Gbyl Krzysztof, Rostrup Egill, Raghava Jayachandra Mitta, Andersen Carsten, Rosenberg Raben, Larsson Henrik Bo Wiberg, Videbech Poul
Center for Neuropsychiatric Depression Research, Mental Health Center Glostrup, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Science, The University of Copenhagen, Copenhagen, Denmark.
Center for Neuropsychiatric Schizophrenia Research, and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Center Glostrup, Glostrup, Denmark.
Prog Neuropsychopharmacol Biol Psychiatry. 2021 Jan 10;104:110048. doi: 10.1016/j.pnpbp.2020.110048. Epub 2020 Jul 28.
It is thought that the hippocampal neurogenesis is an important mediator of the antidepressant effect of electroconvulsive therapy (ECT). However, most previous studies failed to demonstrate the relationship between the increase in the hippocampal volume and the antidepressant effect. We reinvestigated this relationship by looking at distinct hippocampal subregions and applying repeated measures correlation. Using a 3 Tesla MRI-scanner, we scanned 22 severely depressed in-patients at three time points: before the ECT series, after the series, and at six-month follow-up. The depression severity was assessed by the 17-item Hamilton Rating Scale for Depression (HAMD-17). The hippocampus was segmented into subregions using Freesurfer software. The dentate gyrus (DG) was the primary region of interest (ROI), due to the role of this region in neurogenesis. The other major hippocampal subregions were the secondary ROIs (n = 20). The general linear mixed model and the repeated measures correlation were used for statistical analyses. Immediately after the ECT series, a significant volume increase was present in the right DG (Cohen's d = 1.7) and the left DG (Cohen's d = 1.5), as well as 15 out of 20 secondary ROIs. The clinical improvement, i.e., the decrease in HAMD-17 score, was correlated to the increase in the right DG volume (r = -0.77, df = 20, p < .001), and the left DG volume (r = -0.75, df = 20, p < .001). Similar correlations were observed in 14 out of 20 secondary ROIs. Thus, ECT induces an increase not only in the volume of the DG, but also in the volume of other major hippocampal subregions. The volumetric increases may reflect a neurobiological process that may be related to the ECT's antidepressant effect. Further investigation of the relationship between hippocampal subregions and the antidepressant effect is warranted. A statistical approach taking the repeated measurements into account should be preferred in the analyses.
人们认为海马体神经发生是电休克疗法（ECT）抗抑郁作用的重要介导因素。然而，大多数先前的研究未能证明海马体体积增加与抗抑郁效果之间的关系。我们通过观察不同的海马体亚区域并应用重复测量相关性来重新研究这种关系。使用3特斯拉磁共振成像扫描仪，我们在三个时间点对22名重度抑郁症住院患者进行了扫描：ECT系列治疗前、治疗后以及六个月随访时。抑郁严重程度通过17项汉密尔顿抑郁评定量表（HAMD - 17）进行评估。使用Freesurfer软件将海马体分割为亚区域。由于齿状回（DG）在神经发生中的作用，它是主要的感兴趣区域（ROI）。其他主要的海马体亚区域是次要ROI（n = 20）。采用一般线性混合模型和重复测量相关性进行统计分析。ECT系列治疗后即刻，右侧DG（科恩d值 = 1.7）和左侧DG（科恩d值 = 1.5）以及20个次要ROI中的15个出现了显著的体积增加。临床改善，即HAMD - 17评分的降低，与右侧DG体积的增加相关（r = -0.77，自由度 = 20，p <.001），也与左侧DG体积的增加相关（r = -0.75，自由度 = 20，p <.001）。在20个次要ROI中的14个观察到了类似的相关性。因此，ECT不仅会导致DG体积增加，还会使其他主要海马体亚区域的体积增加。体积增加可能反映了一个可能与ECT抗抑郁作用相关的神经生物学过程。有必要进一步研究海马体亚区域与抗抑郁效果之间的关系。在分析中应优先采用考虑重复测量的统计方法。
