Ishikawa Yuzuki, Oishi Naoya, Kyuragi Yusuke, Hatakoshi Momoko, Hirano Jinichi, Noda Takamasa, Yoshihara Yujiro, Ito Yuri, Miyata Jun, Nemoto Kiyotaka, Fujita Yoshihisa, Igarashi Hiroyuki, Takahashi Kento, Murakami Shingo, Kanno Hiroyuki, Izumi Yudai, Takamiya Akihiro, Matsumoto Junya, Kodaka Fumitoshi, Nakagome Kazuyuki, Mimura Masaru, Murai Toshiya, Suwa Taro
Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Human Brain Research Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Mol Psychiatry. 2025 Jun;30(6):2653-2664. doi: 10.1038/s41380-024-02874-1. Epub 2024 Dec 16.
Electroconvulsive therapy (ECT) is one of the most effective treatments for depression. ECT induces volume changes in the amygdala, a key center of anxiety. However, the clinical relevance of ECT-induced changes in amygdala volume remains uncertain. We hypothesized that nuclei-specific amygdala volumes and anxiety symptoms in depression could explain the clinical correlates of ECT-induced volume changes. To test this hypothesis, we enrolled patients with depression who underwent ECT (N = 20) in this multicenter observational study and collected MRI data at three time points: before and after treatment and a 6-month follow-up. Patients who received medication (N = 52), cognitive behavioral therapy (N = 63), or transcranial magnetic stimulation (N = 20), and healthy participants (N = 147) were included for comparison. Amygdala nuclei were identified using FreeSurfer and clustered into three subdivisions to enhance reliability and interpretability. Anxiety symptoms were quantified using the anxiety factor scores derived from the Hamilton Depression Rating Scale. Before treatment, basolateral and basomedial subdivisions of the right amygdala were smaller than those of healthy controls. The volumes of the amygdala subdivisions increased after ECT and decreased during the follow-up period, but the volumes at 6-month follow-up were larger than those observed before treatment. These volume changes were specific to ECT. Long-term volume changes in the right basomedial amygdala correlated with improvements in anxiety symptoms. Baseline volumes in the right basolateral amygdala correlated with long-term improvements in anxiety symptoms. These findings demonstrate that clinical correlates of ECT-induced amygdala volume changes are existent, but in a nucleus and symptom-specific manner.
电休克疗法（ECT）是治疗抑郁症最有效的方法之一。ECT会引起杏仁核（焦虑的关键中枢）体积变化。然而，ECT引起的杏仁核体积变化的临床相关性仍不确定。我们假设抑郁症患者杏仁核特定核团的体积和焦虑症状可以解释ECT引起的体积变化的临床相关性。为了验证这一假设，我们在这项多中心观察性研究中纳入了接受ECT治疗的抑郁症患者（N = 20），并在三个时间点收集MRI数据：治疗前、治疗后和6个月随访时。纳入接受药物治疗（N = 52）、认知行为疗法（N = 63）或经颅磁刺激（N = 20）的患者以及健康参与者（N = 147）作为对照。使用FreeSurfer识别杏仁核核团，并将其聚类为三个亚区，以提高可靠性和可解释性。使用汉密尔顿抑郁量表得出的焦虑因子评分对焦虑症状进行量化。治疗前，右侧杏仁核的基底外侧和基底内侧亚区比健康对照者小。ECT治疗后杏仁核亚区的体积增加，随访期间体积减小，但6个月随访时的体积大于治疗前观察到的体积。这些体积变化是ECT特有的。右侧基底内侧杏仁核的长期体积变化与焦虑症状的改善相关。右侧基底外侧杏仁核的基线体积与焦虑症状的长期改善相关。这些发现表明，ECT引起的杏仁核体积变化存在临床相关性，但以核团和症状特异性的方式存在。
