Electroconvulsive therapy induces cortical and subcortical structural changes in adolescents with major depressive disorder.

Electroconvulsive therapy is associated with a decrease in anhedonia and axial diffusivity in the medial forebrain bundle in major depressive disorder.

Electroconvulsive therapy modulates brain plasticity in male depression: Links to gut microbial metabolites and diet-derived regulation of Wnt/BDNF signaling.

Structural connectivity correlates of response to electroconvulsive therapy in treatment-resistant depression.

Identifying suicide attempt risk in mood disorders: A multivariate analysis from a specialized clinic.

• In an online survey 766 ECT recipients, from 41 countries, provided up to three positive and three negative outcomes. • 51 % reported only negative effects, 46 % reported a mixture of positive and negative effects and 3 % reported only positive outcomes. • The most reported positive effects were: ‘Improved Mood’ (23 %) and ‘Reduced Suicidality’ (13 %). • The most reported negative effects included: ‘Memory Loss’ (82 %), ‘Cognitive Decline’ (29 %), ‘Abused/Violated/Traumatised’ (8 %), and ‘Impaired Relationships’ (5 %). • Continued usage of ECT is dependent on future research into adverse effects besides memory loss. When assessing the efficacy and safety of any medical procedure the experiences of patients need to be considered. This paper adds to the growing body of studies asking recipients of electroconvulsive therapy about their treatment experiences. Open questions about the positive and negative effects of ECT, in an online international survey, were responded to by 776 ECT recipients, from 41 countries. About half (48.8 %) spontaneously reported one or more positive effects and almost all (96.9 %) spontaneously reported one or more negative effects. About half (51.2 %) reported only negative effects, 45.6 % reported a mixture of positive and negative effects and 3.2 % reported only positive outcomes. Content analysis found that the most reported positive effects were: ‘Improved Mood’ (23.2 %), ‘Reduced Suicidality’ (12.6 %) and ‘Reduced Psychosis’ (3.1 %). The most reported negative effects were: ‘Memory Loss’ (81.6 %), ‘Cognitive Decline’ (29.0 %), ‘Headache’ (11.1 %), ‘Abused/Violated/Traumatised’ (7.9 %), ‘Fear/Anxiety’ (6.8 %), ‘Impaired Relationships’ (5.4 %), ‘Brain Damage’ (5.0 %), ‘Can’t Work’ (4.9 %) and ‘Pain’ (4.9 %). This convenience sample may have been biased towards those with negative or positive attitudes about ECT. Some of the negative and positive effects attributed to ECT may have been the result of other factors (such as illness and age, or placebo, respectively). These results, in conjunction with previous studies, suggest the need for new, more robust, independent research into safety and efficacy. The safety component of such studies should probably include adverse effects beyond memory loss and cognitive decline.

BACKGROUND Neuroinflammation is strongly implicated in the pathophysiology of schizophrenia. Key inflammatory markers including tumor necrosis factor-alpha (TNF-α), which modulates neuronal survival and synaptic transmission; interleukin (IL)-8, a neutrophil chemoattractant involved in synapse modulation; and IL-18, which regulates neuronal plasticity and cognitive processes, show distinct alterations in acute schizophrenia. Electroconvulsive therapy (ECT) demonstrates efficacy in acute schizophrenia, yet its effects on these specific inflammatory pathways remain unclear. AIM To investigate the effects of ECT on serum cytokine levels and their association with clinical symptoms in acute schizophrenia. METHODS Seventy-seven patients with acute schizophrenia (first-episode or relapsed after 4 weeks medication discontinuation, diagnosed per Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) receiving antipsychotic treatment and 55 well-matched healthy controls were recruited. Groups were matched for age, sex, smoking status, and body mass index. Serum TNF-α, IL-8, and IL-18 were measured using Luminex technology. Clinical symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). Both PANSS and cytokines were remeasured after 8-10 ECT treatments at 48-hour intervals. RESULTS Compared to controls, patients exhibited significantly higher serum concentrations of TNF-α (t = 5.445, P < 0.001) and IL-8 (t = 9.612, P < 0.001) but lower IL-18 (t = -10.007, P < 0.001). ECT resulted in significant elevation of IL-8 and IL-18 levels (t = -3.188, P = 0.002; t = -4.682, P < 0.001, respectively), while TNF-α showed no significant change (t = -1.830, P = 0.071). Before ECT, the serum TNF-α concentration positively correlated with the PANSS general psychopathology score (r = 0.251, P = 0.028) and that of IL-8 negatively correlated with the PANSS negative symptom score (r = -0.250, P = 0.028). However, after ECT, the serum IL-8 concentration negatively correlated with the PANSS general psychopathology score (r = -0.320, P = 0.005). In ECT responders, the post-ECT serum IL-8 concentration positively correlated with a reduced PANSS positive symptom score (r = 0.414, P = 0.001). CONCLUSION ECT may mitigate the clinical symptoms of acute schizophrenia through modulation of inflammatory signaling.

