Effects of Electroconvulsive Therapy on Brain Structure - a Neuroradiological Investigation into White Matter Hyperintensities, Atrophy, and Microbleeds.

Abstract

Background: Electroconvulsive therapy (ECT) is a well-established treatment for severe depression, yet it remains stigmatized due to public perceptions linking it with brain injury. Despite extensive research, the neurobiological mechanisms underlying ECT are not fully elucidated. Recent findings suggest that ECT may work through disrupting depression circuitry. However, whether ECT is associated with neuroradiological correlates of brain injury, including white matter changes, atrophy and microbleeds, remains largely unexplored.

Methods: We performed MRI scans on 36 ECT patients (19 female), 19 healthy controls (11 female), and 18 atrial fibrillation patients (1 female) treated with electrical cardioversion while receiving an equivalent anesthetic as the ECT group. Scans were conducted at four time points: at baseline, after the first ECT treatment, after the ECT series, and at six-month follow-up. We evaluated white matter changes using the Fazekas and the Age-Related White Matter Changes scales, atrophy using the Global Cortical Atrophy and Medial Temporal lobe Atrophy scales, and cerebral microbleeds using the Microbleed Anatomical Rating Scale. Data were analyzed using non-parametric statistical methods.

Results: Patients did not show any changes in radiological scores after ECT (all p >0.1), except for a decrease in microbleeds (p = 0.05).

Conclusion: Utilizing state-of-the-art MRI techniques, we found no significant evidence that ECT induces white matter changes, atrophy, or microbleeds. Thus, although ECT may work through disrupting depression circuitry, the treatment is not associated with neuroradiological signs of brain injury.