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The Antipsychotic Effects of ECT: A Review of Possible Mechanisms

Rosenquist, Peter B. MD; Miller, Brian MD, MPH, PhD; Pillai, Anilkumar PhD

doi: 10.1097/YCT.0000000000000131
Invited Reviews

Objectives: Electroconvulsive therapy (ECT) exhibits demonstrable effectiveness for psychotic symptoms associated with a broad range of neuropsychiatric conditions. However, the mechanism remains poorly understood particularly with regard to antipsychotic effects.

Methods: We examined studies of ECT in schizophrenia and mood disorders, as well as from animal models of psychotic disorders, and compared the results to those of antipsychotic medications. This review focuses on 3 potential domains of exploration of ECT’s antipsychotic effects: dopamine and serotonin neurotransmitter activity, neurotrophic effects, and immune system modulation.

Results: Preliminary results support a putative role for all three of these domains but are limited by a lack of replicated findings, including negative studies.

Conclusions: A comparison of the neurophysiologic and molecular properties of antipsychotic drugs and ECT reveals some overlap, but there are also distinctive differences; and the significance of these findings remains uncertain.

From the Department of Psychiatry and Health Behavior, Medical College of Georgia, Georgia Regents University, Augusta, GA

Received for publication February 18, 2014; accepted March 11, 2014.

Reprints: Peter B. Rosenquist, MD, Department of Psychiatry and Health Behavior, Medical College of Georgia, Georgia Regents University, 997 St Sebastian Way, Augusta, GA 30912 (e-mail: prosenquist@gru.edu).

The authors have no conflicts of interest or financial disclosures to report.

© 2014 by Lippincott Williams & Wilkins