BACKGROUND Schizophrenia is a severe neuropsychiatric disorder with unclear pathogenesis, although immune-inflammatory pathways are being increasingly implicated. Elevated proinflammatory cytokines are consistently observed in patients with schizophrenia, suggesting a state of chronic low-grade inflammation. Modified electroconvulsive therapy (MECT) is an effective biological intervention for treatment-resistant schizophrenia, but its mechanisms remain incompletely understood. AIM To examine the association between MECT-induced changes in immunoinflammatory markers and clinical improvement in schizophrenia. METHODS In this prospective study, 619 patients with schizophrenia underwent MECT. Peripheral immunoinflammatory markers, including monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, and systemic immune-inflammatory index (SII), were measured before and after treatment. Clinical symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). Correlation and logistic regression analyses were applied to evaluate associations, and receiver operating characteristic analysis was used to assess predictive performance. RESULTS After MECT, significant reductions were observed in PANSS scores and most peripheral inflammatory markers (MLR, NLR and SII; all P < 0.05). The decreases in MLR, NLR, and SII showed a significant positive correlation with the PANSS score reduction rate (P < 0.05). Patients with marked clinical improvement showed greater decreases in inflammatory markers. Logistic regression identifies the change in MLR before and after treatment (ΔMLR) as a strong predictor of treatment response, with each 0.1-unit increase associated with a 57% greater probability of clinical symptom improvement (odds ratios = 1.57, P < 0.001). Receiver operating characteristic analysis demonstrated that ΔMLR had significant predictive value for MECT efficacy (area under the curve = 0.731, P < 0.001), with an optimal cutoff value of 0.075. CONCLUSION MECT modulates peripheral immune inflammation in schizophrenia, and these changes correlate with clinical improvement. ΔMLR may serve as a valuable predictor of MECT treatment response.

Peripheral immune cell markers as predictors of electroconvulsive treatment response.

Practical Steps: Using Electroconvulsive Therapy in Patients With Neurodevelopmental Disorders and Catatonia.

Electroconvulsive therapy (ECT) is a highly effective treatment for depression, yet relapse rates up to 50% within a year are reported. Studies have examined ECT, pharmacological, and nonpharmacological relapse prevention strategies, and although current guidelines provide general recommendations, no consensus-based or operationalized guidance exists regarding optimal relapse prevention after successful ECT for major depressive disorder. The aims of this study were to identify relapse prevention strategies commonly implemented after ECT, to evaluate their perceived effectiveness among international ECT experts, and to establish consensus-based personalized clinical recommendations. A multiround Delphi study was conducted with a global panel of 18 ECT experts. Consensus was defined as ≥80% agreement on Likert-scale responses. Consensus was reached on key clinical factors influencing relapse prevention, including treatment resistance, psychiatric comorbidities, and prior ECT response. An essential relapse prevention strategy, namely, pharmacotherapy with lithium and an antidepressant (a tricyclic antidepressant, venlafaxine, or a prior effective antidepressant), was endorsed for all patients. Continuation ECT by means of tapering, rather than abrupt cessation, was recommended for patients at high risk of relapse and with severe or psychotic depression. Psychotherapy was considered beneficial as an adjunctive rather than a standalone treatment. No consensus was reached on the role of repetitive transcranial magnetic stimulation, esketamine, or optimal treatment duration of relapse prevention beyond 6 months. This Delphi study provides expert-based guidance on relapse prevention following successful ECT for major depressive disorder. While pharmacotherapy and continuation ECT are core strategies, personalized adjustments based on clinical risk factors remain essential. Further empirical research is needed to refine guidelines and improve long-term outcomes.

