One of the most effective treatments for severe depression is electroconvulsive therapy (ECT). ECT therapy is effective not only for major depressive disorder (MDD) but also for bipolar depression. Furthermore, ECT causes a rapid reduction in suicidal intent.
Given these clinical consequences, a greater understanding of the underlying processes of ECT might lead to the development of innovative antidepressant pharmacological and neuromodulation therapies.
What are the details about the side effects of this procedure?
In both rodents and nonhuman primates, preclinical research has repeatedly demonstrated that electroconvulsive stimulation (ECS), an animal model of ECT Therapy, increases adult hippocampus neurogenesis.
ECS also induced additional neuroplastic effects such as gliogenesis, angiogenesis, and synaptogenesis, and it increased volume in the dentate gyrus of the hippocampus (DG). Furthermore, it appeared that ECS required hippocampal function.
According to our recent meta-analysis, ECT enhanced human hippocampus volume and these improvements were age-dependent, with younger persons benefiting the most.
Because the hippocampus is not a homogeneous structure but rather comprises numerous subfields with different morphology, involving the subiculum, cornu ammonis (CA), and DG, and given previous evidence of subfield-specific alterations, the effect of ECT on hippocampal subfields must be investigated.
To the best of our knowledge, just a few human investigations on the effect of ECT on hippocampus subfields have been done. Abbott et al. discovered that particular hippocampus subfields (CA1, CA2/3, subiculum, and DG) in the right hemisphere had higher volumes in 15 MDD patients who responded to 11 ECT treatments. Cao et al. reported their findings as well.
The current investigation was carried out to add to previous results of ECT-induced hippocampal volume alterations. The current study is to determine if (1) ECT may increase DG volume, (2) whether ECT-induced DG volume changes are associated with demographic variables (e.g., age) and/or clinical remission, and (3) whether DG volume increases are transitory or permanent.
Based on similar findings from animal research, it was hypothesized that ECT would increase DG volume and that clinical improvement would be connected with this volume shift.
Based on a meta-analysis, it was hypothesized that ECT-induced volume increases are inversely linked with age. In addition, it was hypothesized that structural alterations generated by ECT may be connected to long-term clinical improvement.
The ECT procedure
Each participant’s attending psychiatrist gave ECT Therapy in the clinical setting. Participation in our study did not affect any clinical decision about ECT.
A brief-pulse (0.5 ms) square-wave device was used for ECT Therapy (Thymatron system IV device; Somatics, Inc., Lake Bluff, IL, USA). Bilateral ECT was administered to participants two to three times per week. Each attending psychiatrist determined the number of sessions.
The half-age technique was used to establish the first stimulation intensity (e.g. A 60-year-old patient received the first ECT at 30 percent stimulus output of the machine).
Following ECT, an electroencephalogram (EEG) was obtained to ensure at least 20 seconds of epileptiform EEG activity. Propofol (1 mg/kg) was administered to relax the muscles, whereas succinylcholine (0.5–1.0 mg/kg) was employed.
The following are the immediate side effects of the ECT Therapy, which may last up to an hour:
- Aches and pains in the muscles
- Disorientation and perplexity
Patients may also experience memory issues. Memories formed close to the time of ECT are more likely to be lost, whereas memories formed long before ECT Therapy are less likely to be lost.
After a course of ECT treatments, the ability to form new memories is also impaired, but this ability usually recovers completely in the weeks and months following the last treatment.