Electroconvulsive therapy for post-traumatic stress disorder: efficacy, mechanisms and a hypothesis for new directions

ABSTRACT

A small body of literature suggests that posttraumatic stress disorder (PTSD) may respond to ECT. Laboratory research has identified changes in the amygdala, hippocampus and prefrontal cortex that might explain the treatment response. One randomized controlled trial in depressed patients in a laboratory setting demonstrated the use of ECT to impair reconsolidation of reactivated, emotionally-aversive test memories. It can therefore be hypothesized that ECT may be more effective in patients with PTSD if the trauma memories are deliberately recalled immediately before each ECT session. This hypothesis has received preliminary support in a single case report and may be worthy of formal study in carefully designed clinical trials. Practical challenges are discussed.

KEYWORDS:

• Electroconvulsive therapy
• posttraumatic stress disorder
• major depressive disorder
• neuroplasticity
• amygdala
• hippocampus
• prefrontal cortex
• memory reactivation
• memory reconsolidation

Financial & competing interests disclosure

C Andrade authors an independent newsletter, the Synergy Times, which is sent free to mental health professionals across the world; this is sponsored by Sun Pharmaceuticals, which makes payments directly to registered charities. C Andrade also authors a Critical Readings in Psychiatry series and receives authorship royalties from the publishers, Zydus Neurosciences. C Andrade’s research has recently received funding from the Indian Council of Medical Research and the Department of Biotechnology, Government of India.

WV McCall has received honoraria from Wolters Kluwer Publishing.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.