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Time-dependent sensitization and ECT

Molecular Psychiatry volume 6, page 500 (2001)Cite this article

SIR – In a paper published in July 2000 issue of Molecular Psychiatry, Antelman et al1 restate their intriguing hypothesis regarding the role of time-dependent sensitization (TDS) in the mechanism of action of antidepressant drugs and electroconvulsive therapy (ECT). Considerable evidence from animal studies is presented in support of the hypothesis. Antelman et al1 suggest that the therapeutic effect of these treatments in major depression is due to the biological process of TDS that is initiated by the first administration of the treatment and develops thereafter with the passage of time. Since the ultimate neurobiological and therapeutic effect is a consequence of the initial treatment, the implication for clinical practice is that administration of additional doses of the drug or additional sessions of ECT during the intervening period is unnecessary.

ECT is a highly effective treatment for severe depression and is widely used in the management of patients who have not responded to antidepressant drugs. The basis of the treatment is an electrically induced, generalized seizure (modified by prior administration of an anesthetic drug and a muscle relaxant) that is administered twice or three times weekly up to a total of 6–12 sessions. In support of their hypothesis, Antelman et al1 cite the study of Jagdeesh et al2 who showed that a single bilateral ECT followed by five sham sessions (anesthesia and muscle relaxant only) on alternate days was as effective in alleviating depression as six real treatments administered according to the same schedule. ECT is an important test of the Antelman et al1 hypothesis because it is not confounded by pharmacokinetic effects, as are antidepressant drug regimens.

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References

  1. Antelman SM et al. Mol Psychiatry 2000 5: 350–356

  2. Jagadeesh NH et al. J Affect Dis 1992 24: 291–296

  3. Lerer B et al. Am J Psychiatry 1995 152: 564–570

  4. Shapira B et al. Br J Psychiatry 1998 172: 44–48

  5. Segman RH et al. Psychopharmacology 1995 119: 440–448

  6. Kellner CH et al. Convul Ther 1992 8: 245–252

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Acknowledgements

The studies reported here were supported by grants No. MH40734 and No. MH48470 from the US Public Health Service.

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Authors and Affiliations

  1. Department of Psychiatry, Biological Psychiatry Laboratory, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

    B Lerer

  2. Division of Psychiatry, Herzog Hospital, Jerusalem, Israel

    B Shapira

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  1. B Lerer
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  2. B Shapira
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Correspondence to B Lerer.

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Lerer, B., Shapira, B. Time-dependent sensitization and ECT. Mol Psychiatry 6, 500 (2001). https://doi.org/10.1038/sj.mp.4000917

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