New Insights into Depression Treatment with Small Electrical Pulses
Neuroscientist Dore Loef has studied the mechanism of action behind electroconvulsive therapy (ECT). Her research focuses on personalizing and improving ECT treatment for depression. This can contribute to informed shared decision-making about whether to start ECT and help reduce the stigma surrounding this sometimes necessary treatment.
Loef’s research led to the following insights regarding ECT treatment:
- Neuroplasticity (adaptability) in the hippocampus, a crucial brain region.
- Influence on the balance between inflammatory markers and neurotrophins, which promote growth and recovery.
- Cognitive side effects related to memory and executive functioning in the short term. However, significant improvement is often observed after three months.
- Predictors of ECT effectiveness include factors such as older age, (genetic vulnerability to) psychotic symptoms, shorter duration of depression, and lower resistance to medication.
- Individual differences in the brain's electric field strength due to ECT, influenced by factors such as skull thickness, which can impact cognitive side effects. This highlights the need to tailor ECT treatment to the individual.
More Targeted Treatment
According to Loef, a better understanding of how ECT works and evidence of its safety can help reduce stigma and increase acceptance. She also identified easily accessible clinical predictors that can reduce uncertainty about ECT outcomes, supporting clinical decision-making on whether to proceed with ECT. This could lead to a more personalized and targeted selection of patients for treatment.
Additionally, knowledge of cognitive side effects can improve patient education. While most patients experience only short-term complaints, some suffer from long-term issues. Proper communication and appropriate support, such as cognitive strategy training, are essential. Furthermore, personalizing ECT parameters could help prevent cognitive side effects. Recommendations for cognitive monitoring have also been made to provide optimal patient support. This knowledge could improve treatment outcomes and the practical application of ECT in the short term.
Research Methods
Loef used various research methods. In collaboration with Dutch institutions, she established the Dutch ECT Consortium (DEC), comprising clinical and research cohorts from academic hospitals, general hospitals, and mental health institutions, to create a representative picture of ECT practice in the Netherlands. A total of 1,892 patients with severe depression participated. The sample size enabled the development of predictive models for ECT effectiveness and cognitive side effects.
Loef also conducted genetic research, examining polygenic vulnerabilities in ECT patients' DNA that are linked to treatment effectiveness. To study the mechanism of action, she analyzed brain tissue at the cellular level from patients who had received ECT within five years before their death, comparing them with depressive and healthy control donors. Additionally, she used MRI scans to examine the strength of the electric field in the brain caused by ECT and its relationship to effectiveness and side effects.
Depression is Widespread
Depression is one of the most common mental disorders worldwide and ranks among the psychiatric and physical illnesses with the highest disease burden for patients, their loved ones, and society. Although antidepressants and psychotherapy are standard treatments, one-third of depression patients do not respond to them, leading to prolonged suffering and increased mortality rates.
ECT is one of the most effective treatments for depression, but its use is limited by stigma and a lack of knowledge.
