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18 - The paradox of electroconvulsive therapy

Published online by Cambridge University Press:  05 December 2011

Angela Merkl
Affiliation:
University Medicine
Malek Bajbouj
Affiliation:
University Medicine
Narinder Kapur
Affiliation:
University College London
Alvaro Pascual-Leone
Affiliation:
Harvard Medical School
Vilayanur Ramachandran
Affiliation:
University of California, San Diego
Jonathan Cole
Affiliation:
University of Bournemouth
Sergio Della Sala
Affiliation:
University of Edinburgh
Tom Manly
Affiliation:
MRC Cognition and Brain Sciences Unit
Andrew Mayes
Affiliation:
University of Manchester
Oliver Sacks
Affiliation:
Columbia University Medical Center
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Summary

Summary

One of the most dramatic paradoxes in psychiatry is the mechanism of action and efficacy of electroconvulsive therapy (ECT), in which people are anaesthesized and given an electric shock sufficient to produce an epileptic seizure. Although known for over 70 years, many of the hypothesized underlying mechanisms still remain unresolved and under debate. The practice of ECT has evolved into a complex procedure and its application worldwide has had extensive clinical impact in the field of neuropsychiatric disorders. Within this background, we report on current neurophysiological models of ECT, its efficacy and further questions and directions of its use. The chapter reports how the paradox that an epileptic seizure has a beneficial effect on mood has influenced our understanding of brain pathologies.

Introduction

There is arguably no treatment more negatively judged, no treatment more controversially discussed and no treatment more effective in psychiatry than electroconvulsive therapy (ECT). This treatment raises a number of different paradoxes: first, why is a highly effective treatment perceived so negatively at the same time? Second, why can this treatment work at the same time in conditions with increased dopaminergic neurotransmission (like psychosis) and in diseases with decreased dopaminergic neurotransmission (like Parkinson's disease)? Third, why does this therapy work at the same time as an intervention against depression and against mania? And fourth, the main paradox: why does a treatment based on the repetitive induction of generalized seizure activity not lead to considerable brain damage but – on the contrary – have beneficial effects?

Type
Chapter
Information
The Paradoxical Brain , pp. 321 - 331
Publisher: Cambridge University Press
Print publication year: 2011

