Treatment outcomes and cognitive function following electroconvulsive therapy in patients with severe depression

Ke-Yan Han; Chao-Min Wang; Chong-Bo Du; Jun Qiao; Yong-Liang Wang; Li-Zhao Lv

doi:10.5498/wjp.v13.i11.949

Treatment outcomes and cognitive function following electroconvulsive therapy in patients with severe depression

World J Psychiatry. 2023 Nov 19;13(11):949-957. doi: 10.5498/wjp.v13.i11.949.

Authors

Ke-Yan Han¹, Chao-Min Wang¹, Chong-Bo Du¹, Jun Qiao¹, Yong-Liang Wang¹, Li-Zhao Lv²

Affiliations

¹ Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang 050031, Hebei Province, China.
² Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang 050031, Hebei Province, China. 18633889992@163.com.

Abstract

Background: Traditional treatments for major depressive disorder (MDD), including medication and therapy, often fail and have undesirable side effects. Electroconvulsive therapy (ECT) uses electrical currents to induce brief seizures in the brain, resulting in rapid and potent antidepressant effects. However, owing to misconceptions and controversies, ECT is not as widely used as it could and often faces stigmatization.

Aim: To evaluate the efficacy and safety of ECT compared to those of medication and/or therapy in patients with severe MDD.

Methods: This prospective cohort study included 220 individuals with severe MDD who were divided into the ECT and non-ECT groups. The patients in the ECT group underwent bilateral ECT three times a wk until they either achieved remission or reached a maximum of 12 sessions. The non-ECT group received medication and/or therapy according to clinical guidelines for MDD. The primary outcome was the variation in the hamilton depression rating scale (HDRS) score from treatment/ECT initiation to week 12. In addition, patients' quality of life, cognitive abilities, and biomarkers were measured throughout the study.

Results: Although both groups showed significant improvements in their HDRS scores over time, the improvement was more pronounced in the ECT group than in the non-ECT group. Additionally, the ECT group exhibited a more substantial improvement in the quality of life and cognitive function than those of the non-ECT group. Compared with the non-ECT group, the ECT group exhibited evi-dently lower variations in the brain-derived neurotrophic factor (BDNF) and cytokine interleukin-6 (IL-6) levels. The side effects were generally mild and comparable between the two groups. ECT is safer and more potent than medication and/or therapy in mitigating depressive symptoms, enhancing well-being, and bolstering cognitive capabilities in individuals with severe MDD. ECT may also affect the levels of BDNF and IL-6, which are indicators of neuroplasticity and inflammation, respectively.

Conclusion: ECT has emerged as a potentially advantageous therapeutic approach for patients with MDD who are unresponsive to alternative treatments.

Keywords: Alternative therapies; Biomarkers; Cognitive function; Electroconvulsive therapy; Major depressive disorder; Medication therapy.