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Electroconvulsive therapy (ECT), or shock therapy, remains a critical biomedical intervention for severe, treatment-resistant depression. While its origins can be traced back to Hippocrates' observations that malaria-induced convulsions alleviated mental illness, modern ECT has evolved significantly from its earlier, more primitive applications. First introduced in 1938 by Ugo Cerletti and his colleagues, ECT involves inducing controlled seizures using electrical currents. In its early...
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Updated: Oct 8, 2025

Vagus Nerve Stimulation As an Adjunctive Neurostimulation Tool in Treatment-resistant Depression
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Electroconvulsive therapy in treatment resistant depression.

Subha Subramanian1, Ruthzaine Lopez1, Charles F Zorumski1

  • 1Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, MO, USA; Department of Psychiatry, University of Texas Rio Grande Valley School of Medicine, Harlingen, TX, USA.

Journal of the Neurological Sciences
|January 3, 2022
PubMed
Summary

Electroconvulsive therapy (ECT) effectively treats treatment-resistant depression (TRD). Optimizing ECT parameters and understanding its neurobiological effects can improve outcomes for patients with major depression.

Keywords:
Electroconvulsive therapyInterventional psychiatryMajor depressive disorderNeuromodulationTreatment resistant depression

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Electroconvulsive Seizures in Rats and Fractionation of Their Hippocampi to Examine Seizure-induced Changes in Postsynaptic Density Proteins
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Area of Science:

  • Neuroscience
  • Psychiatry
  • Clinical Medicine

Background:

  • Treatment-resistant depression (TRD) is a significant clinical challenge.
  • Electroconvulsive therapy (ECT) is a primary intervention for TRD.
  • Optimizing ECT parameters and understanding its mechanisms are crucial.

Purpose of the Study:

  • To review ECT's effectiveness for TRD.
  • To explore methods for optimizing ECT parameters.
  • To discuss proposed neurobiological mechanisms of ECT.

Main Methods:

  • Qualitative review of existing literature on ECT for TRD.
  • Analysis of studies on electrode placement and remission strategies.
  • Examination of neurobiological findings, including neuroimaging and neurotransmitter research.

Main Results:

  • Right unilateral (RUL) ECT shows comparable efficacy to bilateral ECT with fewer cognitive side effects.
  • Evidence for optimal strategies to sustain remission post-ECT is mixed.
  • ECT is associated with increased gray matter volume in the hippocampus-amygdala complex.
  • Pre-treatment connectivity in specific brain regions predicts treatment response.
  • Neurotransmitter changes (glutamate, GABA, serotonin, dopamine) are implicated, but human data is limited.

Conclusions:

  • ECT is a highly effective treatment for TRD.
  • Further research is needed to clarify the neurobiological underpinnings of ECT's efficacy.
  • Optimizing ECT parameters may enhance remission rates and reduce side effects.