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Review
. 2024 Jan;49(1):150-162.
doi: 10.1038/s41386-023-01677-2. Epub 2023 Jul 24.

How electroconvulsive therapy works in the treatment of depression: is it the seizure, the electricity, or both?

Zhi-De Deng  1 , Pei L Robins  1 , William Regenold  1 , Paul Rohde  1 , Moritz Dannhauer  1 , Sarah H Lisanby  2
Affiliations
Review

How electroconvulsive therapy works in the treatment of depression: is it the seizure, the electricity, or both?

Zhi-De Deng et al. Neuropsychopharmacology. 2024 Jan.

Abstract

We have known for nearly a century that triggering seizures can treat serious mental illness, but what we do not know is why. Electroconvulsive Therapy (ECT) works faster and better than conventional pharmacological interventions; however, those benefits come with a burden of side effects, most notably memory loss. Disentangling the mechanisms by which ECT exerts rapid therapeutic benefit from the mechanisms driving adverse effects could enable the development of the next generation of seizure therapies that lack the downside of ECT. The latest research suggests that this goal may be attainable because modifications of ECT technique have already yielded improvements in cognitive outcomes without sacrificing efficacy. These modifications involve changes in how the electricity is administered (both where in the brain, and how much), which in turn impacts the characteristics of the resulting seizure. What we do not completely understand is whether it is the changes in the applied electricity, or in the resulting seizure, or both, that are responsible for improved safety. Answering this question may be key to developing the next generation of seizure therapies that lack these adverse side effects, and ushering in novel interventions that are better, faster, and safer than ECT.

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Conflict of interest statement

ZD is inventor on patents and patent applications on electrical and magnetic brain stimulation therapy systems held by the National Institutes of Health (NIH), Columbia University, and University of New Mexico. SHL is inventor on patents and patent applications on electrical and magnetic brain stimulation therapy systems held by the NIH and Columbia University. The remaining authors have nothing to disclose. The opinions expressed in this article are the author’s own and do not reflect the views of the NIH, the Department of Health and Human Services, or the United States government.

Figures

Fig. 1
Fig. 1. Seizure and nonseizure modalities for treatment of depression.
Conventional ECT techniques, with standard right unilateral (RUL), bifrontal (BF), and bitemporal (BT) electrode placements, and experimental technique such as focal electrically administered seizure therapy (FEAST), involve the use of high amplitude E-field for seizure induction. With conventional ECT, the E-field and seizure are always coupled, which does not allow for the study their relative contribution to clinical outcome and cognitive side effects. Techniques that use low amplitude currents for seizure induction include: low amplitude ECT (LAMP), frontomedial (FM) ECT, magnetic seizure therapy (MST), and individualized low amplitude seizure therapy (iLAST). The use of chemoconvulsant for seizure induction involves no use of electricity. These techniques allow us to test the hypothesis that the seizure drives efficacy while the E-field drives side effects. Transcranial electrical stimulation therapy (TEST) is a nonconvulsive modality that use high amplitude E-field. TEST allows us to evaluate the hypothesis that sufficiently high amplitude E-field drive efficacy while the seizure drives side effects. Finally, transcranial magnetic stimulation (TMS) is another nonconvulsive modality that use low amplitude E-field, which allows us to test the hypothesis that low amplitude stimulation, applied repetitively, have a cumulative effect on efficacy with minimal side effects.
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References

    1. APA. The Practice of Electroconvulsive Therapy: Recommendations for Treatment, and Privileging: A Task Force Report of the American Psychiatric Association. American Psychiatric Association: Washington, D.C.; 2001.
    1. Lisanby SH. Electroconvulsive therapy for depression. N. Engl J Med. 2007;357:1939–45. doi: 10.1056/NEJMct075234. - DOI - PubMed
    1. Peterchev AV, Rosa MA, Deng Z-D, Prudic J, Lisanby SH. Electroconvulsive therapy stimulus parameters: rethinking dosage. J ECT. 2010;26:159–74. doi: 10.1097/YCT.0b013e3181e48165. - DOI - PMC - PubMed
    1. Sackeim HA, Prudic J, Nobler MS, Fitzsimons L, Lisanby SH, Payne N, et al. Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. Brain Stimul. 2008;1:71–83. doi: 10.1016/j.brs.2008.03.001. - DOI - PMC - PubMed
    1. Loo CK, Katalinic N, Martin D, Schweitzer I. A review of ultrabrief pulse width electroconvulsive therapy. Ther Adv Chronic Dis. 2012;3:69–85. doi: 10.1177/2040622311432493. - DOI - PMC - PubMed