Brain functional effects of electroconvulsive therapy during emotional processing in major depressive disorder

Research output: Contribution to journalResearch articleContributedpeer-review


  • Verena Enneking - , University of Münster (Author)
  • Fanni Dzvonyar - , University of Münster (Author)
  • Kerstin Dück - , University of Münster (Author)
  • Katharina Dohm - , University of Münster (Author)
  • Dominik Grotegerd - , University of Münster (Author)
  • Katharina Förster - , University of Münster (Author)
  • Susanne Meinert - , University of Münster (Author)
  • Hannah Lemke - , University of Münster (Author)
  • Melissa Klug - , University of Münster (Author)
  • Lena Waltemate - , University of Münster (Author)
  • Janik Goltermann - , University of Münster (Author)
  • Carina Hülsmann - , University of Münster (Author)
  • Tiana Borgers - , University of Münster (Author)
  • Joscha Böhnlein - , University of Münster (Author)
  • Lisa Sindermann - , University of Münster (Author)
  • Maike Richter - , University of Münster (Author)
  • Elisabeth J. Leehr - , University of Münster (Author)
  • Jonathan Repple - , University of Münster (Author)
  • Nils Opel - , University of Münster (Author)
  • Bernhard T. Baune - , University of Münster, University of Melbourne (Author)
  • Udo Dannlowski - , University of Münster (Author)
  • Ronny Redlich - , University of Münster (Author)


Background: In treatment-resistant major depressive disorder (MDD), electroconvulsive therapy (ECT) is a treatment with high efficacy. While knowledge regarding changes in brain structure following ECT is growing, the effects of ECT on brain function during emotional processing are largely unknown. Objective: We investigated the effects of ECT on the activity of the anterior cingulate cortex (ACC) and amygdala during negative emotional stimuli processing and its association with clinical response. Methods: In this non-randomized longitudinal study, patients with MDD (n = 37) were assessed before and after treatment with ECT. Healthy controls (n = 37) were matched regarding age and gender. Functional magnetic resonance imaging (fMRI) was obtained twice, at baseline and after six weeks using a supraliminal face-matching paradigm. In order to evaluate effects of clinical response, additional post-hoc analyses were performed comparing responders to non-responders. Results: After ECT, patients with MDD showed a statistically significant increase in ACC activity during processing of negative emotional stimuli (pFWE = .039). This effect was driven by responders (pFWE = .023), while non-responders showed no increase. Responders also had lower pre-treatment ACC activity compared to non-responders (pFWE = .025). No significant effects in the amygdala could be observed. Conclusions: ECT leads to brain functional changes in the ACC, a relevant region for emotional regulation during processing of negative stimuli. Furthermore, baseline ACC activity might serve as a biomarker for treatment response. Findings are in accordance with recent studies highlighting properties of pre-treatment ACC to be associated with general antidepressive treatment response.


Original languageEnglish
Pages (from-to)1051-1058
Number of pages8
JournalBrain stimulation
Issue number4
Publication statusPublished - 1 Jul 2020
Externally publishedYes

External IDs

PubMed 32388195
ORCID /0000-0002-3041-9246/work/86198439
ORCID /0000-0003-0501-7357/work/142247202



  • Biomarker, Depression, Electroconvulsive therapy, Emotional processing, Functional magnetic resonance imaging, Response

Library keywords