Electroconvulsive therapy (ECT) is one of the most effective treatments for depression. ECT induces volume changes in the amygdala, a key center of anxiety. However, the clinical relevance of ECT-induced changes in amygdala volume remains uncertain. We hypothesized that nuclei-specific amygdala volumes and anxiety symptoms in depression could explain the clinical correlates of ECT-induced volume changes. To test this hypothesis, we enrolled patients with depression who underwent ECT (N = 20) in this multicenter observational study and collected MRI data at three time points: before and after treatment and a 6-month follow-up. Patients who received medication (N = 52), cognitive behavioral therapy (N = 63), or transcranial magnetic stimulation (N = 20), and healthy participants (N = 147) were included for comparison. Amygdala nuclei were identified using FreeSurfer and clustered into three subdivisions to enhance reliability and interpretability. Anxiety symptoms were quantified using the anxiety factor scores derived from the Hamilton Depression Rating Scale. Before treatment, basolateral and basomedial subdivisions of the right amygdala were smaller than those of healthy controls. The volumes of the amygdala subdivisions increased after ECT and decreased during the follow-up period, but the volumes at 6-month follow-up were larger than those observed before treatment. These volume changes were specific to ECT. Long-term volume changes in the right basomedial amygdala correlated with improvements in anxiety symptoms. Baseline volumes in the right basolateral amygdala correlated with long-term improvements in anxiety symptoms. These findings demonstrate that clinical correlates of ECT-induced amygdala volume changes are existent, but in a nucleus and symptom-specific manner.

电休克疗法 （ECT） 是治疗抑郁症最有效的方法之一。ECT 会引起杏仁核的体积变化，杏仁核是焦虑的关键中心。然而，ECT 诱导的杏仁核体积变化的临床相关性仍不确定。我们假设抑郁症中的核特异性杏仁核体积和焦虑症状可以解释 ECT 诱导的体积变化的临床相关性。为了检验这一假设，我们在这项多中心观察性研究中招募了接受 ECT （N = 20） 的抑郁症患者，并在三个时间点收集了 MRI 数据：治疗前后和 6 个月的随访。纳入接受药物治疗 （N = 52） 、认知行为疗法 （N = 63） 或经颅磁刺激 （N = 20） 的患者与健康参与者 （N = 147） 进行比较。使用 FreeSurfer 鉴定杏仁核核并将其分为三个细分，以提高可靠性和可解释性。使用来自汉密尔顿抑郁量表的焦虑因素评分量化焦虑症状。治疗前，右侧杏仁核的基底外侧和基底内侧细分比健康对照者小。ECT 后杏仁核细分的体积增加，随访期间减少，但 6 个月随访时的体积大于治疗前观察到的体积。这些体积变化是 ECT 特有的。右侧基底内侧杏仁核的长期体积变化与焦虑症状的改善相关。右侧基底外侧杏仁核的基线体积与焦虑症状的长期改善相关。 这些发现表明，ECT 诱导的杏仁核体积变化的临床相关性是存在的，但以细胞核和症状特异性的方式存在。