Severity of subcortical gray matter hyperintensity predicts ECT response in geriatric depression

Objective: To determine the effect of subcortical white and gray matter lesions on ECT outcome. Method: 41 geriatric psychiatric inpatients underwent an MRI scan during their ECT work-up. Periventricular, deep white matter, and subcortical gray matter hyperintensities were graded. The associations of low versus high hyperintensity ratings and symptom scores, Clinical Global Impression severity (CGS) ratings, Montgomery-Asberg Depression Scale score, and number of treatments were examined using t-tests and repeated measures ANOVA. Results: Patients with more severe subcortical gray hyperintensities (SCG) had significantly less improvement as measured by CGS ratings. Conclusions: SCG severity may limit the improvement of patients receiving ECT. Further studies are needed to examine differences based on electrode placement and to determine whether patients with severe SCG may require more ECT treatments in an index course.