A Primer for the Conceptualization of the Mechanism of Action of Electroconvulsive Therapy, 1: Defining the Question

Abstract

Each month in his online column, Dr Andrade offers practical knowledge, ideas, and tips in psychopharmacology to JCP readers in psychiatric and general medical settings. Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore, India (candrade@psychiatrist.com). Department of ABSTRACTWith regard to the question of how electroconvulsive therapy (ECT) acts, a common answer is that the mechanism of action of the treatment is not well understood. However, this is not true. There is a great deal of information available about what ECT does in the brain, how it does it, and how these effects translate into clinical actions. The very complexity of the available data makes it necessary for the question about mechanisms to be properly defined with regard to physiologic effects, adverse effects, and efficacy in different conditions. This article presents a primer for the conceptualization of the mechanism of action of ECT with special attention to understanding why the question and answer are complex.