Meta-analysis of hippocampal volume changes following electroconvulsive therapy in major depression
release_xehqhx4hyfbbzkjdxsqeedhvny
by
Karolin Elke Einenkel
2018
Abstract
Major depressive disorder (MDD) is one of the most frequent psychiatric disorders and the number one cause of disability worldwide. Depressive symptoms typically encompass clouded mood, avolition and a loss of interests as well as multiple psychophysiological changes. The most powerful treatment option for depression is electroconvulsive therapy (ECT), whereby an electrical stimulation of the brain triggers a generalized seizure. Although the first ECT was already conducted in the 1930s, the mechanisms of action of this treatment option are still not fully decoded. One potential target to explain both the emergence of depression and ECT's antidepressant effects is adult neurogenesis. As demonstrated in various investigations, ECT seems to counteract alterations of neurogenesis mirrored in hippocampal shrinkage observed in depressed patients. Based on these findings, the thesis at hands aims at determining the real effect size of ECT on hippocampal volume in patients suffering from MDD by combining the outcomes of multiple magnetic resonance imaging (MRI) studies in a meta-analysis.
Following a thorough literature search, 11 MRI studies including a total of 235 patients with depression were used in this meta-analysis. The primary outcome was the standardized change score of hippocampal volume before and after ECT.
The total hippocampal volume increased significantly following a course of ECT (0.86, 95% confidence interval (CI): [0.59, 1.13]; p < 0.0001; n = 11). Similarly, the left (0.71, 95% CI: [0.38, 1.03]; p < 0.0001; n = 9) and right (0.84; 95% CI: [0.54, 1.14]; p < 0.0001; n = 9) hippocampus showed a significant volume increase after administration of ECT. Alterations in hippocampal volume and changes in depressive symptom scores were not correlated.
The present meta-analysis demonstrated a strong effect of ECT on bilateral hippocampal volume in patients with MDD. The relationship between hippocampal volume alterations and changes in depressive symptomatology should be evaluated in more homogeneous [...]
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