title: Grey matter volume increase following electroconvulsive therapy in patients with late life depression: a longitudinal MRI study.
abstract: BACKGROUND
  The evidence on the mechanisms of action of electroconvulsive therapy (ECT) has grown over the past decades. Recent studies show an ECT-related increase in hippocampal, amygdala and subgenual cortex volume. We examined grey matter volume changes following ECT using voxel-based morphometry (VBM) whole brain analysis in patients with severe late life depression (LLD).
  
  
  METHODS
  Elderly patients with unipolar depression were treated twice weekly with right unilateral ECT until remission on the Montgomery-Åsberg Depression Rating Scale (MADRS) was achieved. Cognition (Mini Mental State Examination) and psychomotor changes (CORE Assessment) were monitored at baseline and 1 week after the last session of ECT. We performed 3 T structural MRI at both time points. We used the VBM8 toolbox in SPM8 to study grey matter volume changes. Paired t tests were used to compare pre- and post-ECT grey matter volume (voxel-level family-wise error threshold p < 0.05) and to assess clinical response.
  
  
  RESULTS
  Twenty-eight patients (mean age 71.9 ± 7.8 yr, 8 men) participated in our study. Patients received a mean of 11.2 ± 4 sessions of ECT. The remission rate was 78.6%. Cognition, psychomotor agitation and psychomotor retardation improved significantly (p < 0.001). Right-hemispheric grey matter volume was increased in the caudate nucleus, medial temporal lobe (including hippocampus and amygdala), insula and posterior superior temporal regions but did not correlate with MADRS score. Grey matter volume increase in the caudate nucleus region correlated significantly with total CORE Assessment score (r = 0.63; p < 0.001).
  
  
  CONCLUSIONS
  Not all participants were medication-free.
  
