Electroconvulsive therapy (ECT) has always seemed like a barbaric treatment. Even though anesthesia now makes the procedure itself painless for patients, it still involves literally shocking the delicate electrical systems of the brain to produce seizures and may cause painful muscle spasms and memory problems afterwards. Still, after seven decades of use, ECT remains the most effective treatment known for severe depression — and a new study offers intriguing hints as to why. Researchers in Scotland used fMRI to scan the brains of nine people with profound depression, both before and after ECT. The patients had all failed to respond to antidepressants or other therapies and none had had ECT in the previous six months. The scientists found that after ECT — given twice a week until symptoms lifted — patients showed significant decreases in connectivity between certain parts of the brain. Specifically, the researchers found that the treatment dampened the connections within and radiating out from a region called the dorsolateral prefrontal cortex (DLPFC), but only on the left side of the brain. The left DLPFC has long been associated with negative thoughts, criticism, anxiety, pessimism and rumination. The same region in the right hemisphere appears to handle more uplifting, optimistic and cheery ideas. Healthy thinking and planning requires a balance of both. Until now, researchers really didn’t know how ECT worked. But the new findings may help reassure doctors and patients who use it. “We believe we’ve solved a 70-year-old therapeutic riddle because our study reveals that ECT affects the way different parts of the brain involved in depression connect with one another,” lead author Ian Reid, a professor of psychiatry at the University of Aberdeen, said in a statement. MORE: Antidepressants: Are They Effective or Just a Placebo? “When the mechanisms of illness and recovery are not fully known, as is the case in depression, there’s a decided advantage in stepping back and taking a look at the big picture.  This work has done just that,” says Aimee Hunter, assistant professor of psychiatry at University of California, … Continue reading How Electroconvulsive Therapy Works for Depression