Brain volumetric correlates of electroconvulsive therapy versus transcranial magnetic stimulation for treatment-resistant depression

Background

Electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) are effective neuromodulation therapies for treatment-resistant depression (TRD).

While ECT is generally considered the most effective antidepressant, rTMS is less invasive, better tolerated and leads to more durable therapeutic benefits.

Both interventions are established device antidepressants, but it remains unknown if they share a common mechanism of action.

Here the aim was to compare the brain volumetric changes in patients with TRD after right unilateral (RUL) ECT versus left dorsolateral prefrontal cortex (lDLPFC) rTMS.

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Methods

Thirty-two patients with TRD were assessed before the first treatment session and after treatment completion using structural magnetic resonance imaging.

Fifteen patients were treated with RUL ECT and seventeen patients received lDLPFC rTMS.

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Results

Patients receiving RUL ECT, in comparison with patients treated with lDLPFC rTMS, showed a greater volumetric increase in the right striatum, pallidum, medial temporal lobe, anterior insular cortex, anterior midbrain, and subgenual anterior cingulate cortex.

However, ECT- or rTMS-induced brain volumetric changes were not associated with the clinical improvement.

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Limitations

A modest sample size was evaluated with concurrent pharmacological treatment and without neuromodulation therapies randomization.

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Conclusions

These findings suggest that despite comparable clinical outcomes, only RUL ECT is associated with structural change, while rTMS is not.

It is hypothesized that structural neuroplasticity and/or neuroinflammation may explain the larger structural changes observed after ECT, whereas neurophysiological plasticity may underlie the rTMS effects.

More broadly, the results support the notion that there are multiple therapeutic strategies to move patients from depression to euthymia.

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Read the full publication here.

Cano, M., Lee, E., Polanco, C., Barbour, T., Ellard, K. K., Andreou, B., Uribe, S., Henry, M. E., Seiner, S., Cardoner, N., Soriano-Mas, C., & Camprodon, J. A. (2023). Brain volumetric correlates of electroconvulsive therapy versus transcranial magnetic stimulation for treatment-resistant depression. Journal of affective disorders, 333, 140–146.

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