Decreased cognitive functioning after electroconvulsive therapy is related to increased hippocampal volume: Exploring the role of brain plasticity

Iris van Oostrom*, Philip van Eijndhoven, E. Butterbrod, Maria H van Beek, Joost Janzing, Rogier Donders, Aart Schene, Indira Tendolkar

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

42 Citations (Scopus)



Electroconvulsive therapy (ECT) is still the most effective treatment of severe and therapy-refractory major depressive disorder. Cognitive side effects are the major disadvantage of ECT. Cognitive deficits are generally temporary in nature and may be mediated by the hippocampus. Recent studies have shown a temporary increase in hippocampal volume and a temporary decrease in cognitive functioning post-ECT compared with pre-ECT. This study investigates whether these volumetric changes are related to changes in cognitive functioning after ECT.


Nineteen medication-free patients with treatment-resistant major depressive disorder underwent a whole-brain magnetic resonance imaging scan and a neuropsychological examination (including the Rey auditory verbal learning task, Wechsler Memory Scale Visual Reproduction, fluency, Trail Making Task) within 1 week before and within 1 week after the course of ECT. Electroconvulsive therapy was administered twice a week bitemporally with a brief pulse. A matched healthy control group (n = 18) received the same neuropsychological examination and at a similar interval to that of the patients.


Hippocampal volumes increased significantly from pretreatment to posttreatment in patients. Mean performance on cognitive tasks declined, or remained stable, whereas performance in controls generally improved because of retesting effects. The increase in hippocampal volume was related to changes in cognitive performance, indicating that this increase co-occurred with a decrease in cognitive functioning.


Our findings tentatively suggest that the temporal increase in hippocampal volume after treatment, which may result from neurotrophic processes and is thought to be crucial for the antidepressive effect, is also related to the temporary cognitive side effects of ECT.

Original languageEnglish
Pages (from-to)117–123
JournalThe Journal of ECT
Issue number2
Publication statusPublished - 2018


  • Adult
  • Cognition
  • Cognition Disorders/etiology
  • Depressive Disorder, Treatment-Resistant/therapy
  • Electroconvulsive Therapy/adverse effects
  • Female
  • Hippocampus/diagnostic imaging
  • Humans
  • Longitudinal Studies
  • Magnetic Resonance Imaging/methods
  • Male
  • Middle Aged
  • Neuronal Plasticity/physiology
  • Neuropsychological Tests
  • Prospective Studies
  • Psychiatric Status Rating Scales
  • Treatment Outcome


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