• Leif Oltedal, Katherine L Narr, Christopher Abbott, Amit Anand, Miklos Argyelan, Hauke Bartsch, Udo Dannlowski, Annemieke Dols, Philip van Eijndhoven, Louise Emsell, Vera Jane Erchinger, Randall Espinoza, Tim Hahn, Lars G Hanson, Gerhard Hellemann, Martin Balslev Jorgensen, Ute Kessler, Mardien L Oudega, Olaf B Paulson, Ronny Redlich, Pascal Sienaert, Max L Stek, Indira Tendolkar, Mathieu Vandenbulcke, Ketil J Oedegaard, and Anders M Dale.
• Department of Clinical Medicine, University of Bergen, Bergen, Norway; Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway; Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, California; Department of Radiology, University of California, San Diego, La Jolla, California. Electronic address: leif.oltedal@uib.no.
• Biol. Psychiatry. 2018 Oct 15; 84 (8): 574-581.

BackgroundHippocampal enlargements are commonly reported after electroconvulsive therapy (ECT). To clarify mechanisms, we examined if ECT-induced hippocampal volume change relates to dose (number of ECT sessions and electrode placement) and acts as a biomarker of clinical outcome.MethodsLongitudinal neuroimaging and clinical data from 10 independent sites participating in the Global ECT-Magnetic Resonance Imaging Research Collaboration (GEMRIC) were obtained for mega-analysis. Hippocampal volumes were extracted from structural magnetic resonance images, acquired before and after patients (n = 281) experiencing a major depressive episode completed an ECT treatment series using right unilateral and bilateral stimulation. Untreated nondepressed control subjects (n = 95) were scanned twice.ResultsThe linear component of hippocampal volume change was 0.28% (SE 0.08) per ECT session (p < .001). Volume change varied by electrode placement in the left hippocampus (bilateral, 3.3 ± 2.2%, d = 1.5; right unilateral, 1.6 ± 2.1%, d = 0.8; p < .0001) but not the right hippocampus (bilateral, 3.0 ± 1.7%, d = 1.8; right unilateral, 2.7 ± 2.0%, d = 1.4; p = .36). Volume change for electrode placement per ECT session varied similarly by hemisphere. Individuals with greater treatment-related volume increases had poorer outcomes (Montgomery-Åsberg Depression Rating Scale change -1.0 [SE 0.35], per 1% volume increase, p = .005), although the effects were not significant after controlling for ECT number (slope -0.69 [SE 0.38], p = .069).ConclusionsThe number of ECT sessions and electrode placement impacts the extent and laterality of hippocampal enlargement, but volume change is not positively associated with clinical outcome. The results suggest that the high efficacy of ECT is not explained by hippocampal enlargement, which alone might not serve as a viable biomarker for treatment outcome.Copyright © 2018 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

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