Brain volumetric and metabolic correlates of electroconvulsive therapy for treatment-resistant depression: a longitudinal neuroimaging study.
Recent research suggests that neuroplastic and neuroinflammatory changes may account for the mode of action of electroconvulsive therapy (ECT), although extant data do not allow for a clear disambiguation between these two hypotheses. Multimodal neuroimaging approaches (for example, combining structural and metabolic information) may help in clarifying this issue. Here we aimed to assess longitudinal changes in (i) regional gray matter (GM) volumes and (ii) hippocampal metabolite concentrations throughout an acute course of bitemporal ECT, as well as (iii) to determine the association between imaging changes and clinical improvement. We assessed 12 patients with treatment-resistant depression (TRD) at four time points (pre-treatment, after the first ECT session, after the ninth ECT session and 15 days after ECT course completion) and 10 healthy participants at two time points, 5 weeks apart. Patients with TRD showed bilateral medial temporal lobe (MTL) and perigenual anterior cingulate cortex volume increases. Left MTL volume increase was associated with (i) a hippocampal N-acetylaspartate concentration decrease, (ii) a hippocampal Glutamate+Glutamine concentration increase and (iii) significant clinical improvement. The observed findings are, in part, compatible with both neuroplastic and neuroinflammatory changes induced by ECT. We postulate that such phenomena may be interrelated, therefore reconciling the neuroplasticity and neuroinflammatory hypotheses of ECT action.
Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.|Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.
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Cano
Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.
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Martínez-Zalacaín
Magnetic Resonance Department, Inscanner SL, Alicante, Spain.
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Bernabéu-Sanz
Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.|Carlos III Health Institute, CIBERSAM, Madrid, Spain.
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Contreras-Rodríguez
Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.|Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.|Carlos III Health Institute, CIBERSAM, Madrid, Spain.
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Hernández-Ribas
Mental Health Department, Parc Taulí Sabadell, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Via
Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.
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de Arriba-Arnau
School of Psychiatry, University of New South Wales (UNSW) and Black Dog Institute, Randwick, Sydney, NSW, Australia.
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Gálvez
Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.|Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.|Carlos III Health Institute, CIBERSAM, Madrid, Spain.
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Urretavizcaya
Carlos III Health Institute, CIBERSAM, Madrid, Spain.|MRI Research Unit, Radiology Department, Hospital del Mar, Barcelona, Spain.
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Pujol
Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.|Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.|Carlos III Health Institute, CIBERSAM, Madrid, Spain.
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Menchón
Mental Health Department, Parc Taulí Sabadell, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Cardoner
Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.|Carlos III Health Institute, CIBERSAM, Madrid, Spain.|Department of Psychobiology and Methodology in Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Soriano-Mas
D000368:Aged; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000378:metabolism; D001921:Brain / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D016022:Case-Control Studies; D061218:Depressive Disorder, Treatment-Resistant / Q000000981:diagnostic imaging / Q000378:metabolism / Q000628:therapy*; D004565:Electroconvulsive Therapy; D005260:Female; D018698:Glutamic Acid / Q000378:metabolism; D005973:Glutamine / Q000378:metabolism; D006179:Gyrus Cinguli / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D006624:Hippocampus / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D066244:Proton Magnetic Resonance Spectroscopy; D013702:Temporal Lobe / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology
D005973:Glutamine; D001224:Aspartic Acid; D018698:Glutamic Acid; C000179:N-acetylaspartate