Electroconvulsive therapy (ECT) has been used to treat mood disorders such as major depressive disorder and treatment-resistant depression since 1938. Despite the fact that ECT has a success rate of 50% to 70%, less than 1% of TRD patients select therapy owing to stigma and concerns about cognitive adverse effects such as short-term forgetfulness. Â
In the quest for long-term alleviation, cutting-edge therapies such as magnetic seizure therapy (MST) and repeated transcranial magnetic stimulation (rTMS) have been developed. MST, which first appeared in the year 2000, is a more accurate approach that matches the therapeutic advantages of ECT while limiting its negatives.
MST has fewer cognitive adverse effects and a shorter recovery period than ECT, and it has been reported to generate remission rates ranging from 30% to 60%. Despite ECT and MST’s apparent clinical effectiveness, their underlying neural underpinnings remain unknown.
Because of the information it gives about neurological features, non-invasive electroencephalography (EEG) has lately been investigated as a possible biomarker. The emphasis here is on increased aperiodic activity following both ECT and MST. Aperiodic activity, defined by fluctuations in brain excitation and inhibition, has been linked to a variety of diseases and abnormal behaviors, depression being only one of them. Â
Both ECT and MST increase aperiodic activity, as seen by a steepening of the power spectrum. This enhancement is consistent with ECT’s anticonvulsant effects and suggests more excellent inhibitory action. Given that MDD patients are assumed to lack proper inhibitory function, this line of thought might have consequences for the cortical inhibition hypothesis of depression. Â
While interesting, the study cannot show a relationship between changes in aperiodic activity and improved health. The lack of data to show a causal association between the two suggests that there is a knowledge gap about the particular mechanisms of action of ECT and MST. This study underlines the importance of additional research comparing data such as oscillations and aperiodic activity to provide a complete picture of the situation at hand. Â
Despite these limitations, the study provides a significant advance in our understanding of depression treatment. New insights into brain circuits and the advent of MST as a viable alternative to ECT have created opportunities to develop therapeutic processes and eliminate the stigma associated with existing therapies.
Although it is presently uncertain how these novel therapies may affect patients’ mental health in the long term, future studies will hopefully shed light on the probable link between neurophysiological changes and these outcomes.Â
Journal Reference Â
Smith, S. E., Kosik, E. L., van Engen, Q., Kohn, J., Hill, A. T., Zomorrodi, R., … Voytek, B. (2023). Magnetic seizure therapy and electroconvulsive therapy increase aperiodic activity. Retrieved from https://www.nature.com/articles/s41398-023-02631-y#Sec7