Early clinical response to electroconvulsive therapy (ECT) varies substantially across patients. The physiological expression of ECT-induced seizures, captured by routinely recorded EEG seizure duration and suppression indices together with autonomic responses, reflects interactions among cortical excitability, inhibitory processes, and peripheral activation. In younger patients, these systems may operate within a distinct physiological range, making early-session responses a particularly informative window for examining how seizure dynamics and cortical suppression relate to antidepressant effects, yet the clinical relevance of coordinated early physiological patterns remains unclear. We studied 28 young patients with major depressive disorder receiving ECT. Five routinely recorded physiological measures-stimulus dose, EEG seizure duration, EEG suppression index, systolic blood pressure change, and pulse rate change-were averaged across the first three ECT sessions and standardized. Unsupervised k-means clustering characterized early physiological response patterns, and exploratory logistic regression examined associations with early clinical improvement, defined as a ≥ 5-point reduction in HAMD-17 score by the third session. Two early physiological patterns were identified. A pattern characterized by longer seizure duration and lower EEG suppression was associated with greater early symptom improvement, despite heterogeneous autonomic responses. In regression analyses, seizure duration was positively associated with improvement, whereas EEG suppression index showed a strong negative association. Collectively, early physiological features showed clear within-sample separation between patients with and without early improvement (apparent AUC = 0.86). These findings suggest that early ECT physiology in young patients reflects coordinated response states rather than isolated markers, highlighting the potential value of multivariate interpretation of routine EEG-derived indices.

Introduction: Schizophrenia represents a leading cause of acute psychotic episodes and is frequently associated with profound social dysfunction and in severe cases, it may result in conditions posing an immediate threat to life. Management typically involves biological treatment modalities combined with psychotherapy; however, a subset of patients develops treatment resistance. Electroconvulsive therapy (ECT) remains a key intervention for overcoming pharmacoresistance, despite its limited availability in Poland. Material and method: The article present a clinical case report and a literature review based on the MEDLINE database. Results: The case study concerns a 20-year-old woman who developed a severe, prolonged psychotic state as a consequence of treatment refusal. Owing to the critical clinical condition, confirmed pharmacoresistance and progressive secondary malnutrition, ECT was initiated as a life-saving measure under the principle of medical necessity. A marked improvement in mental status was observed after the first session. Upon completion of the full ECT course, the patient was discharged home in logical contact, without psychotic symptoms, with a diagnosis of paranoid schizophrenia. Conclusions: The case supports the conclusion that ECT is an effective method for overcoming pharmacoresistance in acute psychosis and may constitute one of the most efficacious therapeutic options. In certain situations, the benefits of ECT outweigh those of pharmacotherapy alone. This case is of particular clinical relevance as it illustrates a life-saving application of ECT. The literature review further confirms the efficacy and safety of this treatment modality. Nevertheless, access to ECT in Poland remains insufficient and excessive ancillary procedural requirements reduce its cost-effectiveness, contributing to the persistence of this limitation.

Administering Electroconvulsive Therapy to Critically Ill Individuals: Risks, Monitoring, and Benefits.

