Effect of Electroconvulsive Therapy on Neural Response to Affective Pictures: A Randomized, Sham-Controlled fMRI Study

Eur Neuropsychopharmacol. 2018 Aug;28(8):915-924. doi: 10.1016/j.euroneuro.2018.05.013. Epub 2018 Jun 8.


Electroconvulsive therapy (ECT) is the most effective treatment for severe depression but its neurocognitive mechanisms are unclear. This randomized, sham-controlled functional magnetic resonance imaging (fMRI) study explored the effects of a single ECT on neural response to affective pictures. Twenty-seven patients with major depressive disorder were randomized to a single active ECT (N = 15) or sham (N = 12) session in a double-blind, parallel-group design. On the following day, patients underwent fMRI during which they viewed pleasant, unpleasant and neutral pictures and performed a free recall test after the scan. Mood symptoms were assessed before ECT/sham and at the time of fMRI. Subsequently, all patients continued active ECT as usual. Mood symptoms were reassessed after six active ECT sessions. A single ECT vs. sham session reduced neural response to unpleasant vs. pleasant pictures in the medial prefrontal cortex, a region showing greater response in the more depressed patients. This effect occurred in the absence of between-group differences in picture recall, mood symptoms or concomitant medication. In conclusion, modulation of medial prefrontal hyper-activity during encoding of negative affective information may be a common mechanism of distinct biological depression treatments.

Keywords: Depression; ECT; Magnetic resonance imaging; Neurocognition; Prefrontal cortex.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Affect / physiology*
  • Antidepressive Agents / therapeutic use
  • Brain / diagnostic imaging
  • Brain / physiopathology*
  • Brain Mapping
  • Cross-Sectional Studies
  • Depressive Disorder, Major / diagnostic imaging
  • Depressive Disorder, Major / physiopathology*
  • Depressive Disorder, Major / psychology
  • Depressive Disorder, Major / therapy*
  • Double-Blind Method
  • Electroconvulsive Therapy*
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Mental Recall / physiology
  • Photic Stimulation
  • Treatment Outcome
  • Visual Perception / physiology*


  • Antidepressive Agents