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Malhi GS, Outhred T, Irwin L. Do we need to know more about repetitive transcranial magnetic stimulation in the treatment of depression? Aust N Z J Psychiatry 2019; 53:505-508. [PMID: 30957507 DOI: 10.1177/0004867419839784] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Gin S Malhi
- 1 Department of Psychiatry, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia.,2 Department of Academic Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,3 CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Tim Outhred
- 1 Department of Psychiatry, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia.,2 Department of Academic Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,3 CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Lauren Irwin
- 1 Department of Psychiatry, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia.,2 Department of Academic Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,3 CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
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302
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Bulteau S, Guirette C, Brunelin J, Poulet E, Trojak B, Richieri R, Szekely D, Bennabi D, Yrondi A, Rotharmel M, Bougerol T, Dall’Igna G, Attal J, Benadhira R, Bouaziz N, Bubrovszky M, Calvet B, Dollfus S, Foucher J, Galvao F, Gay A, Haesebaert F, Haffen E, Jalenques I, Januel D, Jardri R, Millet B, Nathou C, Nauczyciel C, Plaze M, Rachid F, Vanelle JM, Sauvaget A. Troubles de l’humeur : quand recourir à la stimulation magnétique transcrânienne ? Presse Med 2019; 48:625-646. [DOI: 10.1016/j.lpm.2019.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/30/2018] [Accepted: 01/31/2019] [Indexed: 12/24/2022] Open
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303
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Neuroimaging Biomarkers at Baseline Predict Electroconvulsive Therapy Overall Clinical Response in Depression: A Systematic Review. J ECT 2019; 35:77-83. [PMID: 30628993 DOI: 10.1097/yct.0000000000000570] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Major depressive disorder is a frequent and disabling disease and can be treated with antidepressant drugs. When faced with severe or resistant major depressive disorder, however, psychiatrists may resort to electroconvulsive therapy (ECT). Although very effective, the response falls short of 100%. A recent meta-analysis established clinical and biological predictive factors of the response to ECT. We decided to explore neuroimaging biomarkers that could be predictors of the ECT response. METHODS We performed a systematic literature review up to January 1, 2018, using a Boolean combination of MeSH terms. We included 19 studies matching our inclusion criteria. RESULTS Lower hippocampal, increased amygdala, and subgenual cingulate gyrus volumes were predictive for a better ECT response. Functional magnetic resonance imaging also found that the connectivity between the dorsolateral prefrontal cortex and posterior default-mode network is predictive of increased efficacy. Conversely, deep white matter hyperintensities in basal ganglia and Virchow-Robin spaces, medial temporal atrophy, ratio of left superior frontal to left rostral middle frontal cortical thickness, cingulate isthmus thickness asymmetry, and a wide range of gray and white matter anomalies were predictive for a poorer response. CONCLUSIONS Our review addresses the positive or negative predictive value of neuroimaging biomarkers for the ECT response, indispensable in a personalized medicine dynamic. These data could reduce the risk of nonresponders or resistance with earlier effective management. It might also help researchers elucidate the complex pathophysiology of depressive disorders and the functioning of ECT.
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304
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Marques RC, Vieira L, Marques D, Cantilino A. Transcranial magnetic stimulation of the medial prefrontal cortex for psychiatric disorders: a systematic review. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2019; 41:447-457. [PMID: 31166547 PMCID: PMC6796817 DOI: 10.1590/1516-4446-2019-0344] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/31/2019] [Indexed: 03/11/2023]
Abstract
OBJECTIVE The medial prefrontal cortex (mPFC) is a highly connected cortical region that acts as a hub in major large-scale brain networks. Its dysfunction is associated with a number of psychiatric disorders, such as schizophrenia, autism, depression, substance use disorder (SUD), obsessive-compulsive disorder (OCD), and anxiety disorders. Repetitive transcranial magnetic stimulation (rTMS) studies targeting the mPFC indicate that it may be a useful therapeutic resource in psychiatry due to its selective modulation of this area and connected regions. METHODS This review examines six mPFC rTMS trials selected from 697 initial search results. We discuss the main results, technical and methodological details, safety, tolerability, and localization strategies. RESULTS Six different protocols were identified, including inhibitory (1 Hz) and excitatory (5, 10, and 20 Hz) frequencies applied therapeutically to patient populations diagnosed with major depressive disorder, OCD, autistic spectrum disorder, SUD, specific phobia, and post-traumatic stress disorder (PTSD). In the OCD and acrophobia trials, rTMS significantly reduced symptoms compared to placebo. CONCLUSION These protocols were considered safe and add interesting new evidence to the growing body of mPFC rTMS literature. However, the small number and low methodological quality of the studies indicate the need for further research.
