Prospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Nov 19, 2023; 13(11): 949-957
Published online Nov 19, 2023. doi: 10.5498/wjp.v13.i11.949
Treatment outcomes and cognitive function following electroconvulsive therapy in patients with severe depression
Ke-Yan Han, Chao-Min Wang, Chong-Bo Du, Jun Qiao, Yong-Liang Wang, Li-Zhao Lv
Ke-Yan Han, Chao-Min Wang, Chong-Bo Du, Jun Qiao, Yong-Liang Wang, Li-Zhao Lv, Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang 050031, Hebei Province, China
Author contributions: Han KY, Wang CM, and Lv LZ were responsible for the study conception and design; Du CB and Qiao J provided administrative support; Han KY and Lv LZ provided the study materials and patients; Wang YL and Qiao J conducted data collection; Han KY and Lv LZ conducted data analysis and interpretation; All authors contributed to the manuscript writing process and granted final approval for the manuscript.
Supported by Hebei Province 2018 Medical Science Research Key Discipline Programs, No. 20180214.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the First Hospital of Hebei Medical University.
Clinical trial registration statement: This registration policy applies to registry trials. This study is registered at
Informed consent statement: All study participants, or their legal guardian, provided written consent prior to study enrollment.
Conflict-of-interest statement: The authors of this manuscript having no conflicts of interest to disclose.
Data sharing statement: There is no additional data available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Li-Zhao Lv, MSc, Attending Doctor, Department of Neurology, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Yuhua District, Shijiazhuang 050031, Hebei Province, China.
Received: September 13, 2023
Peer-review started: September 13, 2023
First decision: September 28, 2023
Revised: October 7, 2023
Accepted: October 28, 2023
Article in press: October 28, 2023
Published online: November 19, 2023

Traditional treatments for major depressive disorder (MDD), including medication and therapy, often fail and have undesirable side effects. Electroconvulsive therapy (ECT) uses electrical currents to induce brief seizures in the brain, resulting in rapid and potent antidepressant effects. However, owing to misconceptions and controversies, ECT is not as widely used as it could and often faces stigmatization.


To evaluate the efficacy and safety of ECT compared to those of medication and/or therapy in patients with severe MDD.


This prospective cohort study included 220 individuals with severe MDD who were divided into the ECT and non-ECT groups. The patients in the ECT group underwent bilateral ECT three times a wk until they either achieved remission or reached a maximum of 12 sessions. The non-ECT group received medication and/or therapy according to clinical guidelines for MDD. The primary outcome was the variation in the hamilton depression rating scale (HDRS) score from treatment/ECT initiation to week 12. In addition, patients’ quality of life, cognitive abilities, and biomarkers were measured throughout the study.


Although both groups showed significant improvements in their HDRS scores over time, the improvement was more pronounced in the ECT group than in the non-ECT group. Additionally, the ECT group exhibited a more substantial improvement in the quality of life and cognitive function than those of the non-ECT group. Compared with the non-ECT group, the ECT group exhibited evi-dently lower variations in the brain-derived neurotrophic factor (BDNF) and cytokine interleukin-6 (IL-6) levels. The side effects were generally mild and comparable between the two groups. ECT is safer and more potent than medication and/or therapy in mitigating depressive symptoms, enhancing well-being, and bolstering cognitive capabilities in individuals with severe MDD. ECT may also affect the levels of BDNF and IL-6, which are indicators of neuroplasticity and inflammation, respectively.


ECT has emerged as a potentially advantageous therapeutic approach for patients with MDD who are unresponsive to alternative treatments.

Keywords: Alternative therapies, Biomarkers, Cognitive function, Electroconvulsive therapy, Major depressive disorder, Medication therapy

Core Tip: Electroconvulsive therapy (ECT) is more efficient and safer in treating severe major depressive disorder (MDD) compared to medication and/or therapy. Here, ECT led to more pronounced improvements in depressive symptoms, quality of life, and cognitive function than non-ECT treatments. Additionally, ECT affected biomarkers related to neuroplasticity (brain-derived neurotrophic factor) and inflammation (interleukin-6). These findings highlight the potential of ECT as a therapeutic approach for individuals with severe MDD who do not respond to conventional treatments. By providing evidence of its beneficial outcomes, this study aimed to address the stigmatization surrounding ECT and facilitate its broader adoption in clinical practice.