Ruiz Ana C, Haseeb Abdul, Baumgartner William, Leung Edison, Scaini Giselli, Quevedo Joao
Center for Interventional Psychiatry, Faillace Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States.
Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States.
Front Psychiatry. 2025 Aug 14;16:1614076. doi: 10.3389/fpsyt.2025.1614076. eCollection 2025.
Electroconvulsive therapy (ECT) remains one of the most effective interventions for treatment-resistant depression (TRD), particularly in cases involving severe symptomatology, suicidality, or psychotic features. Despite advancements aimed at enhancing the safety and cognitive tolerability of ECT, concerns about cognitive side effects continue to limit its broader acceptance. A deeper understanding of the mechanisms underlying ECT is therefore critical for refining its use and maximizing clinical outcomes. Through a narrative review of recent literature, this paper synthesizes current evidence comparing the efficacy of ECT, ketamine, and repetitive transcranial magnetic stimulation (rTMS) in the treatment of TRD. Then, the review delves into the neurobiological mechanisms through which ECT exerts its therapeutic effects, including modulation of neurotransmitter systems, enhancement of neurogenesis, changes in brain network connectivity, immune response regulation, neurotrophic signaling, and epigenetic alterations. These mechanistic insights may inform the identification of biomarkers predictive of treatment response. Moving forward, future research guided by interaction mechanisms hypotheses could provide more insights into alternative neuromodulation techniques, optimize ECT procedures, and improve patient-specific treatment approaches to enhance therapeutic benefits while minimizing adverse effects.
电休克疗法（ECT）仍然是治疗难治性抑郁症（TRD）最有效的干预措施之一，特别是在涉及严重症状、自杀倾向或精神病性特征的病例中。尽管在提高ECT的安全性和认知耐受性方面取得了进展，但对认知副作用的担忧仍然限制了其更广泛的应用。因此，深入了解ECT的潜在机制对于优化其使用和最大化临床疗效至关重要。通过对近期文献的叙述性综述，本文综合了目前比较ECT、氯胺酮和重复经颅磁刺激（rTMS）治疗TRD疗效的证据。然后，该综述深入探讨了ECT发挥治疗作用的神经生物学机制，包括神经递质系统的调节、神经发生的增强、脑网络连接的变化、免疫反应调节、神经营养信号传导和表观遗传改变。这些机制性见解可能有助于识别预测治疗反应的生物标志物。展望未来，以相互作用机制假说为指导的未来研究可以为替代神经调节技术提供更多见解，优化ECT程序，并改进针对患者的治疗方法，以提高治疗效果，同时将不良反应降至最低。
