EPV576 - Electroconvulsive Therapy in Treatment-Resistant Depression: A Comprehensive Literature Review

EPV576

Electroconvulsive Therapy in Treatment-Resistant Depression: A Comprehensive Literature Review

A. Rami ^1,*

¹Razi Hospital, Manouba, Tunisia

 

Introduction: Treatment-resistant depression (TRD) affects approximately one-third of patients with major depressive disorder and remains a significant public health concern due to its chronicity, disability, and high suicide risk. Among available therapeutic strategies, electroconvulsive therapy (ECT) — also known as electroconvulsive seizure therapy or sismotherapy — continues to demonstrate robust efficacy, particularly in severe or pharmacologically refractory cases.

Objectives: This literature review aims to synthesize contemporary evidence regarding the efficacy, neurobiological mechanisms, safety, and clinical positioning of ECT in the management of treatment-resistant depression.

Methods: A narrative review of articles published between 2010 and 2025 was conducted using PubMed, ScienceDirect, and PsycINFO. Randomized controlled trials, meta-analyses, and clinical guidelines were included to assess both therapeutic outcomes and cognitive effects associated with modern ECT protocols.

Results: Across studies, ECT shows response rates of 60–80% and remission rates around 50–60%, outperforming all other interventions for TRD. Advances in technique , such as unilateral ultrabrief pulse stimulation, optimized seizure monitoring, and individualized titration , have significantly improved tolerability while preserving efficacy. Neurobiological findings implicate modulation of fronto-limbic circuits, enhanced neuroplasticity, and upregulation of BDNF as key mechanisms underlying clinical response. The most frequent adverse effects remain transient cognitive disturbances, mainly short-term memory deficits, which tend to resolve within weeks.

Conclusions: ECT remains the most effective and rapidly acting intervention for severe, treatment-resistant, and suicidal depression. Its modern refinements have greatly enhanced safety and reduced cognitive burden. Despite persistent stigma and underutilization, ECT should be considered a first-line option for TRD, especially in cases of life-threatening depression or when rapid remission is critical. Continued research on biomarkers and maintenance strategies may further optimize its clinical integration.

 

Disclosure of Interest: None Declared