The curious relationship between ECT and Parkinson disease

Electroconvulsive therapy (ECT) has long been recognized as an effective treatment for severe depression, but its impact extends beyond mood disorders. Recent anecdotal evidence suggests a curious relationship between ECT and Parkinson disease, particularly regarding improvements in both depressive and parkinsonian symptoms. This phenomenon points to the complex interplay between dopamine, ECT, and neuropsychiatric conditions, offering intriguing possibilities for patient management.

Depression in Parkinson disease

Depression is a common comorbidity in Parkinson disease, affecting up to 50% of patients. The underlying mechanisms linking Parkinson disease and depression are multifaceted, involving neurochemical changes, particularly in the dopaminergic system. Dopamine depletion in Parkinson disease affects not only motor function but also mood regulation, leading to significant depressive symptoms. These symptoms can severely impact the quality of life and complicate the overall management of patients with Parkinson disease.

Anecdotal evidence of ECT benefits in Parkinson disease

Clinical cases have reported remarkable improvements in both depressive and parkinsonian symptoms following ECT. One such case involved a patient treated for severe depression with ECT, who subsequently experienced significant alleviation of extrapyramidal symptoms alongside improvement in mood. This dual benefit raises important questions about the underlying mechanisms of ECT and its potential role in managing Parkinson disease.

In this particular case, the patient also suffered from delusions, which improved after ECT. The improvement in both motor and psychiatric symptoms suggests that ECT may influence dopaminergic pathways, providing a temporary reversal of the dopaminergic deficit characteristic of Parkinson disease. This observation aligns with the hypothesis that dopamine serves as an intermediary between ECT and the observed clinical improvements.

Mechanisms of ECT in neuropsychiatric conditions

ECT's exact mechanisms remain partially understood, but several hypotheses exist regarding its effects on neuropsychiatric conditions:

1. Neurotransmitter modulation. ECT is believed to modulate neurotransmitter systems, including serotonin, norepinephrine, and dopamine. In Parkinson disease, where dopamine deficiency is central, ECT might temporarily enhance dopaminergic transmission, alleviating both depressive and motor symptoms.
2. Neuroplasticity. ECT may promote neuroplasticity and neurogenesis, potentially improving neural network function and connectivity. This effect could help in mitigating the neurodegenerative processes seen in Parkinson disease.
3. Electrophysiological effects. By inducing controlled seizures, ECT might reset aberrant neural circuits involved in both mood regulation and motor control. This reset could lead to a temporary improvement in the symptoms of Parkinson disease.

Implications for clinical practice

The potential benefits of ECT in Parkinson disease warrant further investigation through systematic studies. For neurologists, these anecdotal observations highlight the need to consider ECT not only as a treatment for refractory depression but also as a potential therapeutic avenue for improving motor symptoms in Parkinson disease. Although ECT is not a standard treatment for Parkinson disease, its utility in selected cases with comorbid severe depression offers a valuable clinical option.

Conclusion

The intersection of ECT, depression, and Parkinson disease underscores the complex interplay between neuropsychiatric and neurodegenerative disorders. The anecdotal improvements in both depressive and parkinsonian symptoms following ECT point to a potential dopaminergic mechanism, offering intriguing insights for neurologists. Further research is needed to elucidate the pathways involved and to explore the broader applicability of ECT in managing Parkinson disease.

These insights encourage a broader consideration of ECT in neurologic practice, potentially enhancing patient outcomes in complex cases of Parkinson disease with concurrent severe depression.

References

Borisovskaya A, Bryson WC, Buchholz J, Samii A, Borson S. Electroconvulsive therapy for depression in Parkinson's disease: systematic review of evidence and recommendations. Neurodegener Dis Manag 2016;6(2):161-76. PMID 27033556

National Institute of Neurologic Disorders and Stroke (NINDS). Parkinson’s Disease. Available at: https://www.ninds.nih.gov/health-information/disorders/parkinsons-disease. Accessed August 27, 2024.

Takamiya A, Seki M, Kudo S, et al. Electroconvulsive therapy for Parkinson's disease: a systematic review and meta-analysis. Mov Disord 2021;36(1):50-8. PMID 33280168

MedLink acknowledges the use of ChatGPT-4, an Artificial Intelligence chatbot, in drafting this blog entry.

Are you interested in being a guest blogger for MedLink Neurology? Contact us at editorial@medlink.com.