Treatment-characteristic brain structural changes in depression: A multi-center longitudinal observational study

Summary

Depression is treated with various modalities including antidepressant medication (ADM), cognitive behavioral therapy (CBT), electroconvulsive therapy (ECT), and repetitive transcranial magnetic stimulation (rTMS), yet how each treatment affects brain structure remains poorly understood. Momoko Hatakoshi, Naoya Oishi, Taro Suwa, Toshiya Murai, and colleagues investigated gray matter volume (GMV) changes in 155 patients with depression and 152 healthy controls across three timepoints (pre-treatment, post-treatment, and 6-month follow-up) using voxel-based morphometry at multiple sites. Patients with depression showed reduced GMV in the hippocampus, amygdala, and insula compared to healthy controls. Notably, treatment-related GMV change patterns differed　across modalities. Both ECT and ADM were associated with transient GMV increases following treatment, which subsequently decreased at long-term follow-up. In the ADM group, long-term insular GMV reduction was significantly associated with symptom worsening, suggesting its potential as a biological marker of relapse risk. In contrast, no significant GMV changes were detected in the CBT or rTMS groups despite clinical improvement. This study is the first to characterize treatment-characteristic brain structural change patterns across four major depression treatment modalities within a unified longitudinal framework, and may contribute to the advancement of personalized treatment approaches for depression.

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