Nils Opel, MD; Katherine L. Narr, PhD; Christopher Abbott, MD; Miklos Argyelan, MD; Randall Espinoza, MD, MPH; Louise Emsell, PhD; Filip Bouckaert, MD, PhD; Pascal Sienaert, MD, PhD; Mathieu Vandenbulcke, MD, PhD; Pia Nordanskog, MD, PhD; Jonathan Repple, MD; Erhan Kavakbasi, MD; Martin B. Jorgensen, MD, DMSc; Olaf B. Paulson, MD, DMSc; Lars G. Hanson, PhD; Annemieke Dols, MD, PhD; Eric van Exel, MD, PhD; Mardien L. Oudega, MD, PhD; Akihiro Takamiya, MD; Taishiro Kishimoto, MD, PhD; Olga Therese Ousdal, MD, PhD; Jan Haavik, MD, PhD; Åsa Hammar, PhD; Ketil Joachim Oedegaard, MD, PhD; Ute Kessler, MD, PhD; Hauke Bartsch, PhD; Anders M. Dale, PhD; Bernhard T. Baune, MD, PhD; Udo Dannlowski, MD, PhD; Leif Oltedal, MD, PhD; Ronny Redlich, PhD
Background: Obesity is a frequent somatic comorbidity of major depression, and it has been associated with worse clinical outcomes and brain structural abnormalities. Converging evidence suggests that electroconvulsive therapy (ECT) induces both clinical improvements and increased subcortical grey matter volume in patients with depression. However, it remains unknown whether increased body weight modulates the clinical response and structural neuroplasticity that occur with ECT.
Methods: To address this question, we conducted a longitudinal investigation of structural MRI data from the Global ECT-MRI Research Collaboration (GEMRIC) in 223 patients who were experiencing a major depressive episode (10 scanning sites). Structural MRI data were acquired before and after ECT, and we assessed change in subcortical grey matter volume using FreeSurfer and Quarc.
Results: Higher body mass index (BMI) was associated with a significantly lower increase in subcortical grey matter volume following ECT. We observed significant negative associations between BMI and change in subcortical grey matter volume, with pronounced effects in the thalamus and putamen, where obese participants showed increases in grey matter volume that were 43.3% and 49.6%, respectively, of the increases found in participants with normal weight. As well, BMI significantly moderated the association between subcortical grey matter volume change and clinical response to ECT. We observed no significant association between BMI and clinical response to ECT.
Limitations: Because only baseline BMI values were available, we were unable to study BMI changes during ECT and their potential association with clinical and grey matter volume change.
Conclusion: Future studies should take into account the relevance of body weight as a modulator of structural neuroplasticity during ECT treatment and aim to further explore the functional relevance of this novel finding.
Submitted Sep. 7, 2020; Revised Dec. 23, 2020; Accepted Feb. 5, 2021
Affiliations: From the Institute for Translational Psychiatry, University of Münster, Münster, Germany (Opel, Repple, Dannlowski, Redlich); Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany (Kavakbasi, Baune); the Departments of Neurology, Psychiatry, and Biobehavioral Sciences, University of California, Los Angeles, CA (Narr); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Abbott); the Institute of Behavioral Science, Feintein Institutes for Medical Research, Manhasset, NY (Argyelan); the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY (Argyelan); the Department of Psychiatry, University of California, Los Angeles (Espinoza); the Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium (Emsell, Vandenbulcke); the KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry & Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium (Bouckaert); the Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)–KU Leuven, Kortenberg, Belgium (Sienaert); the Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (Nordanskog); the Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark (Jorgensen); the Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Denmark (Paulson); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark (Hanson); the Center for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kgs, Lyngby, Denmark (Hanson); the GGZ in Geest Specialized Mental Health Care, Amsterdam, the Netherlands (Dols, Van Exel, Oudega); the Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands (Dols, van Exel, Oudega); the Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan (Takamiya, Kishimoto); the Department of Radiology, Haukeland University Hospital, Bergen, Norway (Ousdal); the Department of Biomedicine, University of Bergen, Bergen, Norway (Haavik); the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway (Haavik, Hammar); the Department of Biological and Medical Psychology, University of Bergen, Norway (Hammar); the NORMENT, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway (Oedegaard, Kessler); the Department of Clinical Medicine, University of Bergen, Bergen, Norway (Oedegaard, Kessler, Oltedal); the Department of Radiology, University of California, San Diego, La Jolla, California (Bartsch); the Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway (Bartsch, Oltedal); the Departments of Radiology, Neurosciences, and Psychiatry, University of California, San Diego (Dale); the Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California (Dale); the Department of Psychiatry, University of Melbourne, Melbourne, Australia (Baune); the The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia (Baune); and the Department of Psychology, University of Halle, Halle, Germany (Redlich).
Funding: The Münster cohort was funded by the German Research Foundation (DFG, grant FOR2107 DA1151/5-1 and DA1151/5-2 to UD; SFB-TRR58, Projects C09 and Z02 to UD) and the Interdisciplinary Center for Clinical Research (IZKF) of the medical faculty of Münster (grant Dan3/012/17 to UD and SEED 11/19 to NO). For the UCLA site, work was supported by NIH/NIMH grants U01 MH110008, and R01 MH092301. For the UNM site, work was supported by NIH/MIMH Grants U01 MH111826 MJ, OP and LH (Copenhagen) report funding from the Lundbeck Foundation.
Competing interests: A. Dale reports that he was a founder of and holds equity in CorTechs Labs, Inc., and serves on its scientific advisory board; he is a member of the scientific advisory boards of Human Longevity, Inc., the Mohn Medical Imaging and Visualization Centre; he receives funding through research grants from GE Healthcare to UCSD. The terms of these arrangements have been reviewed by and approved by the University of California, San Diego in accordance with its conflict of interest policies. No other competing interests declared.
Contributors: N. Opel, M. Argyelan, O. Ousdal, Å. Hammar, A. Dale, U. Dannlowski, L. Oltedal and R. Redlich designed the study. K. Narr, C. Abbott, M. Argyelan, L. Emsell, F. Bouckaert, P. Sienaert, M. Vandenbulcke, P. Nordanskog, E. Kavakbasi, M. Jorgensen, O. Paulson, L. Hanson, A. Dols, E. van Exel, M. Oudega, A. Takamiya, U. Kessler, A. Dale, L. Oltedal and R. Redlich acquired the data, which R. Espinoza, L. Emsell, F. Bouckaert, J. Repple, E. Kavakbasi, M. Oudega, A. Takamiya, T. Kishimoto, J. Haavik, K. Oedegaard, H. Bartsch, A. Dale, B. Baune, U. Dannlowski and R. Redlich analyzed. N. Opel, M. Oudega and A. Takamiya wrote the article, which N. Karr, C. Abbott, M. Argyelan, R. Espinoza, L. Emsell, F. Bouckaert, P. Sienaert, M. Vandenbulcke, P. Nordanskog, J. Repple, E. Kavakbasi, M. Jorgensen, O. Paulson, L. Hanson, A. Dols, E. van Exel, M. Oudega, A. Takamiya, T. Kishimoto, O. Ousdal, J. Haavik, Å. Hammar, K. Oedegaard, U. Kessler, H. Bartsch, B. Baune, U. Dannlowski, L. Oltedal and R. Redlich reviewed. All authors approved the final version to be published and can certify that no other individuals not listed as authors have made substantial contributions to the paper.
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Correspondence to: N. Opel, Department of Psychiatry, University of Münster, Albert-Schweitzer-Strasse 11, 48149 Münster, Germany; email@example.com