Martin Balslev Jørgensen
Henrik Bo Wiberg Larsson
Objectives: Although electroconvulsive therapy (ECT) has been the most effective treatment for depression for over 80 years, the mechanism of its action remains unclear. Background and Aims: Several studies have found increases in hippocampal volume following ECT, but its effect on cortical thickness is less investigated. We aimed to examine the effect of ECT on changes in cortical thickness and their associations with the antidepressant effect. Materials and Methods: Using 3 Tesla MRI-scanner, we obtained brain images of 18 severely depressed patients and assessed the severity of depression at three time points: before, right after, and six months after a series of ECT. The thickness of 68 cortical regions was measured using Free Surfer, and the General Linear Mixed Model was used to analyse the longitudinal changes. Results and Conclusions: We found significant increases of cortical thickness of 26 regions following a series of ECT, mainly within the frontal, temporal and insular cortex. The increases returned to the baseline-values at six-month follow-up evaluation. No significant decreases in the cortical thickness were detected. The increase in the thickness of the right lateral orbitofrontal cortex correlated with a greater antidepressant effect, when controlled for age (r = 0,75, p = 0,0005). The findings support the neurotrophic hypothesis of the mechanism of ECT's action. Further studies should focus on a potential association between the ECT-induced increases in cortical thickness and the antidepressant effect.
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