Predictors of Response to Electroconvulsive Therapy in Major Depressive Disorder: A Review of Recent Research Findings

In the context of the current global move towards precision medicine, considering the adverse effects, costs and efficacy limitations of electroconvulsive therapy (ECT) in major depression, this review aimed to identify predictors of ECT response based on recent research.

Established predictors such as older age, psychotic symptoms, melancholic features, shorter episode duration, higher baseline severity, medication failure, and comorbid personality disorder were replicated in recent studies. Genetic polymorphisms showed little utility, whereas potentially useful epigenetic predictors were identified. Neurotrophic factors offer some predictive value. Some evidence for inflammatory markers emerged. Structural neuroimaging mainly implicates the hippocampal structures, amygdala, cingulate cortex, and other frontal lobe regions. Functional neuroimaging suggests an important role of brain functional connectivity, especially involving the default mode network.

Many previously recognized demographic and clinical predictors of ECT response were supported, but evidence for biological predictors remains largely inconclusive, and requires further exploration and replication in future research.