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Functional Neuroimaging Changes Subsequent to Electroconvulsive Therapy in Unipolar Depression: A Review of the Literature

Zhuo, Chuanjun MD*†; Yu, Chunshui MD*

doi: 10.1097/YCT.0000000000000114

Abstract: Electroconvulsive therapy (ECT) is an effective treatment for major depressive episodes; however, the neural mechanisms underlying its therapeutic effects remain largely unknown. This review summarizes the findings of functional neuroimaging studies on the effects of the ECT treatment in patients with unipolar depression. Functional neuroimaging studies show that ECT induces changes in cerebral metabolism, blood flow, neurotransmitter activity, neuronal metabolites, and brain functional connectivity. Nevertheless, most of these studies are cross-sectional, with small sample sizes, and the findings across these studies are inconsistent and often contradictory. The levels of brain functional changes are seldom correlated with alleviation of depressive symptoms. Based on the results of current functional neuroimaging studies, one cannot draw any conclusions about the exact neural mechanisms of the antidepressant effect of ECT. Additional multicenter, large-sample, unified-protocol studies with long-term follow-up and multiple observational markers are needed to clarify and cross-validate the neural mechanisms of the antidepressant effect of ECT and to explore validated neuroimaging markers for predicting and evaluating the clinical efficacy of ECT treatment.

From the *Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Heping District, Tianjin, China and †Department of Psychiatry, Anning Hospital of Tianjin City, Dongli District, Tianjin, China.

Received for publication June 10, 2013; accepted January 21, 2014.

Reprints: Chunshui Yu, MD, Department of Radiology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin 300052, China (e-mail:

The authors have no conflicts of interest or financial disclosures to report.

This work was supported by the China Postdoctoral Science Foundation: 2012M520585.

© 2014 by Lippincott Williams & Wilkins