How Electroconvulsive Therapy Works?: Understanding the Neurobiological Mechanisms

Abstract

Electroconvulsive therapy (ECT) is a time tested treatment modality for the management of various psychiatric disorders. There have been a lot of modifications in the techniques of delivering ECT over decades. Despite lots of criticisms encountered, ECT has still been used commonly in clinical practice due to its safety and efficacy. Research evidences found multiple neuro-biological mechanisms for the therapeutic effect of ECT. ECT brings about various neuro-physiological as well as neuro-chemical changes in the macro- and micro-environment of the brain. Diverse changes involving expression of genes, functional connectivity, neurochemicals, permeability of blood-brain-barrier, alteration in immune system has been suggested to be responsible for the therapeutic effects of ECT. This article reviews different neurobiological mechanisms responsible for the therapeutic efficacy of ECT.

Short- and long-term efficacy of electroconvulsive stimulation in animal models of depression: The essential role of neuronal survival

“…Electroconvulsive Therapy (ECT) is a very effective treatment for drug-resistant major depressive disorder and bipolar disorder, as well as acute resistant schizophrenia [1]. Multiple mechanisms modifying the brain's macro-and micro-environment have been proposed to support the therapeutic effect of ECT, including changes in neurotransmission, gene expression, functional connectivity, or even modifications to the neuroendocrine and immune systems [2]. These theories of how ECT works were mainly developed based on results obtained from electroconvulsive stimulation (ECS), the animal equivalent of ECT [3].…”

Transcranial pulsed electromagnetic fields for treatment-resistant depression: A multicenter 8-week single-arm cohort study

“…Decades of research has been performed to elucidate the mechanism of ECT and indicates involvement of numerous biologic processes, including alterations in neuroplasticity, levels of various neurotrophic factors and neurotransmitters, functional connectivity, immune mechanisms, neuroendocrine function, as well as epigenetic processes [22]. Our study indicates that T-PEMF may have an effect in some ECT nonresponders, which may imply a different neurobiological effect.…”

The Role of Activity-Dependent DNA Demethylation in the Adult Brain and in Neurological Disorders

“…Moreover, a reduction in expression levels of the immediate early gene Arc was also associated with reduced levels of GADD45B and DNA demethylation in this stress model (Grassi et al, 2017 ). Although its neurobiological underpinnings have not been fully understood, electroconvulsive therapy (ECT) is currently in clinical practice for the treatment of several psychiatric diseases including depression (Singh and Kar, 2017 ). In an animal model ECT reduces the methylation levels of Bdnf 9 promoter, hence inducing the mRNA expression of the gene, however, in the transgenic mice model in which Gadd45b was knocked out the effect of ECT on the Bdnf IX promoter methylation level is abolished and mRNA expression is perturbed (Ma et al, 2009 ).…”