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References

Abrams, R. 2002. Electroconvulsive Therapy, 4th Edition. Oxford: Oxford University Press.Google ScholarPubMed
Bajbouj, M., Brakemeier, E. L., Schubert, F., et al. (2005a). Repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex and cortical excitability in patients with major depressive disorder. Experimental Neurology, 196: 332–8.CrossRefGoogle ScholarPubMed
Bajbouj, M., Lang, U. E., Neu, P., & Heuser, I. (2005b). Therapeutic brain stimulation and cortical excitability in depressed patients. American Journal of Psychiatry, 162: 2192–3.CrossRefGoogle ScholarPubMed
Bajbouj, M., Lang, U. E., Niehaus, L., Hellen, F. E., Heuser, I., & Neu, P. (2006a). Effects of right unilateral electroconvulsive therapy on motor cortical excitability in depressive patients. Journal of Psychiatric Research, 40: 322–7.CrossRefGoogle ScholarPubMed
Bajbouj, M., Lisanby, S. H., Lang, U. E., Danker-Hopfe, H., Heuser, I., & Neu, P. (2006b). Evidence for impaired cortical inhibition in patients with unipolar major depression. Biological Psychiatry, 59: 395–400.CrossRefGoogle ScholarPubMed
Bocchio-Chiavetto, L., Zanardini, R., Bortolomasi, M., et al. (2006). Electroconvulsive therapy (ECT) increases serum brain derived neurotrophic factor (BDNF) in drug-resistant depressed patients. European Neuropsychopharmacology, 16: 620–4.CrossRefGoogle Scholar
Cerletti, U. (1956). Electroshock therapy. In: Sackler, A., Sackler, M., & Sackler, R. (Eds.). The Great Physiodynamic Therapies in Psychiatry. New York, NY: Hoeber-Harper.Google Scholar
Cerletti, U., & Bini, L. (1938). Un nuevo metodo di shockterapie ‘L'elettroshock’. Bolletino Accademia Medica Roma, 64: 136–8.Google Scholar
Chen, A. C., Shin, K. H., Duman, R. S., & Sanacora, G. (2001). ECS-induced mossy fiber sprouting and BDNF expression are attenuated by ketamine pretreatment. Journal of ECT, 17: 27–32.CrossRefGoogle ScholarPubMed
Dolenc, T. J., Barnes, R. D., Hayes, D. L., & Rasmussen, K. G. (2004). Electroconvulsive therapy in patients with cardiac pacemakers and implantable cardioverter defibrillators. Pacing and Clinical Electrophysiology, 27: 1257–63.CrossRefGoogle ScholarPubMed
Donahue, A. B. (2000). Electroconvulsive therapy and memory loss: a personal journey. Journal of ECT, 16: 133–43.CrossRefGoogle ScholarPubMed
Fernandes, B., Gama, C. S., Massuda, R., et al. (2009). Serum brain-derived neurotrophic factor (BDNF) is not associated with response to electroconvulsive therapy (ECT): a pilot study in drug resistant depressed patients. Neuroscience Letters, 453: 195–8.CrossRefGoogle Scholar
Fink, M. (1979). Convulsive Therapy: Theory and Practice. New York, NY: Raven Press.Google Scholar
Fink, M. (1984). Meduna and the origins of convulsive therapy. American Journal of Psychiatry, 141: 1034–41.Google ScholarPubMed
Fink, M. (2001). Convulsive therapy: a review of the first 55 years. Journal of Affective Disorders, 63: 1–15.CrossRefGoogle ScholarPubMed
Fink, M., & Taylor, M. A. (2003). Catatonia: A Clinician's Guide to Diagnosis and Treatment. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Fink, M., & Taylor, M. A. (2009). The catatonia syndrome: forgotten but not gone. Archives of General Psychiatry, 66: 1173–7.CrossRefGoogle Scholar
Fink, M., Korin, H., & Kwalwasser, S. (1956). Relation of changes in memory and learning to improvement in electroshock. Confinia Neurologica, 16: 88–96.Google ScholarPubMed
Green, A. R., & Vincent, N. D. (1987). The effect of repeated electroconvulsive shock on GABA synthesis and release in regions of rat brain. British Journal of Pharmacology, 92: 19–24.CrossRefGoogle ScholarPubMed
Husain, M. M., Rush, A. J., Fink, M., et al. (2004). Speed of response and remission in major depressive disorder with acute electroconvulsive therapy (ECT): a Consortium for Research in ECT (CORE) report. Journal of Clinical Psychiatry, 65: 485–91.CrossRefGoogle ScholarPubMed
Kayser, S., Bewernick, B., Axmacher, N., & Schlaepfer, T. E. (2009). Magnetic seizure therapy of treatment-resistant depression in a patient with bipolar disorder. Journal of ECT, 25: 137–40.CrossRefGoogle Scholar
Krishnamoorthy, E. S., & Trimble, M. R. (1999). Forced normalization: clinical and therapeutic relevance. Epilepsia, 40: S57–64.CrossRefGoogle ScholarPubMed
Landolt, H. (1953). Some clinical EEG correlations in epileptic psychoses (twilight states). EEG and Clinical Neurophysiology, 5: 121.Google Scholar
Lisanby, S. H. (2002). Update on magnetic seizure therapy: a novel form of convulsive therapy. Journal of ECT, 18: 182–8.CrossRefGoogle ScholarPubMed
Lisanby, S. H. (2007). Electroconvulsive therapy for depression. New England Journal of Medicine, 357: 1939–45.CrossRefGoogle Scholar
Lisanby, S. H., Luber, B., Schlaepfer, T. E., & Sackeim, H. A. (2003). Safety and feasibility of magnetic seizure therapy (MST) in major depression: randomized within-subject comparison with electroconvulsive therapy. Neuropsychopharmacology, 28: 1852–65.CrossRefGoogle ScholarPubMed
Lisanby, S. H., Maddox, J. H., Prudic, J., Devanand, D. P., & Sackeim, H. A. (2000). The effects of electroconvulsive therapy on memory of autobiographical and public events. Archives of General Psychiatry, 57: 581–90.CrossRefGoogle ScholarPubMed
Lisanby, S. H., Schlaepfer, T. E., Fisch, H. U., & Sackeim, H. A. (2001). Magnetic seizure therapy of major depression. Archives of General Psychiatry, 58: 303–05.CrossRefGoogle ScholarPubMed
