Why Electroconvulsive Therapy Worksby Lindsey Kay, MD | February 10, 2008
Electroconvulsive therapy (ECT) has a bad reputation, due in part to the graphic media portrayals we see in films like One Flew Over the Cuckoo’s Nest and A Beautiful Mind, and probably also in part to an innate distaste for the idea of receiving electrical shocks to the brain.
Despite the popular disgust for this treatment, ECT is still used in patients with psychiatric disorders that have not responded to other therapies, most commonly major depression and bipolar disorder. In these severely affected patients, who have tried counseling, medication and hospitalization to no avail, ECT often provides a huge improvement in their mental state, with 80 to 90 percent of patients responding to ECT. New research suggests that the effects of ECT may be associated with proliferation of brain cells.
Researchers used rats to looked at the effects of ECT on the prefrontal cortex, an area of the brain linked to emotional function, and with physical connections to the amygdala and hypothalamus, also involved in emotional processing. Patients with mood disorders have decreased activity and a reduction in glial cells (“support cells” to the active neurons) in the prefrontal cortex. In this study, rats were treated with ECT and then evaluated for cellular changes in this area.
The study showed ECT to stimulate increased production of glial cells, the exact cells that are decreased in mood disorders. The increase in cellular growth persisted for four weeks after treatment. These findings agree with earlier studies that showed ECT to increase cell proliferation in other emotional control centers, including the amygdala and hippocampus.
ECT was initiated as therapy many years ago, long before the mechanisms behind its effects were understood. Most rational people would scoff at the idea of electrocuting the brain to treat any disease, and this is reflected in popular culture. I don’t doubt that there are plenty of people out there with horror stories related to ECT and its adverse effects. But there is also a large population of people who can thank ECT for saving their life when nothing else worked.
However, desperate times call for desperate measures. ECT is now reserved for only the most severe cases, and can provide life-changing improvements for very sick people. It’s nice to see scientifically sound support for a treatment that has such a negative connotation. Hopefully, evidence such as this will allow patients to feel a measure of ease with a procedure that, in and of itself, is frightening.
Ongur D et al. Electroconvulsive Seizures Stimulate Glial Proliferation and Reduce Expression of Sprouty2 within the Prefrontal Cortex of Rats. Biol Psychiatry. 2007 Sep 1;62(5):505-12. Epub 2007 Mar 6.
Mental Context – A Delicate Subject
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