Neuromodulation in response to electroconvulsive therapy in schizophrenia and major depression.
Electroconvulsive therapy (ECT) is one of the most effective treatments in severe and treatment-resistant major depressive disorder (MDD). ECT has been also shown to be effective in schizophrenia (SZ), particularly when rapid symptom reduction is needed or in cases of resistance to drug-treatment. However, its precise mechanisms of action remain largely unknown.



This study examined whether ECT exerts disorder-specific or unspecific modulation of brain structure and function in SZ and MDD.



We investigated neuromodulatory effects of right-sided unilateral ECT in pharmacoresistant patients with SZ or MDD. Magnetic resonance imaging was conducted before and after ECT to investigate treatment-related effects on brain structure and function. Imaging data were analyzed by means of Voxel Based Morphometry and Resting State Functional Connectivity (RSFC) methods.



Right unilateral ECT induced transdiagnostic regional increases of limbic gray matter and modulations of neural coupling at rest. Structural effects were accompanied by a decrease in RSFC within temporoparietal, prefrontal and cortical midline structures, and an increase in hypothalamic RSFC. The extent of structural and functional change was partially inversely associated with the baseline measures.



The present findings provide first evidence for transdiagnostic changes of brain structure together with modulation of brain function after ECT. The data indicate diagnosis-unspecific mechanisms of action with respect to regional gray matter volume and resting-state functional connectivity.
Center for Psychosocial Medicine, Department of Psychiatry, University of Heidelberg, 69115 Heidelberg, Germany. Electronic address: philipp.thomann@med.uni-heidelberg.de.
Philipp Arthur
PA
Thomann
Center for Psychosocial Medicine, Department of Psychiatry, University of Heidelberg, 69115 Heidelberg, Germany.
Robert Christian
RC
Wolf
Center for Psychosocial Medicine, Department of Psychiatry, University of Heidelberg, 69115 Heidelberg, Germany.
Henrike Maria
HM
Nolte
Center for Psychosocial Medicine, Department of Psychiatry, University of Heidelberg, 69115 Heidelberg, Germany; Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, 68159 Mannheim, Germany.
Dusan
D
Hirjak
Department of Anaesthesiology, University of Heidelberg, 69120 Heidelberg, Germany.
Stefan
S
Hofer
Center for Mental Health, Klinikum Stuttgart, 70374 Stuttgart, Germany.
Ulrich
U
Seidl
Center for Psychosocial Medicine, Department of Psychiatry, University of Heidelberg, 69115 Heidelberg, Germany.
Malte Sebastian
MS
Depping
Department of Radiology, Section Quantitative Imaging Based Disease Characterization, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany.
Bram
B
Stieltjes
Medical Image Computing Group, Division of Medical and Biological Informatics, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany.
Klaus
K
Maier-Hein
Brain Center for Motor and Social Cognition@UniPR, Istituto Italiano di Tecnologia, Parma, Italy.
Fabio
F
Sambataro
Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Charité Campus Mitte, 10117 Berlin, Germany.
Torsten
T
Wüstenberg
D000328:Adult; D003865:Major Depressive Disorder / Q000000981:diagnostic imaging* / Q000628:therapy; D004565:Electroconvulsive Therapy; D005260:Female; D066128:Gray Matter / Q000000981:diagnostic imaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012559:Schizophrenia / Q000000981:diagnostic imaging* / Q000628:therapy
Electroconvulsive therapy; Magnetic resonance imaging; Major depression; Schizophrenia