liu.seSearch for publications in DiVA
Change search
ReferencesLink to record
Permanent link

Direct link
Increase in Hippocampal Volume After Electroconvulsive Therapy in Patients With Depression: A Volumetric Magnetic Resonance Imaging Study
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Department of Medical and Health Sciences, Radiology. Linköping University, Faculty of Health Sciences.
Lund University.
Lund University.
Aarhus University Hospital.
Show others and affiliations
2010 (English)In: JOURNAL OF ECT, ISSN 1095-0680, Vol. 26, no 1, 62-67 p.Article in journal (Refereed) Published
Abstract [en]

Background: Major depression has traditionally been regarded as a neurochemical disease, but findings of a decreased hippocampal volume in patients with depression have turned the pathophysiological focus toward impairments in structural plasticity. The mechanisms of action of the most effective antidepressive treatment, electroconvulsive therapy (ECT), still remains elusive, but recent animal research has provided evidence for a cell proliferative effect in the hippocampus. The aim of this prospective study was to determine if hippocampal volume changes after ECT in patients with depression.

Methods: Twelve patients with depression and ongoing antidepressive pharmacological treatment were investigated with clinical ratings and 3 T magnetic resonance imaging within 1 week before and after the ECT series. Each hippocampus was manually outlined on coronal slices, and the volume was calculated.

Results: The left as well as the right hippocampal volume increased significantly after ECT.

Conclusions: The hippocampal volume increases after ECT, supporting the hypothesis that hippocampus may play a central role in the treatment of depression.

Place, publisher, year, edition, pages
2010. Vol. 26, no 1, 62-67 p.
Keyword [en]
ECT, depression, hippocampus, MRI, neurogenesis
National Category
Psychiatry Neurology
URN: urn:nbn:se:liu:diva-54702DOI: 10.1097/YCT.0b013e3181a95da8ISI: 000275571000017OAI: diva2:308426
Available from: 2010-04-06 Created: 2010-04-06 Last updated: 2015-09-22Bibliographically approved
In thesis
1. On electroconvulsive therapy in depression: Clinical, cognitive and neurobiological aspects
Open this publication in new window or tab >>On electroconvulsive therapy in depression: Clinical, cognitive and neurobiological aspects
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Electroconvulsive therapy (ECT) is used worldwide to treat severe mental disorders. The most common mental disorder, and the third leading cause of disease burden in the world is depression. The clinical efficacy of ECT for severe depression is well-established. However, both the pathophysiology of depression and the mechanism of action of ECT remain elusive.

The main aims of this thesis are to address the following issues: 1) the use and practice of ECT in Sweden has not been systematically evaluated since 1975, 2) cognitive side-effects (memory disturbances) are a major concern with ECT and 3) the mechanism of action of ECT remain elusive. The neurobiological aspects of ECT focus on two hypotheses. First, the recent years´ preclinical studies that have provided evidence that ECT induces hippocampal cell proliferation, including neurogenesis. Second, that enhanced functional inhibition of neuronal activity is a key feature.

Current use and practice of ECT in Sweden (paper I) is based on data from the national quality register for ECT, the mandatory patient register of the National Board of Health and Welfare and a survey. Treated person rate (TPR) in Sweden 2013 was found to be 41 individuals / 100 000, and thus unchanged since the latest systematic investigation in Sweden 1975. In more than 70% of treatment series the indication was a depressive episode. The selection of patients for ECT and treatment technique in Sweden was similar to that in other western countries, but the consent procedure and the involvement of nurses and nursing assistants in the delivery of ECT differ. Data also shows that there is room for improvement in both the specificity of use and availability of ECT.

The second study in this thesis is a longitudinal observational trial where 12 (paper II and III) and 14 (paper IV) patients with depression referred for ECT were investigated. Patients underwent a 3 T MRI structural scanning and DSC-MRI perfusion, a neuropsychological test battery and clinical ratings before ECT, within one to two weeks after ECT and after 6 and 12 months.  In line with preclinical findings and the plasticity hypothesis of mechanism of action of ECT, the hippocampal volume increased after ECT in patients with depression. However, this increase was transient and returned to baseline levels within 6 months. No correlation was found between volumetric changes and clinical effect or cognitive outcome. Instead our results suggested an association to the number of treatments, without relation to the side of stimulation. A right-sided decrease in frontal blood flow distinguished remission from non-remission after ECT. There were significant impairments in verbal episodic memory and verbal fluency within one week after ending the ECT course, but these impairments were transient and no persistent cognitive impairments were seen during the follow-up.

In summary, this thesis present the first update on the use and practice of ECT in Sweden in the last 40 years as well as a pioneering MRI-study on the hippocampal volume increase in the treatment of depression with ECT. Supportive to earlier findings we also found the cognitive side-effects that are measurable after ECT to be transient. Furthermore, we found that a decreased frontal blood flow is of importance for the anti-depressive response to ECT.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. 68 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1468
ECT, electroconvulsive therapy, depression, MRI, cognitive, hippocampus
National Category
urn:nbn:se:liu:diva-121458 (URN)10.3384/diss.diva-121458 (DOI)978-91-7519-026-6 (print) (ISBN)
Public defence
2015-10-16, Berzeliussalen, Ingång 64/65, Campus US, Linköping, 13:00 (Swedish)
Available from: 2015-09-21 Created: 2015-09-21 Last updated: 2016-04-06Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full text

Search in DiVA

By author/editor
Nordanskog, Pia
By organisation
Department of Clinical and Experimental MedicineRadiologyFaculty of Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 151 hits
ReferencesLink to record
Permanent link

Direct link