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Searching for the Mechanism(s) of ECT’s Therapeutic Effect

McCall, W. Vaughn MD, MS*; Andrade, Chittaranjan MD; Sienaert, Pascal MD, PhD

doi: 10.1097/YCT.0000000000000121

The exact therapeutic mechanism of action of electroconvulsive therapy (ECT) remains unresolved. Numerous psychological theories from decades ago have been proven untrue. In the ensuing years, ECT has been proven to have numerous reproducible effects on brain chemistry, regional brain activity, electroencephalographic sleep stages, and neurogenesis. Clinically, ECT has been shown to have antidepressant, antipsychotic, antimanic, antiparkinsonian, and anticonvulsive effects. It is possible that different biological effects of ECT are responsible for different clinical effects or that several biological effects in concert work together to produce a given clinical effect. This paper comments on the array of possible mechanisms and points toward the future of mechanistic research in ECT.

From the *Department of Psychiatry and Health Behavior, The Medical College of Georgia; Georgia Regents University; Augusta, GA; †Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore, India and ‡Department of Mood Disorders and Department of ECT, University Psychiatric Center, Catholic University Leuven, Campus Kortenberg, Belgium.

Received for publication January 21, 2014; accepted February 11, 2014.

Reprints: W. Vaughn McCall, MD, Department of Psychiatry and Health Behavior, The Medical College of Georgia, Augusta, GA (e-mail:

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

© 2014 by Lippincott Williams & Wilkins