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