Effects of electroconvulsive therapy on amygdala function in major depression - a longitudinal functional magnetic resonance imaging study

Psychol Med. 2017 Sep;47(12):2166-2176. doi: 10.1017/S0033291717000605. Epub 2017 Apr 11.


Background: Electroconvulsive therapy (ECT) is one of the most effective treatments for severe depression. However, little is known regarding brain functional processes mediating ECT effects.

Method: In a non-randomized prospective study, functional magnetic resonance imaging data during the automatic processing of subliminally presented emotional faces were obtained twice, about 6 weeks apart, in patients with major depressive disorder (MDD) before and after treatment with ECT (ECT, n = 24). Additionally, a control sample of MDD patients treated solely with pharmacotherapy (MED, n = 23) and a healthy control sample (HC, n = 22) were obtained.

Results: Before therapy, both patient groups equally showed elevated amygdala reactivity to sad faces compared with HC. After treatment, a decrease in amygdala activity to negative stimuli was discerned in both patient samples indicating a normalization of amygdala function, suggesting mechanisms potentially unspecific for ECT. Moreover, a decrease in amygdala activity to sad faces was associated with symptomatic improvements in the ECT sample (r spearman = -0.48, p = 0.044), and by tendency also for the MED sample (r spearman = -0.38, p = 0.098). However, we did not find any significant association between pre-treatment amygdala function to emotional stimuli and individual symptom improvement, neither for the ECT sample, nor for the MED sample.

Conclusions: In sum, the present study provides first results regarding functional changes in emotion processing due to ECT treatment using a longitudinal design, thus validating and extending our knowledge gained from previous treatment studies. A limitation was that ECT patients received concurrent medication treatment.

Keywords: Amygdala; depression; electroconvulsive therapy; emotion processing; functional magnetic resonance imaging.

MeSH terms

  • Adult
  • Amygdala / diagnostic imaging
  • Amygdala / physiopathology*
  • Depressive Disorder, Major / diagnostic imaging
  • Depressive Disorder, Major / physiopathology*
  • Depressive Disorder, Major / therapy*
  • Electroconvulsive Therapy / methods*
  • Facial Expression
  • Female
  • Follow-Up Studies
  • Humans
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care*
  • Prospective Studies