Effects of ECT on Brain Structure - a Neuroradiological Investigation into White Matter Hyperintensities, Atrophy, and Microbleeds From Norway

 Out on PubMed, from authors in Norway, is this study:

Effects of Electroconvulsive Therapy on Brain Structure - a Neuroradiological Investigation into White Matter Hyperintensities, Atrophy, and Microbleeds.

Erchinger VJ, Evjenth Sørhaug OJ, Aukland SM, Moen G, Schuster PM, Ersland L, Grüner R, Oedegaard KJ, Kessler U, Ousdal OT, Oltedal L.Biol Psychiatry Cogn Neurosci Neuroimaging. 2024 Dec 18:S2451-9022(24)00380-X. doi: 10.1016/j.bpsc.2024.12.004. Online ahead of print.PMID: 39706259

The abstract is copied below:

Background: Electroconvulsive therapy (ECT) is a well-established treatment for severe depression, yet it remains stigmatized due to public perceptions linking it with brain injury. Despite extensive research, the neurobiological mechanisms underlying ECT are not fully elucidated. Recent findings suggest that ECT may work through disrupting depression circuitry. However, whether ECT is associated with neuroradiological correlates of brain injury, including white matter changes, atrophy and microbleeds, remains largely unexplored.

Methods: We performed MRI scans on 36 ECT patients (19 female), 19 healthy controls (11 female), and 18 atrial fibrillation patients (1 female) treated with electrical cardioversion while receiving an equivalent anesthetic as the ECT group. Scans were conducted at four time points: at baseline, after the first ECT treatment, after the ECT series, and at six-month follow-up. We evaluated white matter changes using the Fazekas and the Age-Related White Matter Changes scales, atrophy using the Global Cortical Atrophy and Medial Temporal lobe Atrophy scales, and cerebral microbleeds using the Microbleed Anatomical Rating Scale. Data were analyzed using non-parametric statistical methods.

Results: Patients did not show any changes in radiological scores after ECT (all p >0.1), except for a decrease in microbleeds (p = 0.05).

Conclusion: Utilizing state-of-the-art MRI techniques, we found no significant evidence that ECT induces white matter changes, atrophy, or microbleeds. Thus, although ECT may work through disrupting depression circuitry, the treatment is not associated with neuroradiological signs of brain injury.

Keywords: Brain injury; Magnetic resonance imaging (MRI); Major depressive disorder; Susceptibility weighted imaging (SWI); fluid-attenuated inversion recovery (FLAIR); neurostimulation.

The article is here.

And from the text:

Here is yet another excellent Scandinavian contribution to the ECT neuroimaging literature.

The addition of the second control group, atrial fibrillation patients undergoing cardioversion with propofol anesthesia, is very clever.

These data are a powerful additional nail in the coffin of the false "ECT causes brain damage" refrain.

Kudos to our Norwegian colleagues!