Precision Seizure Therapy: Towards safer and personalized depression care for the future

Abstract

Electroconvulsive therapy (ECT) has evolved throughout the past century, including the introduction of anesthesia, new electrode placements, modifications in the shape of the electrical pulse, and individualization of dosage. Each innovation has made the treatment safer and had a major impact on clinical care for persons with severe depression, however cognitive side effects continue to affect its use, and we still need effective methods to select those most likely to respond as well as to predict individual dosage requirements. Will seizure therapy in the future be even safer, faster acting, more precisely targeted, and personalized? We hope the answer to all of these questions is “yes.” To get to “yes”, we as a field need to conduct the research necessary to answer other key questions such as “what are the mechanisms underlying the antidepressant effects and cognitive side effects”, “how can we tailor the treatment to maximize efficacy while minimizing side effects,” and “how can we identify those most likely to respond and at what phase of their illness?” This presentation will review the rational development of experimental forms of seizure therapy, including magnetic seizure therapy (MST) and individualized low amplitude seizure therapy (iLAST), as examples illustrating how improving the focality and individualization of the seizure inducing stimulus may improve the risk/benefit ratio of seizure therapy in the future. These focal approaches to inducing therapeutic seizures present unparalleled scientific opportunities to probe mechanisms of action of our most rapidly acting and effective anti-suicide intervention available today. Such knowledge could inform the development of more targeted and safer treatments for our most severely ill psychiatric patients. Removing barriers that prevent patients from accessing highly effective treatments such as seizure therapy may be key to lowering the suicide rate and improving functional health outcomes in persons with severe depression.