Published online Nov 19, 2023. doi: 10.5498/wjp.v13.i11.949
Peer-review started: September 13, 2023
First decision: September 28, 2023
Revised: October 7, 2023
Accepted: October 28, 2023
Article in press: October 28, 2023
Published online: November 19, 2023
Major depressive disorder (MDD) is a prevalent mental health condition characterized by persistent feelings of sadness and loss of interest. Traditional treatments for MDD, such as medications and therapy, often have limited effectiveness and can lead to undesirable side effects. Electroconvulsive therapy (ECT) is an alternative treatment that uses electrical currents to induce controlled brain seizures, resulting in rapid and potent antidepressant effects. However, ECT is associated with misconceptions, controversies, and stigmatization, which hinder its wider acceptance and utilization.
The main theme of this study is to evaluate the efficacy and safety of ECT compared to medication and/or therapy in patients with severe MDD. The key problems that need to be addressed are the limited effectiveness and undesirable side effects of traditional treatments for MDD, which often lead to treatment failure. Despite its rapid and potent antidepressant effects, ECT faces misconceptions, controversies, and stigmatization, resulting in its underutilization.
The main objective of this study was to evaluate the efficacy and safety of ECT compared to medication and/or therapy in individuals with severe MDD. The specific goals accomplished were as follows: (1) Variation in the hamilton depression rating scale (HDRS) scores between the ECT and non-ECT groups over a 12-wk period; (2) improvements in the quality of life and cognitive function between the ECT and non-ECT groups were compared; (3) variations in the levels of brain-derived neurotrophic factor (BDNF) and interleukin-6 (IL-6), potential biomarkers of neuroplasticity and inflammation, respectively, between the ECT and non-ECT groups; and (4) evaluation of the safety and tolerability of ECT compared to medication and/or therapy. The achievement of these objectives has significant implications for future research. First, it provided evidence supporting the superior efficacy and safety of the ECT as a treatment option for individuals with severe MDD who do not respond to traditional therapy. This challenges the prevailing misconceptions and stigmatization surrounding ECT and encourages further investigation and acceptance of this modality. Second, the identification of biomarkers influenced by ECT opens avenues for future studies to explore the underlying mechanisms of its antidepressant effects and potentially identify predictors of treatment response. Overall, this study contributes to optimizing therapeutic approaches for severe MDD and guides future research toward better understanding and improved treatment outcomes for affected individuals.
A prospective cohort design was used to achieve the research objectives. The study included 220 individuals with severe MDD who were divided into the ECT and non-ECT groups. In the ECT group, bilateral ECT was administered three times a wk until remission was achieved or a maximum of 12 sessions were reached. The non-ECT group received medication and/or therapy according to clinical guidelines for MDD. The HDRS score was used as the primary outcome measure, with variations in scores assessed from the beginning to 12 wk. In addition to the HDRS score, this study measured the patients’ quality of life, cognitive abilities, and biomarkers throughout the study. The biomarkers of interest were BDNF and IL-6, which are indicators of neuroplasticity and inflammation, respectively. The collected data were analyzed using appropriate statistical methods, such as t-tests or analysis of variance, to compare the outcomes between the ECT and non-ECT groups. The study also assessed the safety and tolerability of ECT compared to medication and/or therapy by monitoring and documenting any side effects experienced by the participants. The novelty of this study lies in its comprehensive evaluation of the efficacy, safety, and biomarker influences of ECT compared to conventional treatments for severe MDD. By incorporating multiple outcome measures and biomarker assessments, this study provides a holistic understanding of the effects of ECT on depressive symptoms, well-being, cognitive function, neuroplasticity, and inflammation. This prospective cohort design allows the observation of treatment outcomes over time and contributes to a growing body of evidence supporting the potential advantages of ECT as a therapeutic approach for treatment-resistant MDD.
The results of this study indicated that ECT was more effective and safer than medication and/or therapy for severe MDDs. Both the ECT and non-ECT groups showed significant improvements in the HDRS scores over the 12-wk period. However, the ECT group demonstrated a more pronounced improvement in depressive symptoms than that of the non-ECT group. Moreover, the ECT group exhibited greater improvements in quality of life and cognitive function. The study also revealed that the ECT group had lower variations in the levels of BDNF and IL-6 compared with the non-ECT group. This suggests that ECT influences neuroplasticity and inflammation, potentially contributing to its therapeutic effects. These findings highlight the superior efficacy and safety of ECT as a treatment option for severe MDD, particularly in cases where traditional therapies fail. This study emphasizes the potential advantages of ECT in mitigating depressive symptoms, improving well-being, and enhancing cognitive capabilities. Furthermore, the exploration of biomarkers provides insights into the mechanisms underlying the effects of ECT and opens avenues for future research on personalized treatment approaches. Despite these positive outcomes, further investigations are required to address certain unresolved questions. Future studies should focus on the long-term effects, potential mechanisms of action, and comparisons between ECT and emerging treatment modalities. Further research is necessary to optimize therapeutic approaches, address stigmatization, and improve outcomes in patients with treatment-resistant MDD.
The conclusions of this study indicate that ECT is a potentially advantageous therapeutic approach for individuals with severe MDD who do not respond to traditional treatments. This study found that ECT is safer and more potent than medication and/or therapy in mitigating depressive symptoms, enhancing well-being, and bolstering cognitive capabilities. This study also demonstrated that ECT may influence the levels of BDNF and the cytokine IL-6, indicators of neuroplasticity and inflammation, respectively. This study provides new evidence for the efficacy and safety of ECT as a treatment option for severe MDD and challenges the misconceptions and stigma surrounding this alternative therapy. These findings have implications for the development of new therapeutic approaches for MDD and underscore the need for further research in this area.
Future studies in this field should focus on several aspects. First, further investigations are needed to examine the long-term effects of ECT on depressive symptoms, quality of life, and cognitive function in individuals with MDD. Longitudinal studies can provide valuable insights into the durability of the effects of ECT and its potential as maintenance therapy. Additionally, future research should explore the underlying mechanisms of ECT, particularly its influence on neuroplasticity and inflammatory markers such as BDNF and IL-6. Understanding these mechanisms could guide the development of targeted interventions and improve treatment outcomes. Moreover, studies should be conducted to directly compare ECT with other emerging treatments, such as transcranial magnetic stimulation or ketamine infusion therapy, to determine the most effective and personalized treatment options for different subgroups of patients with MDD. These research perspectives can contribute to advancing the field and optimizing therapeutic approaches for patients with severe MDD.