Early and Late Brain Structure Volume Changes with ECT

Out on Pubmed, from investigators in Kyoto, Japan, is this study:Early and late effects of electroconvulsive therapy associated with different temporal lobe structures.

Yamasaki S, Aso T, Miyata J, Sugihara G, Hazama M, Nemoto K, Yoshihara Y, Matsumoto Y, Okada T, Togashi K, Murai T, Takahashi H, Suwa T.Transl Psychiatry. 2020 Oct 13;10(1):344. doi: 10.1038/s41398-020-01025-8.PMID: 33051437 

The abstract is copied below:

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.

The pdf is here.

This is a conceptually very interesting study, but the results must be taken with more than a grain of salt because the sample size is tiny (7 patients with psychotic depression, 7 patients with non-psychotic depression).

There are two concepts here: 1) that certain brain regions may change early in the course of ECT, while others change later in the course, and 2) that psychotic symptoms in psychotic depression resolve earlier than depressive symptoms, possibly because of this difference in time course of brain region changes.

It would be interesting to see this study design carried out by one of the large ECT neuroimaging consortia.

(A detail note about the sloppiness of the manuscript: the APA Task Force report on ECT is noted in the text as from the American Psychological Association, and the reference for it is to the book review in the American Journal of Psychiatry by Richard Jaffe, not the actual book itself...)