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Structural Plasticity of the Hippocampus and Amygdala Induced by Electroconvulsive Therapy in Major Depression
Open accessAbstract
Background Electroconvulsive therapy (ECT) elicits a rapid and robust clinical response in patients with refractory depression. Neuroimaging measures of structural plasticity relating to and predictive of ECT response may point to the mechanisms underlying rapid antidepressant effects and establish biomarkers to inform other treatments. Here, we determine the effects of 1) diagnosis and 2) ECT on global and local variations of hippocampal and amygdalar structure in major depression and predictors of ECT-related clinical response Methods Longitudinal changes in hippocampal and amygdala structure were examined in patients with major depression (N= 43, scanned thrice; prior to ECT, after the 2nd ECT session, and within one week of completing the ECT treatment series) referred for ECT as part of their standard clinical care. Cross-sectional comparisons with demographically similar controls (N= 32, scanned twice) established effects of diagnosis. Results Patients showed smaller hippocampal volumes compared to controls at baseline (p<.04). Both hippocampal and amygdalar volumes increased with ECT (p<.001) and in relation to symptom improvement (p<.01). Hippocampal volume at baseline predicted subsequent clinical response (p<.05). Shape analysis revealed pronounced morphometric changes in the anterior hippocampus and basolateral and centromedial amygdala. All structural measures remained stable across time in controls. Conclusions ECT induced neuroplasticity in the hippocampus and amygdala relates to improved clinical response and is pronounced in regions with prominent connections to ventromedial prefrontal cortex and other limbic structures. Smaller hippocampal volumes at baseline predict a more robust clinical response. Neurotrophic processes including neurogenesis shown in preclinical studies may underlie these structural changes.
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“Recent clinical studies showed that electroconvulsive therapy (ECT) promoted structural plasticity including increased volume and morphometric changes in the hippocampus and the amygdala along with improved clinical responses, especially in patients with a smaller hippocampal volume (Joshi et al. 2016; Nordanskog et al. 2010; Tendulkar et al. 2013).”
From Neurotrophic factors and neuroplasticity pathways in the pathophysiology and treatment of depression (2018) · cites this paper as Joshi et al. 2016
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Self-citation(2019) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379422.bm01
Chapter 9. Cognitive Effects of ECT
(2019) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379422.lg09
Chapter 4. The Pre-ECT Medical Workup
(2019) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379422.lg04
Chapter 2. Patient Selection for ECT
(2019) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379422.lg02
Chapter 3. Patient Education and Informed Consent for ECT
(2019) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379422.lg03
Chapter 1. Introduction to ECT
(2019) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379422.lg01
Chapter 10. ECT Versus Other Neuropsychiatric Treatments
(2019) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379422.lg10
Chapter 6. ECT Technique, Part I: Managing the Individual Treatment
(2019) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379422.lg06 · Cited by 1
(2019) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379422.index
(2019) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379422.lg05
Chapter 8. Preventing Relapse After ECT: Maintenance ECT and Pharmacotherapy
(2019) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379422.lg08
Chapter 7. ECT Technique, Part II: Managing the Course of Treatments
(2019) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379422.lg07
(2019) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379422.fm01
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Metadata
- Authors
- Joshi, S. H., Espinoza, R. T., Pirnia, T., Shi, J., Wang, Y., Ayers, B., Leaver, A., Woods, R. P., & Narr, K. L.
- Affiliations
- University of California, Los Angeles (US)
- Arizona State University (US)
- Corresponding author
- Narr, Katherine L.
- ORCID
- Venue
- Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2016-02
- Volume
- 79
- Issue
- 4
- Pages
- 282-292
- ISSN
- 0006-3223 (ISSN-L)
- PMC
- PMC4561035
- OpenAlex
- W2030957288
- Semantic Scholar
- dbc2079d218eb4354800e786a0bc85e1722ca84e
- Cited by
- 320
- References
- 80
- Citations by year
- 2026: 16 · 2025: 18 · 2024: 29 · 2023: 22 · 2022: 23 · 2021: 38 · 2020: 28 · 2019: 43 · 2018: 37 · 2017: 32 · 2016: 25
- FWCI
- 27.84
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Biological Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute of Mental Health (R01MH092301, K24MH102743)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Keywords
- electroconvulsive therapy, major depressive disorder, hippocampus, amygdala, structural plasticity, hippocampal volume, amygdala volume, neuroimaging biomarkers, basolateral amygdala, centromedial amygdala, ventromedial prefrontal cortex, neurogenesis
- MeSH terms
- Adult, Amygdala, Cross-Sectional Studies, Major Depressive Disorder, Electroconvulsive Therapy, Female, Hippocampus, Humans, Male, Middle Aged, Neuronal Plasticity, Psychiatric Status Rating Scales, Treatment Outcome, Depressive Disorder, Treatment-Resistant
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