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Electroconvulsive therapy—a shocking inducer of neuroplasticity?

Molecular Psychiatry volume 29, pages 35–37 (2024)Cite this article

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In our recent review [1], we discussed how pharmacological therapies share some common mechanisms in modulating neuroplasticity and reverse some of the neuropathology observed in untreated major depressive disorder (MDD). We reviewed the utility of a rapid-acting agent like ketamine, that delivers an antidepressant response (decrease in depression severity) within 24 h after a single dose and whose effects can be sustained for at least one week post treatment [1]. This contrasts with selective serotonin reuptake inhibitor (SSRI) treatment, which typically requires four weeks to achieve an antidepressant response. In their letter [2], our colleagues appropriately highlight how electroconvulsive therapy (ECT) is a treatment for MDD that utilizes neuroplasticity mechanisms and may exert its effects more rapidly than SSRIs. A standard course of ECT involves 6–12 treatments, with two to three treatments per week until response has been reached, which generally takes around 2–4 weeks [3]. As such, the clinical response to ECT may be faster than SSRIs but slower than ketamine.

The antidepressant effects of ketamine, ECT, and SSRIs appear to share some molecular mechanisms and neuroplastic processes (increased trophic factor expression, dendritic sprouting, spine formation) but differ in others. For example, ketamine is not known to induce adult hippocampal neurogenesis (AHN) while ECT and SSRIs appear to enhance AHN by different modalities. These differences may explain the differing speed and longevity of antidepressant action between ketamine, ECT and SSRIs. Given that ECT may be continued for months to years [3], we focus this correspondence on how ECT might exert its antidepressant effects in the short term and long term, with specific focus on the hippocampal neural stem cell (NSC) pool and neurogenic niche.

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Authors and Affiliations

  1. Stanford School of Medicine, Stanford University, Stanford, CA, USA

    Alexandria N. Tartt

  2. Area of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA

    Madeline Mariani, J. John Mann & Maura Boldrini

  3. Department of Psychiatry, Columbia University, New York, NY, USA

    Rene Hen, J. John Mann & Maura Boldrini

  4. Neuroscience, Columbia University, New York, NY, USA

    Rene Hen

  5. Pharmacology, Columbia University, New York, NY, USA

    Rene Hen

  6. Area Integrative Neuroscience, New York State Psychiatric Institute, New York, NY, USA

    Rene Hen

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  1. Alexandria N. Tartt
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  2. Madeline Mariani
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  3. Rene Hen
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  4. J. John Mann
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  5. Maura Boldrini
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Contributions

Original draft—AT, MM, and MB. Clinical insights—JJM and MB. Editing: JJM and RH. All authors revised the literature, reviewed, edited, and approved the final version.

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Correspondence to Maura Boldrini.

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JJM receives royalties for commercial use of the C-SSRS from the Research Foundation for Mental Hygiene.

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Tartt, A.N., Mariani, M., Hen, R. et al. Electroconvulsive therapy—a shocking inducer of neuroplasticity?. Mol Psychiatry 29, 35–37 (2024). https://doi.org/10.1038/s41380-023-02015-0

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