Application of brain magnetic resonance imaging in electroconvulsive therapy for major depressive disorder / 中国基层医药

ABSTRACT

Objective:To observe the changes in brain magnetic resonance imaging (MRI) in patients with major depressive disorder (MDD) after modified electroconvulsive therapy (MECT) relative to before treatment.Methods:A total of 105 patients with MDD who received treatment in Hangzhou Seventh People's Hospital and Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine from June 2017 to June 2019 were included in this study. The brain MRI data pre- and post-MECT were collected. These patients were divided into study group (abnormal brain structure, n = 51) and control group (normal brain structure; n = 54) according to brain structure pre-treatment as shown on MRI. Clinical efficacy, scores of the Hamilton Rating Scale for Depression and Hamilton Rating Scale for Anxiety pre and post-treatment, and the incidence of complications were compared between the two groups. Results:MRI data revealed that 51 patients had abnormal brain structure, including 16 patients with hippocampal atrophy, 18 patients with brain volume reduction, 10 patients with intracranial cyst, and 7 patients with large occipital cistern. These patients had no obvious changes in brain structure after MECT compared with before MECT. The age of onset was lower in the study group than in the control group [(24.15 ± 1.64) years vs. (29.33 ± 2.71) years, t = -7.751, P < 0.05]. The proportion of female patients (57.4% vs. 47.1%), the proportion of patients with a family history of MDD (81.5% vs. 56.9%), and the proportion of patients with psychotic symptoms (55.6% vs. 35.3%) were significantly higher in the study group than in the control group ( χ2 = 4.96, 7.50, 4.33, all P < 0.05). Multivariate logistic regression showed that family history was a factor unrelated to MDD ( P = 0.997). Abnormal brain structure in patients with MDD was negatively correlated with age ( OR = 3.89, 95% CI = 2.083 - 7.281, P < 0.01) and it was positively correlated with sex and psychotic symptoms ( OR = 12.05, 0.08, 95% CI = 2.063 - 70.439, 0.010 - 0.698, both P < 0.05). The Hamilton Rating Scale for Depression and the Hamilton Rating Scale for Anxiety scores decreased after MECT in both groups (both P < 0.05). The proportions of patients having dizziness/headache (50.98% vs. 27.78%), vomiting (43.14% vs. 22.22%), muscle soreness (29.41% vs. 11.11%), delirium (23.53% vs. 7.41%), and memory impairment (64.71% vs. 33.33%) were significantly higher in the study group than in the control group ( χ2 = 5.93, 5.24, 5.49, 5.27, 10.33, all P < 0.05). Conclusion:Most patients with MDD have an abnormal brain structure. Female patients at a low age of onset with psychotic symptoms tend to have an abnormal brain structure. MECT can greatly improve depressive symptoms and has no obvious impact on brain structure. Patients with MDD who have an abnormal brain structure are more likely to have complications.