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75-year-old 'shock therapy' mystery solved

London, Tue, 20 Mar 2012 ANI

London, March 20 (ANI): The mystery of how one of psychiatry's most controversial treatments - electro-convulsive therapy (ECT) - can help patients with severe depression has finally been solved.


Researchers at Aberdeen University have discovered that ECT affects the way different parts of the brain involved in depression 'communicate' with each other.


They found that the treatment appears to 'turn down' an overactive connection between areas of the brain that control mood and the parts responsible for thinking and concentrating.


This stops the overwhelming impact that depression has on sufferers' ability to enjoy normal life and carry on with day-to-day activities.


This decrease in connectivity observed after ECT treatment was accompanied by a significant improvement in the patient's depressive symptoms, the Daily Mail reported.


The ECT treatment, which is 75-years-old, involves an electric shock being passed through the cortex of a severely-depressed patient to 'cure' them.


The controversial treatment was introduced in 1938 by an Italian neurologist Ugo Cerletti, who was allegedly inspired by watching pigs being stunned with electric shock before being butchered in Rome. The animals would go into seizures and fall down, making it easier to slit their throats.


At the time psychiatric orthodoxy held - wrongly - that schizophrenia and epilepsy were antagonistic and one could not exist in the presence of the other.


Deciding to try the stunning technique on his patients, Dr Cerletti found electric shocks to the head caused his most obsessive and difficult mental patients to become meek and manageable.


Later the treatment was found to be effective in treating severe depression but its mode of action has remained until now a complete mystery.


The study involved using MRI to scan the brains of nine severely depressed patients before and after ECT, and then applying entirely new and complex mathematical analysis to investigate brain connectivity.


"We believe we've solved a 70 year old therapeutic riddle," said Professor of Psychiatry at the university Ian Reid, who is also a consultant psychiatrist at the Royal Cornhill Hospital, Aberdeen.


"ECT is a controversial treatment, and one prominent criticism has been that it is not understood how it works and what it does to the brain.


"For all the debate surrounding ECT, it is one of the most effective treatments not just in psychiatry but in the whole of medicine, because 75 per cent to 85 per cent of patients recover from their symptoms.


"Over the last couple of years there has been an emerging new perspective on how depression affects the brain.


"This theory has suggested a 'hyper-connection' between the areas of the brain involved in emotional processing and mood change and the parts of the brain involved in thinking and concentrating.


"Our key finding is that if you compare the connections in the brain before and after ECT, ECT reduces this 'hyper-connectivity'.


"For the first time we can point to something that ECT does in the brain that makes sense in the context of what we think is wrong in people who are depressed," Reid added.


Although ECT is extremely effective, it is only used on people who need treatment quickly: those who are very severely depressed, who are at risk from taking their own lives, and perhaps cannot look after themselves, or those who have not responded to other treatments.


"The treatment can also affect memory, though for most patients this is short-lived. However if we understand more about how ECT works, we will be in a better position to replace it with something less invasive and more acceptable," Professor Reid said.


"At the moment only about 40 per cent of people with depression get better with treatment from their GP. Our findings may lead to new drug targets which match the effectiveness of ECT without an impact on memory," the Professor noted.


Professor Christian Schwarzbauer, chair in neuroimaging at Aberdeen, who devised the maths used to analyse the data, said: "We were able to find out to what extent more than 25,000 different brain areas 'communicated' with each other.


"The method could be applied to a wide range of other brain disorders such as schizophrenia, autism, or dementia, and may lead to a better understanding of underlying disease mechanisms and the development of new diagnostic tools," Schwarzbauer added.


The team's findings were published in the journal Proceedings of the National Academy of Sciences.(ANI)



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