EFFICACY OF ELECTROCONVULSIVE THERAPY IN DRUG-REFRACTORY DEPRESSION: A LITERATURE REVIEW

Abstract

Refractory depression is a subtype of major depression that does not respond to at least two treatments with different antidepressants, regardless of the drug class, affecting a significant portion of patients with major depressive disorder (MDD). Electroconvulsive therapy (ECT) is considered one of the best therapeutic options for refractory depression and is indicated as a first-line treatment. Despite its significant use in these cases, its mechanism of action is not yet fully understood, with its antidepressant effects associated with neurochemical changes, improvement in neuroplasticity, and an increase in neurotrophic factors. This literature review aims to investigate the efficacy of ECT in the treatment of refractory depression, analyzing its impact on different patient groups, specific clinical conditions such as comorbidities, and its implications in contemporary psychiatry. The descriptors "(refractory depression or treatment-resistant depression)" and "(electroconvulsive therapy or ECT)" were used in the PubMed and SciELO databases, considering publications from the last 10 years (2014-2024). After applying inclusion and exclusion criteria (articles outside the analyzed period or those that did not directly investigate the efficacy of ECT in refractory depression), 14 studies were selected, including clinical trials, clinical studies, and case reports. The analysis of the articles demonstrated that ECT is highly effective in managing refractory depression, particularly in patients with severe symptoms or psychiatric comorbidities. However, its potential adverse effects highlight the need for careful use and a critical evaluation of the existing literature.