To the Editor: Andrew J. Dwork, M.D., et al. (1) found in their study that increased "cortical and hippocampal immunoreactivity for glial fibrillaryacidic protein…was most intense in thegroup that received ECT" (p. 576). They wrote that these "statistically significant" increases in glial fibrillary acidic protein "probably" indicated "widespread astrocytic activation." In other words, 5 weeks after the last ECT, they found abnormal tissue changes under the microscope that were made visible by specialized staining techniques. This makes sense. Astrocytic activation is the brain’s well-known pathological response to injury and disease of all kinds.

Astrocytic activation evidenced by increased glial fibrillary acidic protein has been found in multiple sclerosis (2), temporal lobe epilepsy (3), amyotrophic lateral sclerosis (4), systemic lupus erythematosus (5), human immunodeficiency virus dementia, Alzheimer’s dementia, and, of course, traumatic injury.

Astrocytic activation, then called reactive astrocytic gliosis, was found after ECT as far back as 1948 (6). This latest finding of astrocytic activation 5 weeks after ECT is additional robust evidence in favor of brain damage—not against it.