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Increase in Hippocampal Volume After Electroconvulsive Therapy in Patients With Depression: A Volumetric Magnetic Resonance Imaging Study

Nordanskog, Pia MD*; Dahlstrand, Ulf MSc; Larsson, Magnus R. PhD; Larsson, Elna-Marie MD, PhD§; Knutsson, Linda PhD; Johanson, Aki PhD

doi: 10.1097/YCT.0b013e3181a95da8
Original Studies

Background: Major depression has traditionally been regarded as a neurochemical disease, but findings of a decreased hippocampal volume in patients with depression have turned the pathophysiological focus toward impairments in structural plasticity. The mechanisms of action of the most effective antidepressive treatment, electroconvulsive therapy (ECT), still remains elusive, but recent animal research has provided evidence for a cell proliferative effect in the hippocampus. The aim of this prospective study was to determine if hippocampal volume changes after ECT in patients with depression.

Methods: Twelve patients with depression and ongoing antidepressive pharmacological treatment were investigated with clinical ratings and 3 T magnetic resonance imaging within 1 week before and after the ECT series. Each hippocampus was manually outlined on coronal slices, and the volume was calculated.

Results: The left as well as the right hippocampal volume increased significantly after ECT.

Conclusions: The hippocampal volume increases after ECT, supporting the hypothesis that hippocampus may play a central role in the treatment of depression.

From the *Department of Psychiatry, Linköping University, Linköping; †Department of Psychiatry, Lund University, ‡Department of Psychology, Lund University, Lund, Sweden; §Department of Radiology, Aalborg Hospital/Aarhus University Hospital, Aalborg, Denmark; ∥Department of Medical Radiation Physics, Lund University, Lund, Sweden.

Received for publication December 19, 2008; accepted April 7, 2009.

Reprints: Aki Johanson, PhD, Department of Psychiatry, Clinical Sciences, Lund, SE-221 85 Lund, Sweden (e-mail:

This study was generously supported by Crafoord Foundation, Ellen and Henrik Sjöbring Foundation, Söderström-Königska Foundation, Thure Carlsson Foundation, OM Persson Foundation, Alzheimer Foundation, Knut and Alice Wallenberg Foundation (grant number 1998.0182), Swedish Research Council (project no. 2007-6079) and by Greta and Johan Kock Foundation.

© 2010 Lippincott Williams & Wilkins, Inc.