Convulsive therapy and endogenous depression

Since the introduction of seizures as a therapy in psychiatry in 1934, much has been learned about the target populations, modes of induction, means to make the treatment safer, and the mechanisms underlying the therapeutic process. The repeated and spaced induction of seizures relieves the symptoms of severe depressive psychoses. The presence of vegetative symptoms is a predictor of good outcome, and brain stem stimulation is a feature of successful treatment. The safest inductions are those using barbiturate and succinylcholine anesthesia, hyperoxygenation, unilateral electrode placements, and minimal inducing currents. Patients with severe depression present neuroendocrine abnormalities, which return to normal with convulsive therapy. Recently, peptides of hypothalamic origin have been identified which have behavioural and mood altering effects. From these experiences, we suggest that the antidepressant efficacy of convulsive therapy results from the increased release and greater penetration into the brain of hypothalamic peptides with behavioral effects.