Little, J. D., Ungvari, G. S., & McFarlane, J. (2000). Successful ECT in a case of Leonhard's cycloid psychosis. Journal of ECT, 16: 62–7.CrossRefGoogle Scholar
Malberg, J. E., Eisch, A. J., Nestler, E. J., & Duman, R. S. (2000). Chronic antidepressant treatment increases neurogenesis in adult rat hippocampus. Journal of Neuroscience, 20: 9104–10.CrossRefGoogle ScholarPubMed
Manji, H. K., & Duman, R. S. (2001). Impairments of neuroplasticity and cellular resilience in severe mood disorders: implications for the development of novel therapeutics. Psychopharmacology Bulletin, 35: 5–49.Google ScholarPubMed
Meduna, L. J. (1935). Die Konvulsionstherapie der Schizophrenie. Psychiatrisch-neurologische Wochenschrift, 37: 317–9.Google Scholar
Mervaala, E., Kononen, M., Fohr, J., et al. (2001). SPECT and neuropsychological performance in severe depression treated with ECT. Journal of Affecticve Disorders, 66: 47–58.CrossRefGoogle ScholarPubMed
Mulsant, B. H., Rosen, J., Thornton, J. E., & Zubenko, G. S. (1991). A prospective naturalistic study of electroconvulsive therapy in late-life depression. Journal of Geriatric Psychiatry and Neurology, 4: 3–13.Google ScholarPubMed
Neuhaus, A. H., Luborzewski, A., Opgen-Rhein, C., Jockers-Scherubl, M. C., & Neu, P. (2007). Electroconvulsive monotherapy in confusion psychosis: a potential standard regimen?Pharmacopsychiatry, 40: 170–1.CrossRefGoogle ScholarPubMed
Newton, S. S., Girgenti, M. J., Collier, E. F., & Duman, R. S. (2006). Electroconvulsive seizure increases adult hippocampal angiogenesis in rats. European Journal of Neuroscience, 24: 819–28.CrossRefGoogle ScholarPubMed
Nobler, M. S., & Sackeim, H. A. (2008). Neurobiological correlates of the cognitive side effects of electroconvulsive therapy. Journal of ECT, 24: 40–5.CrossRefGoogle ScholarPubMed
O'Connor, M. K., Knapp, R., Husain, M., et al. (2001). The influence of age on the response of major depression to electroconvulsive therapy: a C.O.R.E. Report. American Journal of Geriatric Psychiatry, 9: 382–90.CrossRefGoogle ScholarPubMed
Perera, T. D., Coplan, J. D., Lisanby, S. H., et al. (2007). Antidepressant-induced neurogenesis in the hippocampus of adult nonhuman primates. Journal of Neuroscience, 27: 4894–901.CrossRefGoogle ScholarPubMed
Petrides, G., Fink, M., Husain, M. M., et al. (2001). ECT remission rates in psychotic versus nonpsychotic depressed patients: a report from CORE. Journal of ECT, 17: 244–53.CrossRefGoogle Scholar
Prudic, J., Olfson, M., Marcus, S. C., Fuller, R. B., & Sackeim, H. A. (2004). Effectiveness of electroconvulsive therapy in community settings. Biological Psychiatry, 55: 301–12.CrossRefGoogle ScholarPubMed
Rajkowska, G., Miguel-Hidalgo, J. J., Wei, J., et al. (1999). Morphometric evidence for neuronal and glial prefrontal cell pathology in major depression. Biological Psychiatry, 45: 1085–98.CrossRefGoogle ScholarPubMed
Sackeim, H. A. (1999). The anticonvulsant hypothesis of the mechanisms of action of ECT: current status. Journal of ECT, 15: 5–26.CrossRefGoogle ScholarPubMed
Sackeim, H. A., Haskett, R. F., Mulsant, B. H., et al. (2001). Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial. Journal of the American Medical Association, 285: 1299–307.CrossRefGoogle ScholarPubMed
Sackeim, H. A., Prudic, J., Devanand, D. P., et al. (1993). Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. New England Journal of Medicine, 328: 839–46.CrossRefGoogle ScholarPubMed
Sackeim, H. A., Prudic, J., Devanand, D. P., et al. (2000). A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities. Archives of General Psychiatry, 57: 425–34.CrossRefGoogle ScholarPubMed
Sackeim, H. A., Prudic, J., Fuller, R., Keilp, J., Lavori, P. W., & Olfson, M. (2007). The cognitive effects of electroconvulsive therapy in community settings. Neuropsychopharmacology, 32: 244–54.CrossRefGoogle ScholarPubMed
Sackeim, H. A., Prudic, J., Nobler, M. S., et al. (2008). Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. Brain Stimulation, 1: 71–83.CrossRefGoogle ScholarPubMed
Sanacora, G., Gueorguieva, R., Epperson, C. N., et al. (2004). Subtype-specific alterations of gamma-aminobutyric acid and glutamate in patients with major depression. Archives of General Psychiatry, 61: 705–13.CrossRefGoogle ScholarPubMed
Sanacora, G., Mason, G. F., Rothman, D. L., et al. (2003). Increased cortical GABA concentrations in depressed patients receiving ECT. American Journal of Psychiatry, 160: 577–9.CrossRefGoogle ScholarPubMed
Sun, W., Choi, S. H., Park, S. K., et al. (2007). Identification and characterization of novel activity-dependent transcription factors in rat cortical neurons. Journal of Neurochemistry, 100: 269–78.CrossRefGoogle ScholarPubMed
,Task Force on Electroconvulsive Therapy. (2001). Recommendations for Treatment, Training, and Privileging. Washington, DC: American Psychiatric Publishing.Google Scholar
,UK ECT Review Group (2003). Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet, 361: 799–808.CrossRefGoogle Scholar
Vicario-Abejón, C., Collin, C., McKay, R. D., & Segal, M. (1998). Neurotrophins induce formation of functional excitatory and inhibitory synapses between cultured hippocampal neurons. Journal of Neuroscience, 18: 7256–71.CrossRefGoogle ScholarPubMed
Wahlund, B., & Rosen, D. (2003). ECT of major depressed patients in relation to biological and clinical variables: a brief overview. Neuropsychopharmacology, 28 (Suppl 1): S21–6.CrossRefGoogle ScholarPubMed

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