Electroconvulsive therapy increases brain volume in major depression: a systematic review and meta-analysis

Acta Psychiatr Scand. 2018 Sep;138(3):180-195. doi: 10.1111/acps.12884. Epub 2018 Apr 29.


Objective: The main purpose of this review was to synthesise evidence on ECT's effects on brain's structure.

Method: A systematic literature review of longitudinal studies of depressed patients treated with ECT using magnetic resonance imaging (MRI) and meta-analysis of ECT's effect on hippocampal volume.

Results: Thirty-two studies with 467 patients and 285 controls were included. The MRI studies did not find any evidence of ECT-related brain damage. All but one of the newer MRI volumetric studies found ECT-induced volume increases in certain brain areas, most consistently in hippocampus. Meta-analysis of effect of ECT on hippocampal volume yielded pooled effect size: g = 0.39 (95% CI = 0.18-0.61) for the right hippocampus and g = 0.31 (95% CI = 0.09-0.53) for the left. The DTI studies point to an ECT-induced increase in the integrity of white matter pathways in the frontal and temporal lobes. The results of correlations between volume increases and treatment efficacy were inconsistent.

Conclusion: The MRI studies do not support the hypothesis that ECT causes brain damage; on the contrary, the treatment induces volume increases in fronto-limbic areas. Further studies should explore the relationship between these increases and treatment effect and cognitive side effects.

Keywords: depressive disorder, major; diffusion tensor imaging; electroconvulsive therapy; magnetic resonance imaging.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Brain / diagnostic imaging
  • Brain / pathology
  • Depressive Disorder, Major / complications
  • Depressive Disorder, Major / psychology
  • Depressive Disorder, Major / therapy*
  • Electroconvulsive Therapy / adverse effects*
  • Electroconvulsive Therapy / methods
  • Female
  • Hippocampus / diagnostic imaging
  • Hippocampus / pathology*
  • Humans
  • Magnetic Resonance Imaging / methods
  • Male
  • Neuronal Plasticity / physiology
  • Organ Size
  • Prospective Studies
  • White Matter / pathology