A Voxel-Based Morphometry Study Of Patients With Treatment-Resistant Depression Before And After Electroconvulsive Therapy

Objective In this study,voxel-based morphometry(VBM)was used to compare the changes of gray matter voxel in patients with treatment-resistant depressive disorder(TRD)and healthy control(HC),to explore the neuroimaging mechanism of patients with TRD.We investigated the changes in gray matter voxels and emotional changes before and after modified electroconvulsive therapy(MECT),to investigate the efficacy and neurophysiological mechanisms underlying MECT of TRD.Methods A total of 21 patients with TRD and 22 healthy controls were enrolled,all of whom completed one course of MECT(6-12)in TRD patients.Clinical data were collected from HCs and TRDs before and after MECT.Including general demographic data,Hamilton’s Depression scale(HAMD),Hamilton Anxiety scale(HAMA),Magnetic Resonance Imaging(MRI)scan,within 36 hours before and after MECT,obtain high resolution 3D T1-weighted structure image.SPSS22.0 was used for statistical analysis of general demographic data.The data of MRI analysis was based on MATLAB 2013 b platform.CAT12 software package was used for segmentation,reconstruction,correction,registration,smoothing and other pre-processing,SPM12 was used for statistical analysis.Gaussian Random Field(GRF)for multiple comparison correction,and the results were presented by DPABIview software.The regions of interest(ROIs)were extracted by RESTplus and DPABI software,and Spearman correlation analysis was performed on the differences between gray matter voxels with HAMD,HAMA subfractions and MECT times.All statistical tests were performed with bilateral test,and the test level was ɑ=0.05.Results(1)Compared with HCs,gray matter voxel increased in left fusiform gyrus,left anterior central gyrus,left precuneus and right posterior central gyrus in TRD patients at baseline.No decrease in gray matter voxel was found in the brain regions.The above brain areas were extracted as ROIs for correlation analysis with HAMD and HAMA scales,no correlation was found.(2)HAMD and HAMA scores of patients with TRD after MECT were significantly lower than those before(P<0.001).(3)The voxel of bilateral hippocampus,bilateral superior temporal gyrus gray voxel and left psiform pallidus in TRD patients after MECT were increased,while the voxels of left paramedial cingulate gyrus and left caudate nucleus were decreased.There was no correlation between the gray matter voxel difference and HAMD subscore,HAMA subscore and MECT times.Conclusions(1)Compared with the HC group,the brain structure of patients with TRD was increased.This may be related to the pathogenesis of TRD,which is helpful for us to further understand the pathogenesis of TRD.(2)The HAMA and HAMD scale scores of TRD decreased significantly after MECT,and the patients’ anxiety and depression mood changed significantly.(3)The gray matter voxels in the brain regions related to mood,memory and learning in patients with TRD increased after MECT,compared with before treatment,which may be related to the improvement of depressive symptoms in patients with TRD,providing a neurophysiological mechanism for MECT of TRD.