Mechanisms of ECT: Reviewing the Science & Dismissing the Myths
Electroconvulsive therapy (ECT) is the oldest biological treatment in psychiatry still available. Although critics claim that it is (still) performed without any knowledge of how it works,2 from its birth, the use of ECT was based on theory and scientific facts.
Searching for the Mechanism(s) of ECT’s Therapeutic Effect
McCall, W. Vaughn MD, MS*; Andrade, Chittaranjan MD†; Sienaert, Pascal MD, PhD‡
The past 10 years have seen significant developments in the science of electroconvulsive therapy (ECT), including clarification of the differential effects of right unilateral, bitemporal, and bifrontal stimulating electrode placement1,2 and stimulus parameters,3 the role of ECT in improving quality of life in depressed patients,4 the role of concomitant medications in improving ECT outcomes,5,6 the importance of ECT in the treatment of schizophrenia (especially in countries in the Eastern hemisphere),7 and the role of ECT in maintaining the benefits achieved during an acute course.8
Celebrating 80 Years of Inducing Brain Seizures as Psychiatric Treatment
Fink, Max MD
Beginning on January 2, 1934, Meduna induced seizures using intravenous pentylenetetrazol (Metrazol) in long-term hospitalized psychotic patients. By 1937, half the 110 hospitalized schizophrenic patients in whom he had induced seizures had returned to the community.
The Seizure, Not Electricity, Is Essential in Convulsive Therapy: The Flurothyl Experience
Fink, Max MD
In the UK, a challenge by Crow and Johnstone15 that the seizure may not be necessary for effective relief encouraged the Medical Research Council to support 6 well-designed studies of seizure and mock-seizure treatments.16
A Mechanism of Seizure Induction by Electricity and its Clinical Implications
Swartz, Conrad M. PhD, MD
Various studies indicate that ECT efficacy derives almost entirely from the generalized seizure.2 Efficacy of seizure also follows from the greater clinical improvement from some methods of ECT than others.
What Does the Electroencephalogram Tell Us About the Mechanisms of Action of ECT in Major Depressive Disorders?
Farzan, Faranak PhD*; Boutros, Nash N. MD†; Blumberger, Daniel M. MD, MSc, FRCPC*; Daskalakis, Zafiris J. MD, PhD, FRCP(C)*
In this article, we introduce and review the evidence from both the visually inspected EEG (vEEG, without computer assistance) and computer-assisted quantitative EEG analysis (qEEG) for common EEG features across ECT studies in MDD that could help in furthering our understanding of the electrophysiological changes that may underlie the therapeutic efficacy in MDD or could predict response to treatment.
Electroconvulsive Therapy’s Mechanism of Action: Neuroendocrine Hypotheses
Haskett, Roger F. MD
Despite a range of etiological theories that have been considered since the introduction of ECT more than 75 years ago, its mechanism of action remains poorly understood. There is a consensus that repeated generalized seizures are critical for treatment efficacy; and by inference, the biological consequences of these seizures are likely to be responsible for the observed improvement in the clinical syndrome.
Vagal Intimations for Catatonia and Electroconvulsive Therapy
Dhossche, Dirk M. MD, PhD
A few years ago, models of catatonia were described, and overlap was sought between these models and mechanisms of benzodiazepines and ECT.7 Unsurprisingly, we concluded that the etiopathogenesis of catatonia remains unknown, yet benzodiazepines and ECT seem to affect all key systems in catatonia models of motor circuitry, neurotransmitter, seizure activity, genetic, endocrine, and immune dysfunction.
Neurotransmitters and Electroconvulsive Therapy
Baldinger, Pia MD*; Lotan, Amit MD†; Frey, Richard MD*; Kasper, Siegfried MD*; Lerer, Bernard MD†; Lanzenberger, Rupert MD*
This review will focus on the relationship between major neurotransmitter systems underlying the pathogenesis of major depression and the mechanisms of action of ECT as well as provide a comprehensive overview over the current literature.
