Change search
ReferencesLink to record
Permanent link

Direct link
Hippocampal volume in relation to clinical and cognitive outcome after electroconvulsive therapy in depression
Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Psychiatry.
Lund University, Sweden.
Uppsala University, Sweden.
Lund University, Sweden.
2014 (English)In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 129, no 4, 303-311 p.Article in journal (Refereed) Published
Abstract [en]


In a previous magnetic resonance imaging (MRI) study, we found a significant increase in hippocampal volume immediately after electroconvulsive therapy (ECT) in patients with depression. The aim of this study was to evaluate hippocampal volume up to 1 year after ECT and investigate its possible relation to clinical and cognitive outcome.


Clinical and cognitive outcome in 12 in-patients with depression receiving antidepressive pharmacological treatment referred for ECT were investigated with the Montgomery-Asberg Depression Rating Scale (MADRS) and a broad neuropsychological test battery within 1 week before and after ECT. The assessments were repeated 6 and 12 months after baseline in 10 and seven of these patients, respectively. Hippocampal volumes were measured on all four occasions with 3 Tesla MRI.


Hippocampal volume returned to baseline during the follow-up period of 6 months. Neither the significant antidepressant effect nor the significant transient decrease in executive and verbal episodic memory tests after ECT could be related to changes in hippocampal volume. No persistent cognitive side effects were observed 1 year after ECT.


The immediate increase in hippocampal volume after ECT is reversible and is not related to clinical or cognitive outcome.

Place, publisher, year, edition, pages
United States: Wiley-Blackwell, 2014. Vol. 129, no 4, 303-311 p.
Keyword [en]
hippocampus, magnetic resonance imaging, depression, electroconvulsive therapy, cognition, longitudinal
National Category
Psychiatry Neurology
URN: urn:nbn:se:liu:diva-104959DOI: 10.1111/acps.12150ISI: 000332684900006PubMedID: 23745780OAI: diva2:701369
Available from: 2014-03-04 Created: 2014-03-04 Last updated: 2015-09-21
In thesis
1. On electroconvulsive therapy in depression: Clinical, cognitive and neurobiological aspects
Open this publication in new window or tab >>On electroconvulsive therapy in depression: Clinical, cognitive and neurobiological aspects
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Electroconvulsive therapy (ECT) is used worldwide to treat severe mental disorders. The most common mental disorder, and the third leading cause of disease burden in the world is depression. The clinical efficacy of ECT for severe depression is well-established. However, both the pathophysiology of depression and the mechanism of action of ECT remain elusive.

The main aims of this thesis are to address the following issues: 1) the use and practice of ECT in Sweden has not been systematically evaluated since 1975, 2) cognitive side-effects (memory disturbances) are a major concern with ECT and 3) the mechanism of action of ECT remain elusive. The neurobiological aspects of ECT focus on two hypotheses. First, the recent years´ preclinical studies that have provided evidence that ECT induces hippocampal cell proliferation, including neurogenesis. Second, that enhanced functional inhibition of neuronal activity is a key feature.

Current use and practice of ECT in Sweden (paper I) is based on data from the national quality register for ECT, the mandatory patient register of the National Board of Health and Welfare and a survey. Treated person rate (TPR) in Sweden 2013 was found to be 41 individuals / 100 000, and thus unchanged since the latest systematic investigation in Sweden 1975. In more than 70% of treatment series the indication was a depressive episode. The selection of patients for ECT and treatment technique in Sweden was similar to that in other western countries, but the consent procedure and the involvement of nurses and nursing assistants in the delivery of ECT differ. Data also shows that there is room for improvement in both the specificity of use and availability of ECT.

The second study in this thesis is a longitudinal observational trial where 12 (paper II and III) and 14 (paper IV) patients with depression referred for ECT were investigated. Patients underwent a 3 T MRI structural scanning and DSC-MRI perfusion, a neuropsychological test battery and clinical ratings before ECT, within one to two weeks after ECT and after 6 and 12 months.  In line with preclinical findings and the plasticity hypothesis of mechanism of action of ECT, the hippocampal volume increased after ECT in patients with depression. However, this increase was transient and returned to baseline levels within 6 months. No correlation was found between volumetric changes and clinical effect or cognitive outcome. Instead our results suggested an association to the number of treatments, without relation to the side of stimulation. A right-sided decrease in frontal blood flow distinguished remission from non-remission after ECT. There were significant impairments in verbal episodic memory and verbal fluency within one week after ending the ECT course, but these impairments were transient and no persistent cognitive impairments were seen during the follow-up.

In summary, this thesis present the first update on the use and practice of ECT in Sweden in the last 40 years as well as a pioneering MRI-study on the hippocampal volume increase in the treatment of depression with ECT. Supportive to earlier findings we also found the cognitive side-effects that are measurable after ECT to be transient. Furthermore, we found that a decreased frontal blood flow is of importance for the anti-depressive response to ECT.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. 68 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1468
ECT, electroconvulsive therapy, depression, MRI, cognitive, hippocampus
National Category
urn:nbn:se:liu:diva-121458 (URN)10.3384/diss.diva-121458 (DOI)978-91-7519-026-6 (print) (ISBN)
Public defence
2015-10-16, Berzeliussalen, Ingång 64/65, Campus US, Linköping, 13:00 (Swedish)
Available from: 2015-09-21 Created: 2015-09-21 Last updated: 2016-04-06Bibliographically approved

Open Access in DiVA

fulltext(464 kB)106 downloads
File information
File name FULLTEXT01.pdfFile size 464 kBChecksum SHA-512
Type fulltextMimetype application/pdf

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Nordanskog, Pia
By organisation
Division of Radiological SciencesFaculty of Health SciencesDepartment of Psychiatry
In the same journal
Acta Psychiatrica Scandinavica

Search outside of DiVA

GoogleGoogle Scholar
Total: 106 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 115 hits
ReferencesLink to record
Permanent link

Direct link