Electroconvulsive Therapy and Surgery to Treat Mood Disorders Have Come a Long Way

There are two main treatments for mental health conditions such as antidepressants and psychotherapies. Due to the high prevalance of clinical depression in adults, especially during the COVID pandemic, there has been an uptick in demand for mental health services. Unfortunately, mainstream treatments don't work for everyone and there is an estimate of 1-3% of adults in the US that have treatment-resistant depression. While the two mainstream treatment approaches to mental health conditions are medication and talk therapy, there are less widely used approaches such as neuromodulation. This method aims to correct any abnormal connections in the brain that are most associated with mood, thoughts, and behavior. The first forms of neuromoducation were brain surgery and electic convulsive therapy (ECT) which started in the 1930s. With the recent advancements in technology, we now have a better understanding of the neural circuitry that is involved with mood regulation and behavior as well as tools to interact with and modulate these circuits. 

While ECT provides the most effective treatment for depression, there are still some cognitive side effects; however, the ECT techniques have improved significantly making it considerably safer. In this paper, researchers found that there was an association between ECT and a lower risk of suicide and death from all causes in older people with mental health conditions. 

Also in the 1930s, scientists also discovered that the frontal lobes of the brain played a vital role in the control of mood, behavior, and thinking so by distrupting these connections, during a procedure known as prefrontal labotomy or leucotomy the connections responsible for multiple mood disorders would also be disturbed. However, due to the adverse side effects and ethical reasons, this option lost its popularity. 

The improved undestanding of the brain and the neural circuitry has also led to the development of deep brain stimulation (DBS) which involves a surgeon implanting electrodes to key regions of the brain to treat not only Parkinson's Disease but also various mental health conditions. Although surgery for DBS involves a small risk of bleeding and infection of the brain, it is well tolerated and generally safe. 

There is now a noninvasive brain stimulation procedure called repetitive transcranial magnetic stimulation, which was developed by neurologists in 1990s. rTMS works by delivering magnetic pulses inducing an electric current in the brain to help regulate mood and behavior. By stimulating a region called the dorsolateral prefrontal cortex (DLPFC), successful outcomes in an individual's depression can be observed. No anestetics or severe side effects have been seen and is generally well tolerated. 

To read more about the progress and development of ECT, click here.