Electroconvulsive therapy: from mechanisms to clinical practice

Electroconvulsive therapy (ECT) remains the most effective short-term treatment for severe or treatment-resistant depressive episodes. It is also effective in treatment-refractory mania, schizophrenia, suicidal behavior and catatonia. ECT maintains its position as an important treatment in modern psychiatry, and no other treatment – from pharmacological agents to newer neurostimulation methods – have surpassed its efficacy. In certain cases, ECT should be offered as a first-line intervention. Despite this, ECT is often neglected as a treatment option, and this is reflected in the lack of research concerning ECT and the parameters needed to optimize treatment response and minimize side effects. A lack of access to treatment services, a history of stigma and controversy, and concerns about side effects all contribute. Furthermore, the clinical uncertainty is compounded by a lack of understanding regarding the fundamental physiological and molecular mechanisms that could explain how ECT works.

Our objectives are to highlight and understand the relevance of ECT use in modern psychiatry and the perspectives on its use, and to explore the latest findings regarding the underlying neurobiological mechanisms of ECT. We also aim to draw attention to the challenges associated with the use of ECT in clinical practice and to the optimum ways to improve clinical outcomes or limit the short- and long-term side effects of the procedure.

We encourage the submission of manuscripts including original research, systematic reviews, meta-analyses, case reports, letters to the editor regarding the use of ECT in psychiatric practice. For this research topic the following subjects regarding the mechanisms and clinical use of ECT will be considered:
- Neurobiological mechanisms of ECT (e.g. immunomodulation, neuroplasticity, neural connectivity modulation, HPA axis)
- Neuroimaging alterations following ECT use
- Efficacy of ECT in the treatment of psychiatric disorders
- Modified ECT use (e.g. brief and ultrabrief pulse ECT)
- Individualized treatment parameters in ECT
- Impact of various stimulus parameters (e.g. electrical pulse shape, amplitude, width and pulse train directionality, frequency, polarity, duration) on the therapeutic response in ECT
- ECT use in special populations (e.g. comorbid medical problems, pregnancy, geriatric population, children and adolescents)
- Measurement of ECT side-effects and techniques to reduce ECT side-effects
- Attitudes of mental health providers, patients, caregivers and general population about modern ECT

Topic Editor Dr. Joao Quevedo receives clinical research support from LivaNova and holds shares in Instituto de Neurociencias Dr. Joao Quevedo. All other Topic Editors declare no competing interests with regards to the Research Topic subject.

Keywords: mania, ECT, electroconvulsive therapy, neuromodulation, depression, catatonia, psychosis, schizophrenia, treatment resistance, ECT mechanisms

Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.