FDA panel advice may require trials to prove safety of ECTBMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d661 (Published 31 January 2011) Cite this as: BMJ 2011;342:d661
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In the recent account of the FDA's review of ECT devices (BMJ 2011;
342:d661), "brain damage" was included as a problem reported to the FDA.
Unfortunately, this erroneous belief was not commented upon, especially as
there is no evidence to support this claim.
There is clear evidence from the animal literature that repeated
brief seizures such as those associated with ECT, are not associated with
neuropathological change. These studies are often reported by
epileptologists who are deliberately trying to generate such
neuropathology and who have reported their negative findings only as pilot
studies or curiosities.1-4
On the other hand, there is ample evidence that ECT up-regulates
neurotrophic factors and increases synaptogenesis and neurognesis in the
hippocampus.5 ECT shares these molecular and cellular changes in common
with other effective treatments such as antidepressant medications but
induces these changes more profoundly, possibly accounting for it being
the most powerful treatment available for severe depression.
1 Cardoso A, Assuncao M, Andrade JP, Pereira PA, Madeira MD, Paula-
Barbosa MM, et al. Loss of synapses in the entorhinal-dentate gyrus
pathway following repeated induction of electroshock seizures in the rat.
J Neurosci Res 2008;86(1):71-83.
2 Gombos Z, Spiller A, Cottrell GA, Racine RJ, McIntyre Burnham W.
Mossy fiber sprouting induced by repeated electroconvulsive shock
seizures. Brain Res 1999;844(1-2):28-33.
3 Thom M, Zhou J, Martinian L, Sisodiya S. Quantitative post-mortem
study of the hippocampus in chronic epilepsy: seizures do not inevitably
cause neuronal loss. Brain 2005;128(Pt 6):1344-1357.
4 Vaidya VA, Siuciak JA, Du F, Duman RS. Hippocampal mossy fiber
sprouting induced by chronic electroconvulsive seizures. Neuroscience
5 Warner-Schmidt JL, Madsen TM, Duman RS (2008). Electroconvulsive
seizure restores neurogenesis and hippocampus-dependent fear memory after
disruption by irradiation. Eur J Neurosci 2008;27(6):1485-1493.
Competing interests: No competing interests