Clozapine-resistant schizophrenia (CRS) is a severe condition with limited therapeutic options. Electroconvulsive therapy (ECT) has been proposed as augmentation, but its efficacy remains uncertain due to methodological limitations and inconsistent findings. This meta-analysis assessed the efficacy and safety of ECT as an adjunctive treatment in CRS. A systematic review and meta-analysis of RCTs was conducted following PRISMA guidelines. Databases were searched up to March 2025. The primary outcome was clinical response, defined in each RCT as a ≥40% to 50% reduction in positive psychotic symptoms. Secondary outcomes included response at ≥20% reduction, changes in negative/general symptoms, adverse effects, and dropouts. Three RCTs (102 participants) were included, two with sham-ECT controls. ECT significantly increased response compared with control for the primary outcome (RR = 5.63; 95% CI: 1.00 to 31.57; P = 0.04; I² = 0%), but showed no difference at the ≥20% threshold (RR = 1.96; 95% CI: 0.45 to 8.44; P = 0.36; I² = 55%). Other secondary outcomes were not pooled due to heterogeneity. ECT was generally well tolerated, with a low dropout rate. The primary outcome was driven by one large-effect study without sham-ECT and using clozapine monotherapy as control, while sham-controlled studies showed no significant benefit. The absence of differences at the ≥20% response threshold likely reflects the sham-ECT effects. Although underpowered, this outcome was reported to discuss active placebo effects. Given CRS severity and limited options, ECT may still be considered in selected cases, but further high-quality sham-controlled RCTs with standardized protocols are required.

Depression is a complicated, long-lasting, and recurrent mental illness that has a major impact on emotional, cognitive, and physical functioning and has a huge negative impact on global health. The World Health Organization (WHO) estimates that over 280 million people worldwide suffer from depression, making it a substantial contributor to the global illness burden and a primary cause of disability. In addition to lowering quality of life, the disorder raises the risk of morbidity and mortality, especially from suicide and related illnesses including diabetes and cardiovascular disease. Depression has a complex etiology that includes genetic, neurological, psychological, and environmental factors. Additionally, there is growing evidence that oxidative stress and inflammatory cytokines have a role in the neuroprogression of depression. An integrative approach that combines medication, psychotherapy, and lifestyle changes is used to treat depression. The first-line pharmaceutical treatments are still antidepressants such selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and atypical antidepressants. Psychotherapeutic approaches including interpersonal therapy (IPT) and cognitive-behavioral therapy (CBT) have also demonstrated notable effectiveness in enhancing results. Electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and ketamine-based therapies are being used more frequently for treatment-resistant cases. The potential of probiotics, anti-inflammatory drugs, and nutraceuticals as supplemental therapies has also been emphasized by recent studies. An extensive grasp of depression, including its epidemiology, symptomatology, etiology, neurobiological underpinnings, diagnostic techniques, and treatment developments, is the goal of this review. It highlights the significance of early detection, individualized treatment, and holistic care in effectively managing depression by combining recent research.

Electroconvulsive therapy induces rapid microstructural and macrostructural changes, but microstructural changes are longer-lasting.

Electroconvulsive therapy (ECT) is a well-established treatment for severe depressive episodes, but its effect on subsequent occupational functioning remains unclear. This study examined labour market trajectories among individuals with major depression treated with ECT, compared to similar individuals with depression who did not receive ECT. This population-based cohort study included all patients aged 15-55 with a first-time hospital contact for major depression (ICD-10 codes F32 and F33) in Denmark between 2000 and 2022. Patients treated with ECT were identified using the Danish National Patient Registry and matched 1:5 by age and sex to patients not treated with ECT. Labour market outcomes were assessed using data from the Danish Register for Evaluation of Marginalisation, tracking changes in employment and social transfer payments from one year before to three years after ECT/matching. Sequence analysis and Cox proportional hazards regression were used to evaluate time to regained employment, categorized as ≤6months, 7-12months, and 1-3years. We included 6672 ECT-treated patients and 27,940 matched non-ECT individuals. At baseline, ECT patients had lower employment rates (6.9% vs. 39.5%) but higher education and marriage rates. ECT was associated with slower return to work within 6months (adjusted HR: 0.59, 95% CI: 0.54-0.64), but similar or faster return at 7-12months (HR: 1.12, 95% CI: 1.01-1.24) and 1-3years (HR: 1.05, 95% CI: 0.96-1.14). ECT was linked to delayed short-term occupational recovery, but comparable or improved long-term return to work, supporting its continued use in treating major depression.

Effect of electroconvulsive therapy on neural oscillations in schizophrenia: A magnetoencephalography resting-state study.

Magnetic seizure therapy preserves delayed memory and 40-Hz auditory steady-state responses compared with electroconvulsive therapy in schizophrenia.