Reviewing the neurobiology of electroconvulsive therapy on a micro- meso-and macro-level

Abstract: Background: Electroconvulsive therapy (ECT) remains the one of the most effective of biological antidepressant interventions. However, the exact neurobiological mechanisms underlying the efficacy of ECT remain unclear. A gap in the literature is the lack of multimodal research that attempts to integrate findings at different biological levels of analysisMethods: We searched the PubMed database for relevant studies. We review biological studies of ECT in depression on a micro-(molecular), meso-(structural) and macro-(network) level. Results: ECT impacts both peripheral and central inflammatory processes, triggers neuroplastic mechanisms and modulates large scale neural network connectivity.Conclusions: Integrating this vast body of existing evidence, we are tempted to speculate that ECT may have neuroplastic effects resulting in the modulation of connectivity between and among specific large-scale networks that are altered in depression. These effects could be mediated by the immunomodulatory properties of the treatment. A better understanding of the complex interactions between the micro-, meso-and macro-level might further specify the mechanisms of action of ECT