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Affiliation(s)
- Rodrigo C. Marques
- Departamento de Neuropsiquiatria, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
- Programa de Pós-Graduação em Neuropsiquiatria e Ciências do Comportamento, UFPE, Recife, PE, Brazil
| | - Larissa Vieira
- Programa de Pós-Graduação em Neuropsiquiatria e Ciências do Comportamento, UFPE, Recife, PE, Brazil
- Laboratório de Neurociência Aplicada, UFPE, Recife, PE, Brazil
| | - Déborah Marques
- Programa de Pós-Graduação em Neuropsiquiatria e Ciências do Comportamento, UFPE, Recife, PE, Brazil
- Laboratório de Neurociência Aplicada, UFPE, Recife, PE, Brazil
| | - Amaury Cantilino
- Departamento de Neuropsiquiatria, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
- Programa de Pós-Graduação em Neuropsiquiatria e Ciências do Comportamento, UFPE, Recife, PE, Brazil
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305
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Fileccia E, Di Stasi V, Poda R, Rizzo G, Stanzani-Maserati M, Oppi F, Avoni P, Capellari S, Liguori R. Effects on cognition of 20-day anodal transcranial direct current stimulation over the left dorsolateral prefrontal cortex in patients affected by mild cognitive impairment: a case-control study. Neurol Sci 2019; 40:1865-1872. [PMID: 31062189 DOI: 10.1007/s10072-019-03903-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 04/13/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) is a common disorder affecting as much as 15% of the elderly population. Transcranial direct current stimulation (tDCS) is a non-invasive technique of neuromodulation that has proven to influence performance in different cognitive domains. OBJECTIVE/HYPOTHESIS We investigated the effects on cognition of 20-day anodal tDCS in 17 MCI patients compared with 17 matched MCI patients. METHODS Patients underwent neuropsychological evaluation at baseline and then were randomly assigned to the anodal or sham group. The tDCS protocol consisted in 20 min, 5 days per week (up to a total of 20 days), of 2-mA anodal stimulation over the left dorsolateral prefrontal cortex (DLPFC). The location of anodal electrode was chosen in accordance with previous reports which relate anodal stimulation of this site with cognitive enhancement. At the end of the last day of stimulation, a second neuropsychological evaluation was performed. We compared baseline and post-stimulation neuropsychological results in the anodal vs sham group using repeated measures ANOVA as a statistical analysis test. RESULTS At follow-up, patients exposed to anodal stimulation showed improvement in episodic verbal memory (p < 0.001) and figure naming test (p < 0.01), in a general index of cognitive function (Brief Mental Deterioration Battery) (p < 0.0001) and in a mood measurement test (Beck Depression Inventory) (p < 0.01). CONCLUSION Anodal tDCS could be a useful tool to improve cognitive symptoms in MCI although more evidence is needed to understand the exact underlying mechanisms. Confirmation of its potential benefits in MCI would be significant.
