structural increase of brain volumes and clinical improvement [5,12,14,35]. In our study, increase in regional brain volume was not confined to the hippocampus and/or medial temporal lobe, as was suggested by the initial studies [4,5,10].…”

Superior temporal gyrus and cerebellar loops predict nonsuicidal self-injury in major depressive disorder patients by multimodal neuroimaging

“…The STG GMV changes this balance and generates impulsive behaviour. In addition, previous studies reported STG GMV changes in depressive patients with psychotic features [ 50 , 51 ] and were associated with electroconvulsive therapy improvement [ 52 ]. Our previous research also showed the importance of psychiatric symptoms in MDD patients with NSSI.…”