Electroconvulsive therapy, depression, the immune system and inflammation: A systematic review

• Main Authors: Antoine Yrondi, Marie Sporer, Patrice Péran, Laurent Schmitt, Christophe Arbus, Anne Sauvaget
• Format: Article
• Language: English
• Published: Elsevier 2018-01-01
• Series: Brain Stimulation
• Subjects: Depressive disorder; Inflammation; ECT; Immune; Cortisol
• Online Access: http://www.sciencedirect.com/science/article/pii/S1935861X17309464

Background: The management and treatment of major depressive disorder are major public health challenges, the lifetime prevalence of this illness being 4.4%–20% in the general population. Major depressive disorder and treatment resistant depression appear to be, in part, related to a dysfunction of the immune response. Among the treatments for depression ECT occupies an important place. The underlying cerebral mechanisms of ECT remain unclear. Objectives/Hypothesis: The aim of this review is to survey the potential actions of ECT on the immuno-inflammatory cascade activated during depression. Methods: A systematic search of the literature was carried out, using the bibliographic search engines PubMed and Embase. The search covered articles published up until october 2017.The following MESH terms were used: Electroconvulsive therapy AND (inflammation OR immune OR immunology). Results: Our review shows that there is an acute immuno-inflammatory response immediately following an ECT session. There is an acute stress reaction. Studies show an increase in the plasma levels of cortisol and of interleukins 1 and 6. However, at the end of the course of treatment, ECT produces, in the long term, a fall in the plasma level of cortisol, a reduction in the levels of TNF alpha and interleukin 6. Limitations: One of the limitations of this review is that a large number of studies are relatively old, with small sample sizes and methodological bias. Conclusion: Advances in knowledge of the immuno-inflammatory component of depression seem to be paving the way towards models to explain the mechanism of action of ECT.