J Psychiatry Neurosci 2016;41(2):105-114
Filip Bouckaert, MD*; François-Laurent De Winter, MD*; Louise Emsell, PhD; Annemieke Dols, MD, PhD; Didi Rhebergen, MD, PhD; Martien Wampers, PhD; Stefan Sunaert, MD, PhD; Max Stek, MD, PhD; Pascal Sienaert, MD, PhD; Mathieu Vandenbulcke, MD, PhD
Background: The evidence on the mechanisms of action of electroconvulsive therapy (ECT) has grown over the past decades. Recent studies show an ECT-related increase in hippocampal, amygdala and subgenual cortex volume. We examined grey matter volume changes following ECT using voxel-based morphometry (VBM) whole brain analysis in patients with severe late life depression (LLD).
Methods: Elderly patients with unipolar depression were treated twice weekly with right unilateral ECT until remission on the Montgomery– Åsberg Depression Rating Scale (MADRS) was achieved. Cognition (Mini Mental State Examination) and psychomotor changes (CORE Assessment) were monitored at baseline and 1 week after the last session of ECT. We performed 3 T structural MRI at both time points. We used the VBM8 toolbox in SPM8 to study grey matter volume changes. Paired t tests were used to compare preand post-ECT grey matter volume (voxel-level family-wise error threshold p < 0.05) and to assess clinical response.
Results: Twenty-eight patients (mean age 71.9 ± 7.8 yr, 8 men) participated in our study. Patients received a mean of 11.2 ± 4 sessions of ECT. The remission rate was 78.6%. Cognition, psychomotor agitation and psychomotor retardation improved significantly (p < 0.001). Right-hemispheric grey matter volume was increased in the caudate nucleus, medial temporal lobe (including hippocampus and amygdala), insula and posterior superior temporal regions but did not correlate with MADRS score. Grey matter volume increase in the caudate nucleus region correlated significantly with total CORE Assessment score (r = 0.63; p < 0.001).
Limitations: Not all participants were medication-free.
Conclusion: Electroconvulsive therapy in patients with LLD is associated with significant grey matter volume increase, which is most pronounced ipsilateral to the stimulation side.
*These authors contributed equally to this work.
Submitted Oct. 29, 2014; Revised Mar. 8, 2015; Accepted Apr. 15, 2015; Early-released Sept. 22, 2015
Acknowledgments: The research leading to these results was funded by Research Foundation — Flanders (FWO) (M. Vandenbulcke).
Affiliations: From the Department of Old Age Psychiatry, UPC KULeuven, Belgium (Bouckaert, De Winter, Wampers, Vandenbulcke); the GGZ inGeest/Department of Psychiatry and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands (Dols, Rhebergen, Stek); the Department of ECT and Department of Mood Disorders, UPC KULeuven, Belgium (Bouckaert, Sienaert); and Translational MRI, Department of Imaging and Pathology, KU Leuven and Radiology, University Hospitals Leuven, Belgium (Emsell, Sunaert).
Competing interests: None declared.
Contributors: F. Bouckaert, A. Dols, P. Sienaert and M. Vandenbulcke descigned the study. F. Bouckaert, F.-L. De Winter, L. Emsell, A. Dols, P. Sienaert and M. Vandenbulcke acquired the data, which F. Bouckaert, F.-L. De Winter, L. Emsell, D. Rhebergen, M. Wampers, M. Stek, S. Sunaert and M. Vandenbulcke analyzed. F. Bouckaert, F.-L. De Winter, L. Emsell, P. Sienaert and M. Vandenbulcke wrote the article, which all authors reviewed and approved for publication.
Correspondence to: F. Bouckaert, Department of Old Age Psychiatry, University Psychiatric Hospital, KULeuven, Leuvensesteenweg 517, 3070 Kortenberg, Belgium; firstname.lastname@example.org