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Meta-Analysis
. 2021 Jul-Aug;14(4):927-937.
doi: 10.1016/j.brs.2021.05.014. Epub 2021 Jun 11.

Meta-analysis of brain structural changes after electroconvulsive therapy in depression

Gregor Gryglewski  1 , Rupert Lanzenberger  1 , Leo R Silberbauer  1 , Daniel Pacher  1 , Siegfried Kasper  2 , Rainer Rupprecht  3 , Richard Frey  1 , Pia Baldinger-Melich  4
Affiliations
Free article
Meta-Analysis

Meta-analysis of brain structural changes after electroconvulsive therapy in depression

Gregor Gryglewski et al. Brain Stimul. 2021 Jul-Aug.
Free article

Abstract

Background: Increases in the volume of the amygdala and hippocampus after electroconvulsive therapy (ECT) are among the most robust effects known to the brain-imaging field. Recent advances in the segmentation of substructures of these regions allow for novel insights on the relationship between brain structure and clinical outcomes of ECT.

Objective: We aimed to provide a comprehensive synthesis of evidence available on changes in brain structure after ECT, including recently published data on hippocampal subfields.

Methods: A meta-analysis of published studies was carried out using random-effects models of standardized mean change of regional brain volumes measured with longitudinal magnetic resonance imaging of depressive patients before and after a series of ECT.

Results: Data from 21 studies (543 depressed patients) were analysed, including 6 studies (118 patients) on hippocampal subfields. Meta-analyses could be carried out for seven brain regions for which data from at least three published studies was available. We observed increases in left and right hippocampi, amygdalae, cornua ammonis (CA) 1, CA 2/3, dentate gyri (DG) and subicula with standardized mean change scores ranging between 0.34 and 1.15. The model did not reveal significant volume increases in the caudate. Meta-regression indicated a negative relationship between the reported increases in the DG and relative symptom improvement (-0.27 (SE: 0.09) per 10%).

Conclusions: ECT is accompanied by significant volume increases in the bilateral hippocampus and amygdala that are not associated with treatment outcome. Among hippocampal subfields, the most robust volume increases after ECT were measured in the dentate gyrus. The indicated negative correlation of this effect with antidepressant efficacy warrants replication in data of individual patients.

Keywords: Dentate gyrus; Electroconvulsive therapy; Hippocampal subfields; Hippocampus; Meta-analysis; Volume.

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Conflict of interest statement

Declaration of competing interest Without any relevance to this work, P. Baldinger-Melich declares that she has received an Erasmus+ Staff Mobility Grant as well as speaker honoria from Dr. Willmar Schwabe GmbH. R. Lanzenberger received travel grants and/or conference speaker honoraria within the last three years from Bruker BioSpin MR, Heel, and support from Siemens Healthcare regarding clinical research using PET/MR. He is a shareholder of the start-up company BM Health GmbH since 2019. Siegfried Kasper received grants/research support, consulting fees and/or honoraria within the last three years from Angelini, AOP Orphan Pharmaceuticals AG, Celgene GmbH, Janssen-Cilag Pharma GmbH, KRKA-Pharma, Lundbeck A/S, Mundipharma, Neuraxpharm, Pfizer, Sage, Sanofi, Schwabe, Servier, Shire, Sumitomo Dainippon Pharma Co. Ltd., Sun Pharmaceutical Industries Ltd. and Takeda. L.R. Silberbauer is recipient of a DOC fellowship of the Austrian Academy of Sciences at the Department of Psychiatry and Psychotherapy, Medical University of Vienna. G. Gryglewski, R. Frey, D. Pacher and R. Rupprecht have no conflict of interest to declare. Preliminary findings of this study were presented at the 31st CINP congress in Vienna, Austria, and the CINP 2021 Virtual World Congress..

Comment in

  • Is seizure termination a key?
    Sartorius A. Sartorius A. Brain Stimul. 2021 Sep-Oct;14(5):1089-1090. doi: 10.1016/j.brs.2021.07.017. Epub 2021 Jul 28. Brain Stimul. 2021. PMID: 34329796 No abstract available.

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