Recent Updates on Electro-Convulsive Therapy in Patients with Depression

Objective Electro-convulsive therapy (ECI) has been established as a treatment modality for patients with treatment-resistant depression and with some specific subtypes of depression. This narrative review intends to provide psychiatrists with the latest findings on the use of ECT in depression, devided into total eight sub-topics. Methods We searched PubMed for English-language articles using combined keywords and tried to analyze journals published from 1995-2020. Results Pharmacotherapy such as antidepressants or maintenance ECT is more effective than a placebo as prevention of recurrence after ECT. The use of ECT in treatment-resistant depression, depressed patients with suicidal risks, elderly depression, bipolar depression, psychotic depression, and depression during pregnancy or postpartum have therapeutic benefits. As possible mechanisms of ECT, the role of neurotransmitters such as serotonin, dopamine, gamma-aminobutyric acid (GABA), and other findings in the field of neurophysiology, neuro-immunology, and neurogenesis are also supported. Conclusion ECT is evolving toward reducing cognitive side effects and maximizing therapeutic effects. If robust evidence for ECT through randomized controlled studies are more established and the mechanism of Ecr gets further clarified, the scope of its use in the treatment of depression will be more expanded in the future.

Automated summary

ECT has been established as an effective treatment modality for patients with treatment-resistant depression and certain subtypes of depression. Studies have shown that pharmacotherapy and maintenance ECT are more effective than a placebo in preventing recurrence after ECT. ECT is evolving towards reducing cognitive side effects and maximizing therapeutic effects, with potential for further expansion in the future with more robust evidence and clarified mechanisms.