ECT Does NOT Cause Brain Damage- a Narrative Review

 Out on PubMed, from colleagues in Chandigarh, India, is this article:

Does electroconvulsive therapy cause brain damage: An update.

Jolly AJ, Singh SM.Indian J Psychiatry. 2020 Jul-Aug;62(4):339-353. doi: 10.4103/psychiatry.IndianJPsychiatry_239_19. Epub 2020 Jul 27.PMID: 33165343 

The abstract is copied below:

Electroconvulsive therapy (ECT) is an effective modality of treatment for a variety of psychiatric disorders. However, it has always been accused of being a coercive, unethical, and dangerous modality of treatment. The dangerousness of ECT has been mainly attributed to its claimed ability to cause brain damage. This narrative review aims to provide an update of the evidence with regard to whether the practice of ECT is associated with damage to the brain. An accepted definition of brain damage remains elusive. There are also ethical and technical problems in designing studies that look at this question specifically. Thus, even though there are newer technological tools and innovations, any review attempting to answer this question would have to take recourse to indirect methods. These include structural, functional, and metabolic neuroimaging; body fluid biochemical marker studies; and follow-up studies of cognitive impairment and incidence of dementia in people who have received ECT among others. The review of literature and present evidence suggests that ECT has a demonstrable impact on the structure and function of the brain. However, there is a lack of evidence at present to suggest that ECT causes brain damage.

Keywords: Adverse effect; brain damage; electroconvulsive therapy.

The pdf is here.

And from the text:

...Thus, a review of the current evidence amply demonstrates that from looking for ECT-related brain damage – and finding none, we have now moved ahead to looking for a mechanistic understanding of the effect of ECT. In this regard, it has been found that ECT does induce structural changes in the brain – a fact which has been seized upon by some to claim that ECT causes brain damage.[46] Such statements should, however, be weighed against the definition of damage as understood by the scientific medical community and patient population. Neuroanatomical changes associated with effective ECT can be better described as ECT-induced brain neuroplasticity or ECT-induced brain neuromodulation rather than ECT-induced brain damage.

...Our titular question is whether ECT leads to brain damage, where damage indicates destruction or degeneration of nerves or nerve tracts in the brain, which leads to loss of function. This issue was last addressed by Devanand et al. in 1994 since which time our understanding of ECT has grown substantially, helped particularly by the advent of modern-day neuroimaging techniques which we have reviewed in detail. And, what these studies reveal is rather than damaging the brain, ECT has a neuromodulatory effect on the brain. The various lines of evidence – structural neuroimaging studies, functional neuroimaging studies, neurochemical and metabolic studies, and serum BDNF studies all point toward this.

I am pleased to report that this is an excellent and scholarly review. It is quite comprehensive, well referenced and well written. 

I would take issue with a couple of aspects of the piece: 1) the discussion of cognition does not strongly enough state that cognitive effects do not imply "brain damage" and 2) the title is unfortunate. Teaser/sensational titles may be fine for CNN, but not for the serious clinical medical literature, particularly with ECT, when out-of-context citation by anti-psychiatry forces can do so much harm. Better to give the results in the title,  such as "No Evidence of Brain Damage with ECT..."

The conclusions of this review are timely and important, given the recent spate of lawsuits in the United States alleging "brain damage" from ECT.

I recommend a full read (about 30 minutes) to all involved in ECT practice.