Recently out on PubMed is this important animal study from a highly respected group of investigators at Aarhus University in Denmark:

Sustained Ultrastructural Changes in Rat Hippocampal Formation After Repeated Electroconvulsive Seizures

Fenghua Chen 1 2, Jibrin Danladi 1, Gregers Wegener 2 3 4, Torsten M Madsen 1, Jens R Nyengaard 1 5
Affiliations 
Int J Neuropsychopharmacol 2020 Mar 26[Online ahead of print]  PMID: 32215561

The pdf is here.

In a genetic animal model of depression,  this study demonstrated increased synaptic plasticity (and increases in BDNF and VEGF) after a single ECS, as well as sustained changes (at 3 months) in "the efficacy of synaptic plasticity and non-neuronal plasticity [vascular and mitochondrial]" after 10 ECS.
The importance  of these findings is that they begin to explain both the rapid and sustained antidepressant effect of ECT for an episode of depression.
That patients often begin to improve immediately after the first ECT is often ascribed to a placebo effect; these data provide compelling evidence for a biological effect that begins with the first treatment.




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