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Treating depression with electroconvulsive therapy (ECT) has been practiced since the 30s, although nowadays, this treatment is reserved only for the most severe cases of depression, since the therapy has pretty bad side effects such as loss of memory and difficulties forming new memories. A new article just published in PNAS explains why the therapy works in some cases. Depression can be the result of an overactive brain, and the electric shocks can dampen the activity of certain neural circuits. The hypothesis is that when the brain is overactive, there is too much internal communication and the patient's brain is thus focused mainly on itself, rather than on receiving inputs from the outside world. The overactive networks have been shown to converge in a brain region called the dorsal medial prefrontal cortex, in a location called the dorsal nexus. The PNAS paper shows that ECT dramatically decreased activity in the dorsal medial prefrontal cortex, in patients with depression, as assessed by fMRI. Since the dorsal nexus is a major node for attention, memory, and emotion, being the target of ECT makes sense because it explains the success of the therapy as well as the ugly side effects of memory impairment.

Insight Into a Shocking Therapy for Depression

on 19 March 2012, 3:00 PM |
sn-ect.jpg
Toning down internal chatter. Imaging scans show decreases in brain connectivity before (orange) and after (blue) treatment with ECT.
Credit: J. S. Perrin, et al., PNAS Early Edition (March 2012)

Since the 1930s, doctors have been jolting the brains of depressed patients with electricity to relieve their symptoms. The treatment, known as electroconvulsive therapy (ECT), works, but it can cause memory loss and confusion and lead to difficulty forming new memories. Today, physicians generally limit it to patients who are severely ill, including those at risk for suicide. Now, a brain-imaging study highlights the part of the brain most affected, perhaps pointing to safer, less-invasive ways to achieve the same results.

Depression may be caused by an overactive brain, says physicist and neuroscientist Christian Schwarzbauer of the University of Aberdeen in the United Kingdom. "There may be so much internal communication that the brain becomes preoccupied with itself, less able to process information coming in from the outside world," he says, noting that studies have found that people with depression have heightened connectivity among brain networks involved in paying attention, monitoring internal and external cues, remembering the past, and controlling emotions.

In a 2010 study, psychiatrist Yvette Sheline and colleagues at Washington University School of Medicine in St. Louis, Missouri, found that these overactive networks converged on a common point in a region called the dorsal medial prefrontal cortex. This common point, dubbed the dorsal nexus, may "hot wire" the brain networks together in a way that leads to depression, the authors hypothesized.

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The hypothesis is that when the brain is overactive, there is too much internal communication and the patient's brain is thus focused mainly on itself, rather than on receiving inputs from the outside world.

That also pretty well describes meditation. Or prayer. Perhaps you can shock someone out of religion =)

I have known someone who underwent electroconvulsive therapy on a psychiatric ward; her diagnostic was melancholia.  She was far from an agitated person and seem to have little interest in things around her;  I engaged many times in different conversations with her (especially about books)  and visited her at her home a few times.  The last time I saw her she had become a buddhist;  she seemed content (not radiant).

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