Electroconvulsive Therapy: Mechanisms of Action, Clinical Considerations, and Future Directions

Abstract

Learning objectives:• Outline and discuss the fundamental physiologic, cellular, and molecular mechanisms of ECT to devise strategies to optimize therapeutic outcomes• Summarize the overview of ECT, its efficacy in treating depression, the known effects on cognition, evidence of mechanisms, and future directions.AbstractElectroconvulsive therapy (ECT) is the most effective treatment for a variety of psychiatric illnesses, including treatment-resistant depression, bipolar depression, mania, catatonia, and clozapine-resistant schizophrenia. ECT is a medical and psychiatric procedure whereby electrical current is delivered to the brain under general anesthesia to induce a generalized seizure. ECT has evolved a great deal since the 1930s. Though it has been optimized for safety and to reduce adverse effects on cognition, issues persist. There is a need to understand fundamental physiologic, cellular, and molecular mechanisms of ECT to devise strategies to optimize therapeutic outcomes. Clinical trials that set out to adjust parameters, electrode placement, adjunctive medications, and patient selection are critical steps towards the goal of improving outcomes with ECT. This narrative review provides an overview of ECT, its efficacy in treating depression, its known effects on cognition, evidence of its mechanisms, and future directions.

Understanding the Patient Landscape: A Ten-Year Retrospective Examination of Electroconvulsive Therapy in Romania’s Largest Psychiatric Hospital

“…In our study, after undergoing 4-6 sessions of ECT, the patients experienced significant improvement in symptoms, particularly in reducing persistent suicidal ideation. Once again, ECT proved to be more effective than pharma-cotherapy in treating depression, sustaining the data from the literature [49,50]. Similarly, patients who received antidepressants (AD) had lower rates of readmission afterward.…”

Exploring Brain and Heart Interactions during Electroconvulsive Therapy with Point-of-Care Ultrasound

“…Electroconvulsive therapy (ECT) is a procedure commonly used to treat a number of severe psychiatric disorders, including pharmacologic refractory depression, mania, and catatonia, by purposefully inducing a generalized seizure that results in significant hemodynamic changes as a result of an initial transient parasympathetic response that is followed by a marked sympathetic response from a surge in catecholamine release [ 1 , 2 , 3 , 4 , 5 , 6 ]. While the physiologic response of ECT on classic hemodynamic parameters such as heart rate and blood pressure has been well described in the literature, real-time visualization of cardiac function using point-of-care ultrasound (POCUS) of the heart during ECT has never been reported.…”

Introduction

“…Understanding the mechanisms of ECT will allow us to further improve the delivery of ECT treatment, maintaining or even increasing its therapeutic efficacy while reducing the side effect burden. On this premise, Kritzer-Cheren and colleagues 6 review mechanistic research on ECT from rodents to humans, highlighting its relevance for and impact on clinical practice, and trace the implications of this knowledge for treatment development.…”