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Affiliation(s)
- Enrico Fileccia
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
| | | | - Roberto Poda
- Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Giovanni Rizzo
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,Institute of Neurological Sciences of Bologna, Bologna, Italy
| | | | - Federico Oppi
- Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Patrizia Avoni
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Sabina Capellari
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Rocco Liguori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,Institute of Neurological Sciences of Bologna, Bologna, Italy
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306
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Desbeaumes Jodoin V, Miron JP, Lespérance P. Safety and Efficacy of Accelerated Repetitive Transcranial Magnetic Stimulation Protocol in Elderly Depressed Unipolar and Bipolar Patients. Am J Geriatr Psychiatry 2019; 27:548-558. [PMID: 30527274 DOI: 10.1016/j.jagp.2018.10.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 10/24/2018] [Accepted: 10/30/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Major depressive disorder (MDD) is a prevalent condition in older adults. Although antidepressant drugs are commonly prescribed, efficacy is variable, and older patients are more prone to side effects. Repetitive transcranial magnetic stimulation (rTMS) is an alternative therapy used increasingly in the treatment of MDD. Even though recent studies have shown efficacy of rTMS in elderly depressed patients, the safety and efficacy of accelerated rTMS has not been studied in this population. METHODS Data were retrospectively analyzed for adults with treatment-resistant depression (N = 73, n = 19 ≥60years, n = 54 <60 years) who underwent an accelerated protocol of 30 sessions (2 sessions per day) of left dorsolateral prefrontal cortex high-frequency (20 Hz) rTMS. RESULTS There were statistically significant improvements in depression and anxiety symptoms from baseline to post-treatment in both age groups, but those 60years and older showed statistically greater improvement in depression and anxiety symptom scores (p = 0.01) than those less than 60. There were significantly more responders (p = 0.001) and remitters (p = 0.023) in the older group. The age groups did not differ significantly in clinical and demographic characteristics or severity of current depressive episode, although baseline anxiety was less severe in those 60years and older. Unipolar and bipolar patients had a similar clinical response, and treatment appeared to be well tolerated by all patients. CONCLUSION Our results suggest that accelerated rTMS protocol is a safe and effective treatment for unipolar and bipolar depressed subjects, including older adults.
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Affiliation(s)
| | - Jean-Philippe Miron
- Department of Psychiatry (VDJ, JPM, PL), Centre Hospitalier de l'Université de Montréal, Montréal
| | - Paul Lespérance
- Department of Psychiatry (VDJ, JPM, PL), Centre Hospitalier de l'Université de Montréal, Montréal.
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307
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Latorre A, Rocchi L, Berardelli A, Bhatia KP, Rothwell JC. The use of transcranial magnetic stimulation as a treatment for movement disorders: A critical review. Mov Disord 2019; 34:769-782. [PMID: 31034682 DOI: 10.1002/mds.27705] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 04/04/2019] [Accepted: 04/07/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Transcranial magnetic stimulation is a safe and painless non-invasive brain stimulation technique that has been largely used in the past 30 years to explore cortical function in healthy participants and, inter alia, the pathophysiology of movement disorders. During the years, its use has evolved from primarily research purposes to treatment of a large variety of neurological and psychiatric diseases. In this article, we illustrate the basic principles on which the therapeutic use of transcranial magnetic stimulation is based and review the clinical trials that have been performed in patients with movement disorders. METHODS A search of the PubMed database for research and review articles was performed on therapeutic applications of transcranial magnetic stimulation in movement disorders. The search included the following conditions: Parkinson's disease, dystonia, Tourette syndrome and other chronic tic disorders, Huntington's disease and choreas, and essential tremor. The results of the studies and possible mechanistic explanations for the relatively minor effects of transcranial magnetic stimulation are discussed. Possible ways to improve the methodology and achieve greater therapeutic efficacy are discussed. CONCLUSION Despite the promising and robust rationales for the use of transcranial magnetic stimulations as a treatment tool in movement disorders, the results taken as a whole are not as successful as were initially expected. There is encouraging evidence that transcranial magnetic stimulation may improve motor symptoms and depression in Parkinson's disease, but the efficacy in other movement disorders is unclear. Possible improvements in methodology are on the horizon but have yet to be implemented in large clinical studies. © 2019 International Parkinson and Movement Disorder Society © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Anna Latorre
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London, London, UK
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Lorenzo Rocchi
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London, London, UK
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed Institute, Pozzilli, Isernia, Italy
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London, London, UK
| | - John C Rothwell
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London, London, UK
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308
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Netshilema TC, Khamker N, Sokudela F. Mental health professionals' attitudes toward and knowledge about electroconvulsive therapy at Weskoppies Hospital, South Africa. Perspect Psychiatr Care 2019; 55:201-209. [PMID: 30565693 DOI: 10.1111/ppc.12330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 09/14/2018] [Accepted: 09/23/2018] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To investigate the attitudes toward and knowledge of electroconvulsive therapy (ECT) among mental health practitioners. DESIGN AND METHODS One hundred and eighty-three participants from five groups of mental health practitioners were included. Anonymous questionnaires were used. FINDINGS Data were analyzed using SPSS version 24.0. Most of the questionnaires were completed by nurses (N = 142; 77.5%). Mean positive attitude scores were statistically different between the five groups, F(4, 178) = 2.63, P = 0.036). Mean knowledge scores between the five groups were statistically significant, H(4) = 30.0, P < 0.0001. Greater knowledge about ECT was associated with more positive attitude toward ECT, r(183) = 0.290, P = 0.01. PRACTICE IMPLICATIONS ECT educational programs need to be provided to all mental health practitioners and the resulting effects on knowledge and attitudes studied.
