Electroconvulsive Therapy Effective in Treating Inflammation, Depression in Teenagers

A 2023 study examined how electroconvulsive therapy (ECT) impacted inflammatory markers and depression symptoms in teens diagnosed with major depressive disorder (MDD). ECT has been regarded as one of the useful treatment methods for symptom improvement and remission in patients with treatment-resistant depression.¹

Method

A cohort of 38 participants with severe MDD received 6 to 8 ECT sessions in addition to prescribed antidepressant therapy. Participants in the study were diagnosed with depression via the DSM-MD and had a score of 17 or higher on the Hamilton Depression Rating Scale. Eligible patients did not have any concurrent psychiatric disorders or systemic illnesses.

Patients were excluded from the study if they had been diagnosed with comorbid physical conditions affecting mood, immune or endocrine system disorders, acute or recent infections or contagious diseases, chronic physical illnesses, chronic inflammation, or had used anti-inflammatory drugs, immunomodulators, or hormonal treatments within a month before the study. Patients were also excluded if they self-reported a history of epilepsy, experienced uncontrollable physical illness, developed a physical illness during the study, decided to discontinue ECT, or refused to sign the informed consent form.

A control group of 29 participants was gathered based on matching patient age, gender, and educational attainment. The control group reported no lifetime mental disorders among immediate family or a family history of psychiatric conditions.

Blood samples were taken at the beginning and end of the study to measure inflammatory markers (IL-1β, IL-6, IL-10). ECT was administered between 8 AM and 12 PM using the Thymatron DGx system, placing electrodes bilaterally on the temples. A low pulse width setting of 0.25 and a current of 0.9A was administered, with the initial energy adjusted to 50% of the participant’s age. Propofol (1.5-2 mg/kg) and succinylcholine (0.5-1 mg/ kg) were administered for anesthesia and muscle relaxation.

The treatment lasted 2 weeks, starting patients with 3 to 4 days of daily treatment, then transitioning to treatments on alternating days with a 2-day break on weekends.

Results

Researchers found that after ECT, pro-inflammatory cytokines decreased significantly and anti-inflammatory cytokines increased. HAMD-17 scores of 63% of patients were reported as having decreased by 505b or more, classifying them as responders to treatment. The research shows responders exhibited greater reductions of IL-1β and IL-6 and higher IL-10 increases compared to patients considered nonresponders.

“The mitigation of depressive symptoms exhibited a moderate correlation with post-treatments decrements in IL-1β and IL-6 levels, underscoring MDD’s intricacy and ECT’s comprehensive impact,”² authors of the study concluded. Although initial cytokine levels did not predict response to ECT, posttreatment decreases in IL-1β and IL-6 could be used to predict clinical improvement.

The research suggests inflammation may be considered in part when treating MDD, particularly when treatment involves ECT. Elevated inflammatory markers in patients before beginning treatment may indicate a higher immune response activated by depression. Research was limited to a small sample size and a difference in treatment outside of ECT for patients limits the study, but findings support ECT as a viable treatment option for MDD.

References

1. Yun JY, Kim YK. Electroconvulsive therapy (ECT) in major depression: oldies but goodies. Adv Exp Med Biol. 2024;1456:187-196.

2. Du N, Wang Y, Geng D, et al. Effects of electroconvulsive therapy on inflammatory markers and depressive symptoms in adolescents with major depressive disorder. Front Psychiatry. 2024;15:1447839.