Effect of Electroconvulsive Therapy on Striatal Morphometry in Major Depressive Disorder

Abstract

Patients with major depression show reductions in striatal and paleostriatal volumes. The functional integrity and connectivity of these regions are also shown to change with antidepressant response. Electroconvulsive therapy (ECT) is a robust and rapidly acting treatment for severe depression. However, whether morphological changes in the dorsal and ventral striatum/pallidum relate to or predict therapeutic response to ECT is unknown. Using structural MRI, we assessed cross-sectional effects of diagnosis and longitudinal effects of ECT for volume and surface-based shape metrics of the caudate, putamen, pallidum, and nucleus accumbens in 53 depressed patients (mean age: 44.1 years, 13.8 SD; 52% female) and 33 healthy controls (mean age: 39.3 years, 12.4 SD; 57% female). Patients were assessed before ECT, after their second ECT, and after completing an ECT treatment index. Controls were evaluated at two time points. Support vector machines determined whether morphometric measures at baseline predicted ECT-related clinical response. Patients showed smaller baseline accumbens and pallidal volumes than controls (Po0.05). Increases in left putamen volume (Po0.03) occurred with ECT. Global increases in accumbens volume and local changes in pallidum and caudate volume occurred in patients defined as treatment responders. Morphometric changes were absent across time in controls. Baseline volume and shape metrics predicted overall response to ECT with up to 89% accuracy. Results support that ECT elicits structural plasticity in the dorsal and ventral striatum/pallidum. The morphometry of these structures, forming key components of limbic-cortical-striatal-pallidal-thalamic circuitry involved in mood and emotional regulation, may determine patients likely to benefit from treatment.

Association between hippocampal volume change and change in memory following electroconvulsive therapy in late‐life depression

“…In general, an overall increase in HV was seen in our sample following ECT, which was over an average period of 54 days. This is in line with other studies reporting an ECT‐induced increase in HV in depressed patients compared to depressed patients without ECT and healthy controls , during the same time window. The increase must be interpreted with caution since random variation and measurement errors could be a cause of the change in HV over time.…”

SMRI Biomarkers Predict Electroconvulsive Treatment Outcomes: Accuracy with Independent Data Sets

“…Previous machine-learning ECT studies have investigated imaging predictors of response (Redlich et al, 2016;van Waarde et al, 2015;Wade et al, 2016). These investigations have used resting state fMRI or structural measures from one single data set.…”

“…The lack of longitudinal change in predictive ROIs is consistent with a previous datadriven ECT investigation. Wade et al (2016) used baseline GM volume and surface-based shape metrics of the caudate, putamen, pallidum, and nucleus accumbens to predict overall MDD response to ECT with up to 89% accuracy, whereas only the left putamen volume showed significant increase after ECT.…”

“…Second, ECT provides an optimal laboratory to identify prediction and treatment response networks, due to the magnitude and speed of response. Several recent ECTneuroimaging investigations have demonstrated the promise of such methods for isolating prognostic biomarkers of ECT response with accuracy between 78 and 89% (Redlich et al, 2016;van Waarde et al, 2015;Wade et al, 2016). However, these investigations either used binary classification or lacked validation with independent data sets.…”

Electroconvulsive therapy treatment responsive multimodal brain networks

“…Even though the cognitive sequelae are transient and ECT does not increase the risk of dementia (Chu et al, 2018), the possibility of cognitive impairment can be dissuasive to an individual with a depressive episode even if they have found no benefit with other antidepressant modalities, particularly for independent-living outpatients. Specific brain regions including the hippocampus (Oltedal et al, 2018), amygdala , striatum (Wade et al, 2016), and cerebellum (Depping et al, 2017), as well as the whole-brain structural changes Ousdal et al, 2019) were investigated following ECT. In addition, single imaging modality (Abbott et al, 2013;Jiang et al, 2018;Leaver et al, 2019;Redlich et al, 2016;Sun et al, 2019;van Waarde et al, 2015) and multimodal analysis (Cano et al, 2017;Jorgensen et al, 2016;Nickl-Jockschat et al, 2016) but with a small sample size (n < 25 patients) have been assessed with treatment response.…”