title: Are morphological changes necessary to mediate the therapeutic effects of electroconvulsive therapy?
abstract: The neurotrophic hypothesis has become the favorite model to explain the antidepressant properties of electroconvulsive therapy (ECT). It is based on the assumption that a restoration of previously defective neural networks drives therapeutic effects. Recent data in rather young patients suggest that neurotrophic effects of ECT might be detectable by diffusion tensor imaging. We here aimed to investigate whether the therapeutic response to ECT necessarily goes along with mesoscopic effects in gray matter (GM) or white matter (WM) in our patients in advanced age. Patients (n = 21, 15 males and 7 females) suffering from major depressive disorder were treated with ECT. Before the start of treatment and after the completion of the index series, they underwent magnetic resonance imaging, including a diffusion-weighed sequence. We used voxel-based morphometry to assess GM changes and tract-based spatial statistics and an SPM-based whole-brain analysis to detect WM changes in the course of treatment. Patients significantly improved clinically during the course of ECT. This was, however, not accompanied by GM or WM changes. This result challenges the notion that mesoscopic brain structure changes are an obligatory prerequisite for the antidepressant effects of ECT.
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Pauwelsstrasse-30, 52074, Aachen, Germany. tnickl-jockschat@ukaachen.de.|Juelich Aachen Research Alliance - Translational Brain Medicine, Aachen, Germany. tnickl-jockschat@ukaachen.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Nickl-Jockschat
authors.affiliation: Juelich Aachen Research Alliance - Translational Brain Medicine, Aachen, Germany.|Institute of Neuroscience and Medicine (INM-1), Juelich Research Centre, Juelich, Germany.
authors.forename: Nicola
authors.initials: N
authors.lastname: Palomero Gallagher
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Pauwelsstrasse-30, 52074, Aachen, Germany.|Juelich Aachen Research Alliance - Translational Brain Medicine, Aachen, Germany.
authors.forename: Vinod
authors.initials: V
authors.lastname: Kumar
authors.affiliation: Juelich Aachen Research Alliance - Translational Brain Medicine, Aachen, Germany.|Institute of Neuroscience and Medicine (INM-1), Juelich Research Centre, Juelich, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Hoffstaedter
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Pauwelsstrasse-30, 52074, Aachen, Germany.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Brügmann
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Pauwelsstrasse-30, 52074, Aachen, Germany.|Juelich Aachen Research Alliance - Translational Brain Medicine, Aachen, Germany.
authors.forename: Ute
authors.initials: U
authors.lastname: Habel
authors.affiliation: Institute of Neuroscience and Medicine (INM-1), Juelich Research Centre, Juelich, Germany.|Department of Clinical Neuroscience and Medical Psychology, Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: Simon B
authors.initials: SB
authors.lastname: Eickhoff
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Pauwelsstrasse-30, 52074, Aachen, Germany.|Juelich Aachen Research Alliance - Translational Brain Medicine, Aachen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Grözinger
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology*; D003865:Major Depressive Disorder / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D038524:Diffusion Magnetic Resonance Imaging; D004565:Electroconvulsive Therapy; D005260:Female; D066128:Gray Matter / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D066127:White Matter / Q000000981:diagnostic imaging / Q000473:pathology
keywords: Depression; ECT; Imaging; MRI; Unipolar major depression