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A Primer for the Conceptualization of the Mechanism of Action of Electroconvulsive Therapy, 2: Organizing the Information

J Clin Psychiatry 2014;75(6):e548–e551

Much literature is available on the effects of electroconvulsive therapy (ECT) in the brain. Clinicians need to know how to organize this information when they explain hypotheses about the mechanism of action of ECT to patients and caregivers. One possibility is to classify the data under the headings of delivery components, therapeutic mediators, and therapeutic processes. Delivery components are elements of the ECT procedure that modulate the efficacy and efficiency of the treatment; examples are electrical dose, electrode placement, and number and frequency of treatments administered. Therapeutic mediators are physiologic or psychological changes that in themselves are not therapeutic but that lead to the suggested therapeutic changes; examples are the occurrence of the seizure and the occurrence of blood-brain barrier breach. Therapeutic processes are the actual biological changes that compensate for or correct the biological disturbances that underlie the psychiatric illness; examples are changes in the activity of certain neurotransmitter systems and increases or decreases in neuroplasticity in different parts of the brain. Organizing information in this manner can help explain both efficacy and adverse effects of ECT. Brief explanations are provided.