Neurobiological correlates of the antidepressant action of electroconvulsive therapy

This article reviews the major neurobiologic effects of electroconvulsive therapy (ECT) implicated in its antidepressant actions. These effects are organized into three main groups: (1) the action of ECT on the monoamine neurotransmitter system, norepinephrine, serotonin, and dopamine; (2) the neurotrophic action of ECT; and (3) the anticonvulsant effect of ECT. This review emphasizes clinical studies, but relevant animal studies are used to infer more details about changes in neurotransmitter turnover, peptides, and changes in gene expression. There are significant differences in the actions of ECT compared with antidepressant medications, for example, on monoaminergic systems, which may explain why ECT is such an effective antidepressant.