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Affiliation(s)
| | - Nadira Khamker
- Faculty of Medicine, Department of Psychiatry, University of Pretoria, Weskoppies Hospital, Pretoria, South Africa
| | - Funeka Sokudela
- Faculty of Medicine, Department of Psychiatry, University of Pretoria, Weskoppies Hospital, Pretoria, South Africa
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309
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MacMaster FP, Croarkin PE, Wilkes TC, McLellan Q, Langevin LM, Jaworska N, Swansburg RM, Jasaui Y, Zewdie E, Ciechanski P, Kirton A. Repetitive Transcranial Magnetic Stimulation in Youth With Treatment Resistant Major Depression. Front Psychiatry 2019; 10:170. [PMID: 30984044 PMCID: PMC6449763 DOI: 10.3389/fpsyt.2019.00170] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/08/2019] [Indexed: 12/21/2022] Open
Abstract
Background: Major depressive disorder (MDD) is common in youth and treatment options are limited. We evaluated the effectiveness and safety of repetitive transcranial magnetic stimulation (rTMS) in adolescents and transitional aged youth with treatment resistant MDD. Methods: Thirty-two outpatients with moderate to severe, treatment-resistant MDD, aged 13-21 years underwent a three-week, open-label, single center trial of rTMS (ClinicalTrials.gov identifier NCT01731678). rTMS was applied to the left dorsolateral prefrontal cortex (DLPFC) using neuronavigation and administered for 15 consecutive week days (120% rest motor threshold; 40 pulses over 4 s [10 Hz]; inter-train interval, 26 s; 75 trains; 3,000 pulses). The primary outcome measure was change in the Hamilton Depression Rating Scale (Ham-D). Treatment response was defined as a >50% reduction in Ham-D scores. Safety and tolerability were also examined. Results: rTMS was effective in reducing MDD symptom severity (t = 8.94, df = 31, p < 0.00001). We observed 18 (56%) responders (≥ 50% reduction in Ham-D score) and 14 non-responders to rTMS. Fourteen subjects (44%) achieved remission (Ham-D score ≤ 7 post-rTMS). There were no serious adverse events (i.e., seizures). Mild to moderate, self-limiting headaches (19%) and mild neck pain (16%) were reported. Participants ranked rTMS as highly tolerable. The retention rate was 91% and compliance rate (completing all study events) was 99%. Conclusions: Our single center, open trial suggests that rTMS is a safe and effective treatment for youth with treatment resistant MDD. Larger randomized controlled trials are needed. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT01731678.
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Affiliation(s)
- Frank P. MacMaster
- Departments of Pediatrics and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Strategic Clinical Network for Addictions and Mental Health, Alberta Health Services, Calgary, AB, Canada
| | - Paul E. Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, NY, United States
| | - T. Christopher Wilkes
- Departments of Pediatrics and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Quinn McLellan
- Departments of Pediatrics and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lisa Marie Langevin
- Departments of Pediatrics and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Natalia Jaworska
- Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
| | - Rose M. Swansburg
- Departments of Pediatrics and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Yamile Jasaui
- Departments of Pediatrics and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ephrem Zewdie
- Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Patrick Ciechanski
- Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Adam Kirton
- Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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310
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Daskalakis AA, Daskalakis ZJ. Treating resistant depression with 2 forms of convulsive therapy: a clinical case study. J Psychiatry Neurosci 2019; 44:143-144. [PMID: 30810025 PMCID: PMC6397037 DOI: 10.1503/jpn.180141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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311
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Bahji A, Hawken ER, Sepehry AA, Cabrera CA, Vazquez G. ECT beyond unipolar major depression: systematic review and meta-analysis of electroconvulsive therapy in bipolar depression. Acta Psychiatr Scand 2019; 139:214-226. [PMID: 30506992 DOI: 10.1111/acps.12994] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE In this systematic review and meta-analysis, the response, remission, and speed of response in adults with major depressive disorder (MDD) and bipolar disorder in depressive episode (BDD) receiving an acute course of electroconvulsive therapy (ECT) were quantitatively analyzed. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, 1660 citations were identified through five electronic databases. Nineteen articles met final inclusion criteria for meta-analysis. RESULTS The pooled response and remission rates with ECT in MDD were 74.2% (n = 1246/1680) and 52.3% (n = 850/1626), respectively. In BDD, they were 77.1% (n = 437/567) and 52.3% (n = 275/377), respectively. Although response rates to ECT were statistically higher in BDD (OR = 0.73, 95% CI: 0.56-0.95, P = 0.02), remission rates were similar (OR = 0.91, 95% CI: 0.65-1.26, P = 0.56). Individuals with BDD vs. MDD required fewer number of ECT sessions to achieve response (SMD = -0.23, 95% CI: -0.44 to -0.023, P = 0.03). There were no significant moderator effects identified. CONCLUSION Response rates and speed of response are higher in individuals with BDD; however, remission rates are equivalent. These findings support increased utilization of ECT in individuals with treatment-refractory BDD.
