Electroconvulsive therapy for post-traumatic stress disorder: efficacy, mechanisms and a hypothesis for new directions

A small body of literature suggests that posttraumatic stress disorder (PTSD) may respond to ECT. Laboratory research has identified changes in the amygdala, hippocampus and prefrontal cortex that might explain the treatment response. One randomized controlled trial in depressed patients in a laboratory setting demonstrated the use of ECT to impair reconsolidation of reactivated, emotionally-aversive test memories. It can therefore be hypothesized that ECT may be more effective in patients with PTSD if the trauma memories are deliberately recalled immediately before each ECT session. This hypothesis has received preliminary support in a single case report and may be worthy of formal study in carefully designed clinical trials. Practical challenges are discussed.