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Biol Psychiatry Cogn Neurosci Neuroimaging. 2017 May;2(4):327-335. doi: 10.1016/j.bpsc.2017.01.011. Epub 2017 Feb 5.

Hippocampal volume changes following electroconvulsive therapy: a systematic review and meta-analysis.

Author information

1
Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511.
2
Connecticut Mental Health Center, New Haven, CT 06519.
3
Yale Child Study Center, Yale School of Medicine, New Haven, CT 06519.

Abstract

INTRODUCTION:

Reduced hippocampal volume is one of the most consistent morphological findings in Major Depressive Disorder (MDD). Electroconvulsive therapy (ECT) is the most effective therapy for MDD, yet its mechanism of action remains poorly understood. Animal models show that ECT induces several neuroplastic processes, which lead to hippocampal volume increases. We conducted a meta-analysis of ECT studies in humans to investigate its effects on hippocampal volume.

METHODS:

PubMed was searched for studies examining hippocampal volume before and after ECT. A random-effects model was used for meta-analysis with standardized mean difference (SMD) of the change in hippocampal volume before and after ECT as the primary outcome. Nine studies involving 174 participants were included.

RESULTS:

Total hippocampal volumes increased significantly following ECT compared to pre-treatment values (SMD=1.10; 95% CI 0.80-1.39; z=7.34; p<0.001; k=9). Both right (SMD=1.01; 95% CI 0.72-1.30; z=6.76; p<0.001; k=7) and left (SMD=0.87; 95% CI 0.51-1.23; z=4.69; p<0.001; k=7) hippocampal volumes were also similarly increased significantly following ECT. We demonstrated no correlation between improvement in depression symptoms with ECT and change in total hippocampal volume (beta=-1.28, 95% CI -4.51-1.95, z=-0.78, p=0.44).

CONCLUSION:

We demonstrate fairly consistent increases in hippocampal volume bilaterally following ECT treatment. The relationship among these volumetric changes and clinical improvement and cognitive side effects of ECT should be explored by larger, multisite studies with harmonized imaging methods.

KEYWORDS:

Electroconvulsive therapy; hippocampus; magnetic resonance imaging; major depressive disorder; neuroplasticity; volume

PMID:
28989984
PMCID:
PMC5627663
[Available on 2018-05-01]
DOI:
10.1016/j.bpsc.2017.01.011
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