Potential Mechanisms Underlying the Therapeutic Effects of Electroconvulsive Therapy

Abstract

In spite of the extensive application of electroconvulsive therapy (ECT), how it works remains unclear. So far, researchers have made great efforts in figuring out the mechanisms underlying the effect of ECT treatment via determining the levels of neurotransmitters and cytokines and using genetic and epigenetic tools, as well as structural and functional neuroimaging. To help address this question and provide implications for future research, relevant clinical trials and animal experiments are reviewed.

Updated Review on the Clinical Use of Repetitive Transcranial Magnetic Stimulation in Psychiatric Disorders

“…In addition, their study showed that a comparison between rTMS and ECT was statistically in favor of ECT. Usually, ECT is thought to be more effective than antidepressants and rTMS and may be the most effective treatment for major depression [25]. A new meta-analysis involving 10 articles and a total of 425 patients also focused on the effects of rTMS and ECT in major depression [26], and found a superior effect for ECT versus HF rTMS on response and remission rates.…”

Electroconvulsive stimulation attenuates chronic neuroinflammation

“…Electroconvulsive therapy (ECT) is a CNS-targeted treatment that is highly effective in psychiatric disorders such as major depression and catatonic schizophrenia ( 14 ). Suggested mechanisms by which ECT affects the brain include increased hippocampal neurogenesis ( 15 ) and gliogenesis ( 16 ), elevation of trophic factors (BDNF, NGF, VEGF, FGF) ( 17 – 20 ), and modulation of various neurotransmitters ( 21 ). ECT may downregulate immune activation ( 22 ) by inhibiting its markers of cellular activation ( 23 ), microgliosis ( 24 , 25 ), altering TNF-α ( 26 ) and IL-6 ( 27 ) levels.…”

Hippocampal-subregion functional alterations associated with antidepressant effects and cognitive impairments of electroconvulsive therapy

“…These neurocognitive side-effects, subsequently, have generally resulted in negative attitudes regarding ECT among patients with depression who may otherwise benefit from the treatment (Chakrabarti et al ., 2010), although research has suggested that this is only short-lived and self-limited side effects (Semkovska and McLoughlin, 2010). The neural mechanism underlying the antidepressive effect and memory impairment associated with ECT, however, remains unclear (Jiang et al ., 2016; Nobler and Sackeim, 2008). A better understanding of these processes is needed to fine-tune ECT in order to induce less negative side effects and thus enhance the positive attitudes among patients who may benefit from it.…”