Electroconvulsive therapy (ECT) is used to treat patients with major depressive disorder, manic episodes and other serious mental disorders. Virtually every neurotransmitter system is affected in ECT. The significance of the nitric oxide (NO), which has an established role as a neurotransmitter, neuromodulator, and an intraneuronal second messenger, in ECT is still not clear. We described the involvement of NO in long-term potentiation, the N-methyl-D-aspartic acid (NMDA) receptor activity, regulation of cerebral blood flow, and the hypothalamic-pituitary axis and propose that this involvement is critical in ECT's efficiency, treatment refractoriness, and neuropsychological sequelae by its influences on these systems. Nitric oxide's significant role in other pathophysiological mechanisms has led to current therapeutic protocols and may be applicable in this setting.
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