How Does Electroconvulsive Therapy Work?

Nowadays the major indication for electroconvulsive therapy (ECT) in the developed world is treatment-resistant depression, and more than 100,000 patients per year receive ECT in the United States. The major focus of this chapter is ECT's antidepressant mechanism of action. Knowing how ECT works is important for several reasons. First reason, it might help optimize ECT efficacy and minimize cognitive side effects. Secondly, it could guide the development and use of other potentially efficacious treatments for depression and other conditions, both pharmacologic and somatic. Such treatments ideally would not trigger the cognitive side effects of ECT or require anesthesia. Finally, knowing how ECT works could shed light on the pathophysiology of conditions treated with ECT. This chapter starts with observations of ECT patients, reviews what is known about how ECT might work in such patients, and, finally, considers how such findings might be relevant for improving ECT patient care.