Mapping electroconvulsive therapy induced neuroplasticity: Towards a multilevel understanding of the available clinical literature – A scoping review

Since its introduction in 1938, the precise mechanism underlying the efficacy of electroconvulsive therapy (ECT) in treating severe psychiatric disorders remains elusive. This paper presents a comprehensive scoping review aimed to collate and summarize findings from clinical studies on neuroplastic changes induced by ECT. The review categorizes neuroplasticity into molecular, structural, and functional domains, offering a multilevel view of current research and its limitations. Molecular findings detail the varied responses of neurotrophic factors and neurotransmitters post-ECT, highlighting inconsistent evidence on their clinical relevance. Structural neuroplasticity is explored through changes in brain volume, cortical thickness, and white matter properties, presenting ECT as a potent stimulator of brain architecture alterations. Functional plasticity examines ECT's impact on brain function through diverse neuroimaging techniques, suggesting significant yet complex modifications in brain network connectivity and activity. The review emphasizes the multilevel nature of these neuroplasticity levels and their collective role in ECT's therapeutic outcomes. Methodological considerations—including sample size, patient heterogeneity, and variability in assessment timing—emerge as recurring themes in the literature, underscoring the need for more consistent and rigorous research designs. By outlining a cohesive framework of changes in neuroplasticity due to ECT, this review provides initial steps towards a deeper comprehension of ECT's mechanisms.