ECT in Treatment-Resistant Depression

Abstract

Electroconvulsive therapy (ECT), which has been in use for 75 years, is an important treatment for severe and treatment-resistant depression. Although it is acknowledged as the most effective acute treatment for severe mood and psychotic disorders, it remains controversial because of misperceptions about its use and lack of familiarity among health care professionals about modern ECT technique. The authors present an illustrative case of a patient for whom ECT is indicated. They review the basic and clinical science related to ECT's mechanism of action and discuss clinical issues in the administration of a course of ECT, including the consent process.

Effect of Electroconvulsive Therapy on Striatal Morphometry in Major Depressive Disorder

“…For example, electroshock-the animal model of ECT-stimulates neurogenesis in the hippocampus of rodents (Malberg et al, 2000) and non-human primates (Perera et al, 2007). As adult neurogenesis occurs in the hippocampal dentate gyrus, in line with a neurotrophic model of antidepressant response (Kellner et al, 2012;Fosse and Read, 2013), several prior structural imaging studies of ECT in humans showed ECTrelated increases in hippocampal volume (Duman, 2002;Nordanskog et al, 2010;Tendolkar et al, 2013;Abbott et al, 2014;Jorgensen et al, 2015). In a sample overlapping with the current study, we also observed changes in hippocampal morphometry with ECT and relationships with symptom improvement .…”

“…Antidepressants and behavioral therapy are the most frequently prescribed treatments, but up to a third of patients remain unresponsive to initial treatment (Trivedi et al, 2006). With a rapid and high response rate, electroconvulsive therapy (ECT) is typically used after other failed treatments and can be particularly beneficial in suicidal, psychotic, or catatonic depression (Kellner et al, 2012). However, the neural mechanisms underlying clinical response to ECT remain uncertain.…”

“…However, whether structural plasticity occurs in the dorsal or ventral striatum/pallidum in association with treatment and illness recovery remains unknown. As full response to ECT may be observed in only 2-4 weeks (Kellner et al, 2012), using ECT as a treatment model may identify predictors and correlates of response over shorter time intervals where effects are expected to overlap with antidepressant therapies. We thus performed volumetric and shape-based analyses to investigate whether morphological changes are detectable before and after ECT in four constituents of the ventral basal ganglia: the caudate, putamen, pallidum, and nucleus accumbens.…”

Autism-Like Behavior in BTBR Mice Is Improved by Electroconvulsive Therapy

“…ECT represents an effective treatment of pharmacoresistant cases of depression [29][30][31], bipolar disorder [32], and schizophrenia [33,34]. Mechanisms underlying the therapeutic effects of ECT remain largely elusive, with 2 major hypotheses dominating: the anticonvulsant, whereby the effects are attributed to the increase of seizure threshold and decrease of seizure duration observed during the course of ECT [35], and the neurotrophic, which brings in the induction of several neurotrophic factors (e.g., brain-derived neurotrophic factor, vascular endothelial growth factor), transcription factors (e.g., cfos), and neurogenesis as explanations [36,37].…”

Patient with Prolonged Psychosis after Electroconvulsive Therapy

“…Multiple theories describing variations on neurotransmitters causing changes in pituitary hormones and increased neural plasticity or synaptogenesis 1,9 have been developed to explain the mechanism by which ECT works. The monoamine neurotransmitter theory postulates that ECT alters dopamine, serotonin, and adrenergic transmitters by augmenting receptor sensitivity or neurotransmitter availability.…”