  
  CONCLUSIONS
  Electroconvulsive therapy in patients with LLD is associated with significant grey matter volume increase, which is most pronounced ipsilateral to the stimulation side.
authors.affiliation: From the Department of Old Age Psychiatry, UPC KULeuven, Belgium (Bouckaert, De Winter, Wampers, Vandenbulcke); the GGZ inGeest/Department of Psychiatry and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands (Dols, Rhebergen, Stek); the Department of ECT and Department of Mood Disorders, UPC KULeuven, Belgium (Bouckaert, Sienaert); and Translational MRI, Department of Imaging and Pathology, KULeuven and Radiology, University Hospitals Leuven, Belgium (Emsell, Sunaert).
authors.forename: Filip
authors.initials: F
authors.lastname: Bouckaert
authors.affiliation: From the Department of Old Age Psychiatry, UPC KULeuven, Belgium (Bouckaert, De Winter, Wampers, Vandenbulcke); the GGZ inGeest/Department of Psychiatry and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands (Dols, Rhebergen, Stek); the Department of ECT and Department of Mood Disorders, UPC KULeuven, Belgium (Bouckaert, Sienaert); and Translational MRI, Department of Imaging and Pathology, KULeuven and Radiology, University Hospitals Leuven, Belgium (Emsell, Sunaert).
authors.forename: François-Laurent
authors.initials: FL
authors.lastname: De Winter
authors.affiliation: From the Department of Old Age Psychiatry, UPC KULeuven, Belgium (Bouckaert, De Winter, Wampers, Vandenbulcke); the GGZ inGeest/Department of Psychiatry and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands (Dols, Rhebergen, Stek); the Department of ECT and Department of Mood Disorders, UPC KULeuven, Belgium (Bouckaert, Sienaert); and Translational MRI, Department of Imaging and Pathology, KULeuven and Radiology, University Hospitals Leuven, Belgium (Emsell, Sunaert).
authors.forename: Louise
authors.initials: L
authors.lastname: Emsell
authors.affiliation: From the Department of Old Age Psychiatry, UPC KULeuven, Belgium (Bouckaert, De Winter, Wampers, Vandenbulcke); the GGZ inGeest/Department of Psychiatry and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands (Dols, Rhebergen, Stek); the Department of ECT and Department of Mood Disorders, UPC KULeuven, Belgium (Bouckaert, Sienaert); and Translational MRI, Department of Imaging and Pathology, KULeuven and Radiology, University Hospitals Leuven, Belgium (Emsell, Sunaert).
authors.forename: Annemieke
authors.initials: A
authors.lastname: Dols
authors.affiliation: From the Department of Old Age Psychiatry, UPC KULeuven, Belgium (Bouckaert, De Winter, Wampers, Vandenbulcke); the GGZ inGeest/Department of Psychiatry and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands (Dols, Rhebergen, Stek); the Department of ECT and Department of Mood Disorders, UPC KULeuven, Belgium (Bouckaert, Sienaert); and Translational MRI, Department of Imaging and Pathology, KULeuven and Radiology, University Hospitals Leuven, Belgium (Emsell, Sunaert).
authors.forename: Didi
authors.initials: D
authors.lastname: Rhebergen
authors.affiliation: From the Department of Old Age Psychiatry, UPC KULeuven, Belgium (Bouckaert, De Winter, Wampers, Vandenbulcke); the GGZ inGeest/Department of Psychiatry and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands (Dols, Rhebergen, Stek); the Department of ECT and Department of Mood Disorders, UPC KULeuven, Belgium (Bouckaert, Sienaert); and Translational MRI, Department of Imaging and Pathology, KULeuven and Radiology, University Hospitals Leuven, Belgium (Emsell, Sunaert).
authors.forename: Martien
authors.initials: M
authors.lastname: Wampers
authors.affiliation: From the Department of Old Age Psychiatry, UPC KULeuven, Belgium (Bouckaert, De Winter, Wampers, Vandenbulcke); the GGZ inGeest/Department of Psychiatry and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands (Dols, Rhebergen, Stek); the Department of ECT and Department of Mood Disorders, UPC KULeuven, Belgium (Bouckaert, Sienaert); and Translational MRI, Department of Imaging and Pathology, KULeuven and Radiology, University Hospitals Leuven, Belgium (Emsell, Sunaert).
authors.forename: Stefan
authors.initials: S
authors.lastname: Sunaert
authors.affiliation: From the Department of Old Age Psychiatry, UPC KULeuven, Belgium (Bouckaert, De Winter, Wampers, Vandenbulcke); the GGZ inGeest/Department of Psychiatry and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands (Dols, Rhebergen, Stek); the Department of ECT and Department of Mood Disorders, UPC KULeuven, Belgium (Bouckaert, Sienaert); and Translational MRI, Department of Imaging and Pathology, KULeuven and Radiology, University Hospitals Leuven, Belgium (Emsell, Sunaert).
authors.forename: Max
authors.initials: M
authors.lastname: Stek
authors.affiliation: From the Department of Old Age Psychiatry, UPC KULeuven, Belgium (Bouckaert, De Winter, Wampers, Vandenbulcke); the GGZ inGeest/Department of Psychiatry and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands (Dols, Rhebergen, Stek); the Department of ECT and Department of Mood Disorders, UPC KULeuven, Belgium (Bouckaert, Sienaert); and Translational MRI, Department of Imaging and Pathology, KULeuven and Radiology, University Hospitals Leuven, Belgium (Emsell, Sunaert).
authors.forename: Pascal
authors.initials: P
authors.lastname: Sienaert
authors.affiliation: From the Department of Old Age Psychiatry, UPC KULeuven, Belgium (Bouckaert, De Winter, Wampers, Vandenbulcke); the GGZ inGeest/Department of Psychiatry and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands (Dols, Rhebergen, Stek); the Department of ECT and Department of Mood Disorders, UPC KULeuven, Belgium (Bouckaert, Sienaert); and Translational MRI, Department of Imaging and Pathology, KULeuven and Radiology, University Hospitals Leuven, Belgium (Emsell, Sunaert).
authors.forename: Mathieu
authors.initials: M
authors.lastname: Vandenbulcke
mesh_terms: D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology; D003866:Depressive Disorder / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D004565:Electroconvulsive Therapy; D005260:Female; D007839:Functional Laterality; D066128:Gray Matter / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents