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Despite its efficacy, ECT\u2019s neural mechanism of action remains unknown. Although ECT has been associated with \u201cslowing\u201d in the electroencephalogram (EEG), how this change relates to clinical improvement is unresolved. Until now, increases in slow-frequency power have been assumed to indicate increases in slow oscillations, without considering the contribution of aperiodic activity, a process with a different physiological mechanism. In this exploratory study of nine MDD patients, we show that aperiodic activity, indexed by the aperiodic exponent, increases with ECT treatment. This increase better explains EEG \u201cslowing\u201d when compared to power in oscillatory peaks in the delta (1\u20133\u2009Hz) range and is correlated to clinical improvement. In accordance with computational models of excitation-inhibition balance, these increases in aperiodic exponent are linked to increasing levels of inhibitory activity, suggesting that ECT might ameliorate depressive symptoms by restoring healthy levels of inhibition in frontal cortices.<\/jats:p>","DOI":"10.1038\/s41398-023-02634-9","type":"journal-article","created":{"date-parts":[[2023,11,15]],"date-time":"2023-11-15T21:01:36Z","timestamp":1700082096000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Clinical EEG slowing induced by electroconvulsive therapy is better described by increased frontal aperiodic activity"],"prefix":"10.1038","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5293-7247","authenticated-orcid":false,"given":"Sydney E.","family":"Smith","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celene","family":"Gonzalez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Chapman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Printz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1640-2525","authenticated-orcid":false,"given":"Bradley","family":"Voytek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam","family":"Soltani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,11,16]]},"reference":[{"key":"2634_CR1","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1016\/0165-1781(90)90098-P","volume":"31","author":"J Prudic","year":"1990","unstructured":"Prudic J, Sackeim HA, Devanand DP. 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