Electric field strength, hippocampal volume change, and cognitive outcomes following electroconvulsive therapy: the role of sex and anatomy.
9 affiliations
- 1Padova Neuroscience Center, University of Padova, Via Giuseppe Orus, 2, 35131 Padova, Italy.
- 2Department of Clinical and Biological Psychology, University of Bergen, Christies gate 12, 5015 Bergen, Norway; Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Haukelandsveien 22, 5009 Bergen, Norway.
- 3Department of Physics and Technology, University of Bergen, Allégaten 55, 5007 Bergen, Norway; Department of Physics and Computational Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Sognsvannveien 21, 0372 Oslo, Norway.
- 4Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Haukelandsveien 22, 5009 Bergen, Norway; Department of Clinical Medicine, University of Bergen, Haukelandsveien 28, 5009 Bergen, Norway.
- 5Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Haukelandsveien 22, 5009 Bergen, Norway; Department of Biomedicine, Faculty of Medicine, University of Bergen, Jonas Lies vei 91, 5009 Bergen, Norway.
- 6Department of Psychiatry, University of New Mexico, 2600 Marble Ave, Albuquerque, NM 87106, USA.
- 7Department of Clinical Medicine, University of Bergen, Haukelandsveien 28, 5009 Bergen, Norway; Department of Psychiatry, Haukeland University Hospital, Sandviksleitet 1, 5036 Bergen, Norway.
- 8Department of Physics and Technology, University of Bergen, Allégaten 55, 5007 Bergen, Norway.
- 9Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Haukelandsveien 22, 5009 Bergen, Norway; Department of Clinical Medicine, University of Bergen, Haukelandsveien 28, 5009 Bergen, Norway; Department of Psychiatry, Haukeland University Hospital, Sandviksleitet 1, 5036 Bergen, Norway. Electronic address: [email protected].
Abstract
Background
Electroconvulsive therapy (ECT) induces hippocampal volume alterations, but the clinical significance of the volumetric change remains unclear. Greater electric field (EF) strength has been associated with increases in hippocampal volume and decline in cognitive performance following ECT, and this association might be moderated by individual-level variables, such as sex.Methods
In this study, 29 patients with severe or treatment-resistant depression underwent right unilateral ECT. EF strength was simulated using ROAST, and hippocampal volumes were segmented with FreeSurfer. Cognitive performance was assessed pre- and post-ECT using a multidomain neuropsychological battery. Associations between EF strength, hippocampal volume change, and cognitive outcomes were analyzed, with sex as a moderator.Results
At the group level, ECT reduced depressive symptom severity, without cognitive decline. Female patients exhibited higher EF strength in bilateral hippocampi, associated with smaller intracranial volumes and greater changes in the left hippocampal volume following ECT. Exploratory analyses indicated that higher EF strength and greater left hippocampal volume increase were linked to smaller improvement in verbal memory performance; moreover, a sex×volume interaction suggested opposite trends by sex, with volume increase correlating with greater improvement in males but smaller in females. Greater hippocampal volume change was also linked to lower consistency in autobiographical memory; however, post-hoc sensitivity analysis indicated that this association was outlier-driven and should be interpreted with caution.Conclusions
Our findings suggest that individual anatomical variability influences the EF and may contribute to cognitive side effects following ECT. Awareness of anatomy-related EF differences may inform future research strategies for individualized treatment planning and cognitive monitoring.
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BibTeX
@article{biondi2026electric,
title = {{Electric field strength, hippocampal volume change, and cognitive outcomes following electroconvulsive therapy: the role of sex and anatomy.}},
author = {Margherita Biondi and Eivind Haga Ronold and Ingrid Mossige and Leif Oltedal and Olga Therese Ousdal and Christopher C Abbott and Ketil Joachim Ødegaard and Renate Grüner and Ute Kessler},
journal = {NeuroImage. Clinical},
year = {2026},
month = oct,
doi = {10.1016/j.nicl.2026.104078},
url = {https://europepmc.org/article/MED/42874243},
note = {CC BY},
}
RIS
TY - JOUR
TI - Electric field strength, hippocampal volume change, and cognitive outcomes following electroconvulsive therapy: the role of sex and anatomy.
AU - Margherita Biondi
AU - Eivind Haga Ronold
AU - Ingrid Mossige
AU - Leif Oltedal
AU - Olga Therese Ousdal
AU - Christopher C Abbott
AU - Ketil Joachim Ødegaard
AU - Renate Grüner
AU - Ute Kessler
PY - 2026
DA - 2026/10/09
JO - NeuroImage. Clinical
DO - 10.1016/j.nicl.2026.104078
UR - https://europepmc.org/article/MED/42874243
AB - Background Electroconvulsive therapy (ECT) induces hippocampal volume alterations, but the clinical significance of the volumetric change remains unclear. Greater electric field (EF) strength has been associated with increases in hippocampal volume and decline in cognitive performance following ECT, and this association might be moderated by individual-level variables, such as sex.Methods In this study, 29 patients with severe or treatment-resistant depression underwent right unilateral ECT. EF strength was simulated using ROAST, and hippocampal volumes were segmented with FreeSurfer. Cognitive performance was assessed pre- and post-ECT using a multidomain neuropsychological battery. Associations between EF strength, hippocampal volume change, and cognitive outcomes were analyzed, with sex as a moderator.Results At the group level, ECT reduced depressive symptom severity, without cognitive decline. Female patients exhibited higher EF strength in bilateral hippocampi, associated with smaller intracranial volumes and greater changes in the left hippocampal volume following ECT. Exploratory analyses indicated that higher EF strength and greater left hippocampal volume increase were linked to smaller improvement in verbal memory performance; moreover, a sex×volume interaction suggested opposite trends by sex, with volume increase correlating with greater improvement in males but smaller in females. Greater hippocampal volume change was also linked to lower consistency in autobiographical memory; however, post-hoc sensitivity analysis indicated that this association was outlier-driven and should be interpreted with caution.Conclusions Our findings suggest that individual anatomical variability influences the EF and may contribute to cognitive side effects following ECT. Awareness of anatomy-related EF differences may inform future research strategies for individualized treatment planning and cognitive monitoring.
SN - 2213-1582
ER -