What’s new with the oldest form of brain stimulation: Innovations in ECT

Abstract

Abstract The practice of electroconvulsive therapy (ECT) continues to evolve. Changes in the nature of electrical stimulation and in intracerebral current paths have markedly reduced or eliminated ECT’s adverse cognitive side effects, while maintaining its effectiveness. Further improvements in the nature of electrical stimulation will likely involve titrating in the current domain to minimize individual differences in intracranial current density. Improvements in spatial targeting, using magnetic seizure therapy (MST) or focal electrically administered seizure therapy (FEAST), promise to further dissociate therapeutic and adverse effects, and are presently undergoing pivotal trials. The key clinical challenges facing ECT pertain to two issues: when and how to change ECT treatment technique in patients who show inadequate or slow benefit, and optimal methods for enhancing durability of benefit and reducing relapse risk. New research suggests that ECT is routinely terminated prematurely in many depressed patients resulting in unnecessarily reduced remission rates. It will be suggested that there has been a secular shift in ECT practice, where the modal patient currently receives considerably more treatments than in the past. In recent years, it has been demonstrated that ECT results acutely in widespread increases in grey matter volume. The implications of these findings will be briefly discussed. Keywords: electroconvulsive therapy, FEAST, MST, depression