Mechanism of Action of ECT in Depression: New Review

 Out on PubMed, from investigators in Belgium and The Netherlands, is this review book chapter:

Mechanism of Action of ECT in Depression.

Belge JB, van Eijndhoven P, Mulders PCR.Curr Top Behav Neurosci. 2023 Nov 15. doi: 10.1007/7854_2023_450. Online ahead of print.PMID: 37962811

The abstract is copied below:

Electroconvulsive therapy (ECT) remains the most potent antidepressant treatment available for patients with major depressive disorder (MDD). ECT is highly effective, achieving a response rate of 70-80% and a remission rate of 50-60% even in treatment-resistant patients. The underlying mechanisms of ECT are not fully understood, although several hypotheses have been proposed, including the monoamine hypothesis, anticonvulsive hypothesis, neuroplastic effects, and immunomodulatory properties. In this paper, we provide an overview of magnetic resonance imaging evidence that addresses the neuroplastic changes that occur after ECT at the human systems level and elaborate further on ECTs potent immunomodulatory properties. Despite a growing body of evidence that suggests ECT may normalize many of the structural and functional changes in the brain associated with severe depression, there is a lack of convergence between neurobiological changes and the robust clinical effects observed in depression. This may be due to sample sizes used in ECT studies being generally small and differences in data processing and analysis pipelines. Collaborations that acquire large datasets, such as the GEMRIC consortium, can help translate ECT's clinical efficacy into a better understanding of its mechanisms of action.

This is a book chapter that I do not yet have full access to. However, based on the authors, I am quite certain that it is excellent and comprehensive. Can't wait to read it and see if it is likely to eventually attain "Classic" status.