Electroconvulsive Therapy (ECT) in Parkinson’s Disease: ECS and Dopamine Enhancement
Cumper, Samantha K. BS; Ahle, Gabriella M. BA; Liebman, Lauren S. BA; Kellner, Charles H. MD
Electroconvulsive therapy (ECT) is a well-established and effective treatment for multiple psychiatric disorders and for both the behavioral and core motor symptoms of Parkinson’s disease (PD).1
The Antipsychotic Effects of ECT: A Review of Possible Mechanisms
Rosenquist, Peter B. MD; Miller, Brian MD, MPH, PhD; Pillai, Anilkumar PhD
Since the inception of ECT, patients and practitioners have wondered, “How does it work?” Despite keen interest, the mechanisms of action underpinning the remarkable and broad therapeutic effectiveness remain poorly understood.
The Immune System and Electroconvulsive Therapy for Depression
Guloksuz, Sinan MD, MSc*†; Rutten, Bart P.F. MD, PhD*; Arts, Baer MD, PhD*; van Os, Jim MD, PhD*‡; Kenis, Gunter PhD*
An intriguing factor that has received relatively little attention in the search for the biological mechanism of ECT is the immune system. A growing body of evidence shows that disturbances in certain aspects of the immune system are involved in the pathogenesis of depression.9,10
Neuroimaging and Electroconvulsive Therapy: A Review
Bolwig, Tom G. MD, DMSc
The present review will discuss some findings obtained by using a variety of neuroimaging methods including single photon emission computed tomography (SPECT), positron emission tomography (PET), and a variety of magnetic resonance imaging (MRI)-based techniques.
ECT: Its Brain Enabling Effects: A Review of Electroconvulsive Therapy–Induced Structural Brain Plasticity
Bouckaert, Filip MD*; Sienaert, Pascal MD, PhD*; Obbels, Jasmien MSc*; Dols, Annemieke MD, PhD†; Vandenbulcke, Mathieu MD, PhD*; Stek, Max MD, PhD†; Bolwig, Tom MD, PhD‡
Research has been particularly focused on the question whether stress-induced changes in structures like hippocampus, amygdala, and prefrontal cortex can be reversed by antidepressive therapies, such as electroconvulsive stimulation (ECS; an animal model for ECT) and ECT, and whether this correlates with clinical improvement.
Epigenetic Effects of Electroconvulsive Seizures
de Jong, Job O.Z. BSc*; Arts, Baer MD*; Boks, Marco P. MD, PhD†; Sienaert, Pascal MD, PhD‡; van den Hove, Daniel L.A. PhD*; Kenis, Gunter PhD*; van Os, Jim MD, PhD*§; Rutten, Bart P.F. MD, PhD*
Here, we provided a brief background on epigenetics and we reviewed the current state of knowledge on epigenetic mediation of ECT-related therapeutic effects.
Electroconvulsive Therapy, Hypertensive Surge, Blood-Brain Barrier Breach, and Amnesia: Exploring the Evidence for a Connection
Andrade, Chittaranjan MD*; Bolwig, Tom G. MD, DMSc†
Electroconvulsive therapy (ECT) has been associated with several adverse effects, notably amnesia; both anterograde and retrograde amnestic deficits have been described.1 Many mechanisms have been proposed to explain these deficits, ranging from glucocorticoid neurotoxicity2,3 to glutamatergic neurotoxicity.4,5
Multifactorial Determinants of the Neurocognitive Effects of Electroconvulsive Therapy
McClintock, Shawn M. MSCS, PhD*†‡; Choi, Jimmy PsyD§; Deng, Zhi-De PhD*; Appelbaum, Lawrence G. PhD*†; Krystal, Andrew D. MD*; Lisanby, Sarah H. MD*†§
Decades of research have found that ECT is one of the most efficacious treatments for neuropsychiatric diseases, especially MDD.4