ECT in TRD: New Review

Coming out in the Journal of Neurological Sciences is this review:

The abstract is copied below:

Electroconvulsive therapy (ECT) is a treatment modality for patients with treatment

resistant depression (TRD), defined as failure of two adequate antidepressant

medication trials. We provide a qualitative review of ECT’s effectiveness for TRD,

methods to optimize ECT parameters to improve remission rates and side effect

profiles, and ECT’s proposed neurobiological mechanisms. Right unilateral (RUL)

electrode placement has been shown to be as effective for major depression as bilateral

ECT, and RUL is associated with fewer cognitive side effects. There is mixed evidence

on how to utilize ECT to sustain remission (i.e., continuation ECT, psychotropic

medications alone, or a combination of ECT and psychotropic medications). Related to

neurobiological mechanisms, an increase in gray matter volume in the hippocampus/amygdala

complex is reported post-ECT. High connectivity between the subgenual

anterior cingulate and the middle temporal gyrus before ECT is associated with better

treatment response. Rodent models have implicated changes in neurotransmitters

including glutamate, GABA, serotonin, and dopamine in ECT’s efficacy; however,

findings in humans are limited. Altogether, while ECT remains a highly effective therapy,

the neurobiological underpinnings associated with improvement of depression remain uncertain.

This is a generally reasonable review of ECT. While I am not sure who reads the Journal of Neurological Sciences, hopefully this paper will introduce ECT to some readers who are not familiar with it. I have some nits to pick about the way a few things are presented (e.g., the statement that benefits don't start until after the 3rd ECT, and the unnecessarily negative statement that mechanism of action is unknown, after an extensive section on the neurobiology of ECT), but, overall it mostly sends the right message.

Omnivores of the ECT literature will, of course, want to read this in full, ~ 25 minutes; for others, the abstract and vignette, above, should suffice.