Unveiling ECT Benefits: New Insights into Brain Activity Studies

Electroconvulsive therapy (ECT), formerly known as electroshock therapy, is applying regulated doses of electricity to induce a brief seizure in the brain. While ECT is extremely helpful for certain mental diseases, particularly depression, the reasons behind its effectiveness have long perplexed researchers in psychiatry and neuroscience.

Researchers at the University of California, San Diego, believe they have found an answer. They propose a new hypothesis in two new studies published in Translational Psychiatry that ECT alleviates depression symptoms by increasing aperiodic activity, a type of electrical activity in the brain that does not follow a consistent pattern and is generally considered to be the brain’s background noise.

“We’re solving a puzzle that’s stumped scientists and doctors since electroconvulsive therapy was first developed nearly a century ago,” said first author Sydney Smith, a Ph.D. candidate in the Voytek Lab at UC San Diego. “On top of that, we’re also helping to demystify one of the most effective yet stigmatized treatments for severe depression.”

Electroconvulsive therapy has a positive track record but a negative reputation. The therapy is helpful in up to 80% of patients who undergo it, most commonly for depression, but also for bipolar illness and schizophrenia. Despite its high success rate, electroconvulsive therapy is typically linked with pictures of people getting painful, high-voltage shocks.

“A lot of people are surprised to learn that we still use electroconvulsive therapy, but the modern procedure uses highly controlled dosages of electricity and is done under anesthesia,” said Smith. “It really doesn’t look like what you see in movies or television.”

While ECT is generally safe and effective, there are certain downsides, such as transient disorientation and cognitive impairment. It also necessitates several outpatient sessions, which may be prohibitive for some persons who would otherwise benefit from the treatment.

“One of the reasons ECT isn’t more popular is that for a lot of people, it’s easier and more convenient to just take a pill,” said senior author Bradley Voytek, Ph.D., professor of cognitive science at UC San Diego. “However, in people for whom medications don’t work, electroconvulsive therapy can be life-saving. Understanding how it works will help us discover ways to increase the benefits while minimizing side effects.”

Aperiodic activity in the brain assists in controlling how neurons switch on and off. Our neurons are constantly cycling between excitation and inhibition, which correlate to distinct mental states. Aperiodic activity increases inhibitory activity in the brain, slowing it down.

“Something we see regularly in the EEG scans of people who receive electroconvulsive or magnetic seizure therapy is a slowing pattern in the brain’s electrical activity,” said Smith. “This pattern has gone unexplained for many years, but accounting for the inhibitory effects of aperiodic activity helps explain it. It also suggests that these two forms of therapy are causing similar effects in the brain.”

While these findings indicate a relationship between aperiodic activity and ECT advantages, the researchers emphasize the necessity for additional study to use these findings in therapeutic settings. They are currently investigating the use of aperiodic activity as a marker of therapy efficacy in various depressive treatments, such as medicines.

“At the end of the day, what’s most important to patients and to doctors is that the treatment works, which in the case of ECT, it does,” said Voytek. “However, it’s our job as scientists to dig into what’s really going on in the brain during these treatments, and continuing to answer those questions will help us find ways to make these treatments even more effective while reducing negative effects.”