Effects of Electroconvulsive Therapy on Brain Structure: A Neuroradiological Investigation Into White Matter Hyperintensities, Atrophy, and Microbleeds.

Background: Electroconvulsive therapy (ECT) is a well-established treatment for severe depression, but it remains stigmatized due to public perceptions linking it with brain injury. Despite extensive research, the neurobiological mechanisms underlying ECT have not been 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 magnetic resonance imaging (MRI) scans on 36 ECT patients (19 female), 19 healthy control participants (11 female), and 18 patients with atrial fibrillation (1 female) who were treated with electrical cardioversion while receiving an equivalent anesthetic as the ECT group. Scans were conducted at 4 time points: at baseline, after the first ECT treatment, after the ECT series, and at 6-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 nonparametric statistical methods.

Results: Patients did not show any changes in radiological scores after ECT (all ps > .1), except for a decrease in microbleeds (p = .05).

Conclusions: 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.