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.
Highlights
Electroconvulsive therapy (ECT) is considered a rapid and reliable treatment for major depressive disorder (MDD)[1]
Separate mechanisms may produce the rapid and strong therapeutic effects observed during the early period from those related to relapse prevention during the late period of ECT
The aims of the study were to investigate: (i) when during the course of ECT regional gray matter volume (GMV) changes take place; (ii) whether regional volume changes in the early or late period of an ECT course are associated with depressive symptom improvement; and (iii) whether there is a difference in GMV changes between patients with and those without psychotic symptoms
Summary
Electroconvulsive therapy (ECT) is considered a rapid and reliable treatment for major depressive disorder (MDD)[1]. Symptom improvements observed during the early and late periods of ECT may be associated with different mechanisms. A rapid and strong antidepressant effect can be observed during the early period, typically before six sessions[2], whereas the termination of ECT before attaining remission has been reported to increase the risk of relapse[3]. Several reports have indicated that antipsychotic effects begin to emerge in the early period, as suggested by better[4] and faster[5] responses to ECT in patients who have MDD with psychotic features, in comparison with those without psychotic features.
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