NARSAD Grant-Funded Research Demonstrates How ECT Improves Symptoms of Depression

NARSAD Young Investigator Grantee Dr. Rupert Lanzenberger and colleagues at the Medical University of Vienna, in Austria expert on depression
Dr. Rupert Lanzenberger

Electroconvulsive therapy (ECT) has been used successfully for 70 years to relieve symptoms of major depression. Remarkably, though, precise details about how it acts on the brain to produce this effect was unknown—until NARSAD Young Investigator Grantee Dr. Rupert Lanzenberger and colleagues at the Medical University of Vienna, in Austria, recently performed a series of brain scans on a group of 12 patients.

Their results, published in the journal Molecular Psychiatry this month, show that ECT, like other major forms of antidepressant treatment, acts directly on the function of a class of keyhole-like receptors for the neurotransmitter serotonin. These receptors, one of many subtypes of receptors for serotonin, are called the 5-HT1A, or serotonin 1A receptors. They can be found in many places in the brain, including areas such as the hippocampus, cingulate cortex, and amygdale; these areas help regulate emotion and mood, and are thought to be prime areas in which nerve-cell or circuit dysfunctions involved in depression are centered.

Dr. Lanzenberger’s team performed positron emission tomography (PET) scans on the dozen patients in the study, all of whom met the typical standard for ECT treatment: each had been diagnosed with major depression, and none had achieved remission with a minimum of two antidepressant medications of differing classes. Each patient had two PET scans prior to ECT, while still on medication; and one PET scan a week following treatment with ECT. Ten of the 12, or 83%, experienced a remission. And among these 10, a comparison of before-ECT and after-ECT scans revealed “a widespread reduction” in the binding of the serotonin 1A receptor after treatment, with the greatest changes taking place in those areas just mentioned that are involved in emotional regulation.  

The observed “global decrease” in the binding of the receptors following ECT suggests that this form of antidepressant therapy, when it succeeds, does so for at least some of the same reasons that other treatments succeed, such as SSRI (selective serotonin reuptake inhibitor) antidepressant drugs, such as Paxil (paroxetine), Prozac (fluoxetene), Zoloft (sertraline). The study thus provides further insight into the underlying causes of major depression.

Read the original article from Molecular Phsychiatry

Article comments

Interesting article. I had a clear of my symptoms of severe depression for quite awhile after my series of ECT treatments I was disappointed, however, that the positive effects were not long lasting. I also think patients should be made very aware that the loss of memory during and right after the ECT treatments can be permanent. My last series was 6 years ago, due to new medicines and a great psychiatrist, but I have yet to regain my memory of times during and immediately following the treatments. Sadly, my son's high school graduation, where he addressed (I'm told eloquently) his fellow classmates is something I have absolutely no memory of whatsoever. Also, I have no memory of my daughter announcing her engagement, (though I'm told I was overjoyed). Precious times lost forever.

This is an excellent work that adds to our understanding on how rapid antidepressant therapies work. Although authors discuss on a possible reset of 5-HT1A receptors in terminal areas as a consequence of ECT, could it be possible that decreased 5-HT1A binding in projection areas reflected a response to an increased serotonergic release? Interestingly, this does not seem to occur in the dorsal raphe, which would be beneficial for a rapid antidepressant response inasmuch as 5-HT1A autoreceptors are not stimulated.

I also found this interesting. While I think ECT saved my life, it was indeed very short acting, thus requiring many many treatments to keep me going. As time went on I lost more short term memories and then long term memories. The temporary benefits I was receiving were shorter and shorter as I struggled to function with such impaired memory. It made socializing almost impossible because I couldn't remember friends names, when I last saw them, what we did/said, etc.. I had trouble unloading the dishwasher and other chores that needed memory to complete (putting away items not used all the time, where grocery items were located, etc.). I also got lost driving to locations that I should have known well. I don't think enough attention has been given to this debilitating side effect of ECT, nor is this risk being communicated to all potential ECT users. If I hadn't been accepted into an experimental study that put me into remission, I would have committed suicide because of the depression AND the effects of the ECT!

I am desperately trying to find a way to remission. How do you find studies that you can partake in?

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