Editing Major depressive disorder (section)

===Electroconvulsive therapy===
[[Electroconvulsive therapy]] (ECT) is a standard [[psychiatry|psychiatric]] treatment in which [[seizure]]s are electrically induced in a person with depression to provide relief from psychiatric illnesses.<ref name="d505">{{cite journal | last1=Deng | first1=Zhi-De | last2=Robins | first2=Pei L. | last3=Regenold | first3=William | last4=Rohde | first4=Paul | last5=Dannhauer | first5=Moritz | last6=Lisanby | first6=Sarah H. | title=How electroconvulsive therapy works in the treatment of depression: is it the seizure, the electricity, or both? | journal=Neuropsychopharmacology | volume=49 | issue=1 | date=2024 | issn=0893-133X | pmid=37488281 | pmc=10700353 | doi=10.1038/s41386-023-01677-2 | doi-access=free | pages=150–162 | url=https://www.nature.com/articles/s41386-023-01677-2.pdf | access-date=15 March 2025}}</ref> ECT is used with [[informed consent]]<ref name="u822">{{cite journal | last1=Espinoza | first1=Randall T. | last2=Kellner | first2=Charles H. | title=Electroconvulsive Therapy | journal=New England Journal of Medicine | volume=386 | issue=7 | date=17 February 2022 | issn=0028-4793 | doi=10.1056/NEJMra2034954 | pages=667–672| pmid=35172057 }}</ref> as a last line of intervention for major depressive disorder.<ref name="o804" /> A round of ECT is effective for about 50% of people with treatment-resistant major depressive disorder, whether it is unipolar or [[Bipolar II disorder|bipolar]].<ref>{{cite journal |vauthors=Dierckx B, Heijnen WT, van den Broek WW, Birkenhäger TK |title=Efficacy of electroconvulsive therapy in bipolar versus unipolar major depression: a meta-analysis |journal=Bipolar Disorders |volume=14 |issue=2 |pages=146–50 |date=March 2012 |pmid=22420590 |doi=10.1111/j.1399-5618.2012.00997.x |s2cid=44280002 }}</ref> Follow-up treatment is still poorly studied, but about half of people who respond relapse within twelve months.<ref>{{cite journal |vauthors=Jelovac A, Kolshus E, McLoughlin DM |title=Relapse following successful electroconvulsive therapy for major depression: a meta-analysis |journal=Neuropsychopharmacology |volume=38 |issue=12 |pages=2467–74 |date=November 2013 |pmid=23774532 |pmc=3799066 |doi=10.1038/npp.2013.149 }}</ref> Aside from effects in the brain, the general physical risks of ECT are similar to those of brief [[general anesthesia]].<ref name="SG">Surgeon General (1999). [http://www.surgeongeneral.gov/library/mentalhealth/home.html ''Mental Health: A Report of the Surgeon General''] {{webarchive|url=https://web.archive.org/web/20070112012907/http://www.surgeongeneral.gov/library/mentalhealth/home.html |date=12 January 2007 }}, chapter 4.</ref>{{rp|259}} Immediately following treatment, the most common adverse effects are confusion and memory loss.<ref name=FDA2011rev>FDA. [https://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/MedicalDevices/MedicalDevicesAdvisoryCommittee/NeurologicalDevicesPanel/UCM240933.pdf FDA Executive Summary] {{webarchive|url=https://web.archive.org/web/20150924161659/https://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/MedicalDevices/MedicalDevicesAdvisoryCommittee/NeurologicalDevicesPanel/UCM240933.pdf |date=24 September 2015 }}. Prepared for the 27–28 January 2011 meeting of the Neurological Devices Panel Meeting to Discuss the Classification of Electroconvulsive Therapy Devices (ECT). Quote, p38: "Three major practice guidelines have been published on ECT. These guidelines include: APA Task Force on ECT (2001); Third report of the Royal College of Psychiatrists' Special Committee on ECT (2004); National Institute for Health and Clinical Excellence (NICE 2003; NICE 2009). There is significant agreement between the three sets of recommendations."</ref><ref>{{cite book |title=The practice of electroconvulsive therapy: recommendations for treatment, training, and privileging|edition=2nd|location=Washington, DC|publisher=American Psychiatric Association |year=2001|url=https://books.google.com/books?id=iuuLJtmo_EYC|isbn=978-0-89042-206-9|author=Committee on Electroconvulsive Therapy }}</ref> ECT is considered one of the least harmful treatment options available for severely depressed pregnant women.<ref name=Pompili2014Rev>{{cite journal |vauthors=Pompili M, Dominici G, Giordano G, et al |title=Electroconvulsive treatment during pregnancy: a systematic review |journal=Expert Review of Neurotherapeutics |volume=14 |issue=12 |pages=1377–90 |date=December 2014 |pmid=25346216 |doi=10.1586/14737175.2014.972373 |s2cid=31209001 }}</ref>

A usual course of ECT involves multiple administrations, typically given two or three times per week, with a total of six to twelve treatments.<ref name="d426">{{cite book | last=Kroll | first=David S. | title=Caring for Patients with Depression in Primary Care | chapter=Treatment Resistance and Advanced Therapies | publisher=Springer International Publishing | publication-place=Cham | date=2022 | isbn=978-3-031-08494-2 | doi=10.1007/978-3-031-08495-9_6 | pages=61–73}}</ref> ECT is administered under [[anesthesia]] with a [[muscle relaxant]].<ref>{{cite web|url=http://psychcentral.com/lib/5-outdated-beliefs-about-ect/00011255|title=5 Outdated Beliefs About ECT|website=Psych Central.com|url-status=live|archive-url=https://web.archive.org/web/20130808042410/http://psychcentral.com/lib/5-outdated-beliefs-about-ect/00011255|archive-date=8 August 2013|date=17 May 2016}}</ref> Electroconvulsive therapy can differ in its application in three ways: electrode placement, frequency of treatments, and the electrical waveform of the stimulus. These three forms of application have significant differences in both adverse side effects and symptom remission. After treatment, drug therapy is usually continued, and some people receive maintenance ECT.<ref name=FDA2011rev />

ECT appears to work in the short term via an [[anticonvulsant]] effect mostly in the [[frontal lobes]], and longer term via [[neurotrophic]] effects primarily in the [[medial temporal lobe]].<ref name=Abbott2014>{{cite journal |vauthors=Abbott CC, Gallegos P, Rediske N, Lemke NT, Quinn DK |title=A review of longitudinal electroconvulsive therapy: neuroimaging investigations |journal=Journal of Geriatric Psychiatry and Neurology |volume=27 |issue=1 |pages=33–46 |date=March 2014 |pmid=24381234 |pmc=6624835 |doi=10.1177/0891988713516542 }}</ref>