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Affiliation(s)
- A Bahji
- Department of Psychiatry, Providence Care Hospital, Queen's University, Kingston, ON, Canada
| | - E R Hawken
- Department of Psychiatry, Providence Care Hospital, Queen's University, Kingston, ON, Canada
| | - A A Sepehry
- Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - C A Cabrera
- Department of Psychiatry, Providence Care Hospital, Queen's University, Kingston, ON, Canada
| | - G Vazquez
- Department of Psychiatry, Providence Care Hospital, Queen's University, Kingston, ON, Canada
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312
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Abstract
Postpartum depression (PPD) is common, disabling, and treatable. The strongest risk factor is a history of mood or anxiety disorder, especially having active symptoms during pregnancy. As PPD is one of the most common complications of childbirth, it is vital to identify best treatments for optimal maternal, infant, and family outcomes. New understanding of PPD pathophysiology and emerging therapeutics offer the potential for new ways to add to current medications, somatic treatments, and evidence-based psychotherapy. The benefits and potential harms of treatment, including during breastfeeding, are presented.
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Affiliation(s)
- Donna E Stewart
- Department of Psychiatry, University of Toronto, Toronto, Ontario M5G 2C4, Canada; .,Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario M5G 2C4, Canada.,Toronto General Hospital Research Institute, Toronto, Ontario M5G 2C4, Canada.,University Health Network Centre for Mental Health, Toronto, Ontario M5G 2C4, Canada
| | - Simone N Vigod
- Department of Psychiatry, University of Toronto, Toronto, Ontario M5G 2C4, Canada; .,Women's College Research Institute, Women's College Hospital, Toronto, Ontario M5G 2C4, Canada;
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313
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Caldieraro MA, Cassano P. Transcranial and systemic photobiomodulation for major depressive disorder: A systematic review of efficacy, tolerability and biological mechanisms. J Affect Disord 2019; 243:262-273. [PMID: 30248638 DOI: 10.1016/j.jad.2018.09.048] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/24/2018] [Accepted: 09/15/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Photobiomodulation (PBM) with red and near-infrared light (NIR) -also known as Low-Level Light Therapy-is a low risk, inexpensive treatment-based on non-retinal exposure-under study for several neuropsychiatric conditions. The aim of this paper is to discuss the proposed mechanism of action and to perform a systematic review of pre-clinical and clinical studies on PBM for major depressive disorder (MDD). METHODS A search on MEDLINE and EMBASE databases was performed in July 2017. No time or language restrictions were used. Studies with a primary focus on MDD and presenting original data were included (n = 17). References on the mechanisms of action of PBM also included review articles and studies not focused on MDD. RESULTS Red and NIR light penetrate the skull and modulate brain cortex; an indirect effect of red and NIR light, when delivered non-transcranially, is also postulated. The main proposed mechanism for PBM is the enhancement of mitochondrial metabolism after absorption of NIR energy by the cytochrome C oxidase; however, actions on other pathways relevant to MDD are also reported. Studies on animal models indicate a benefit from PBM that is comparable to antidepressant medications. Clinical studies also indicate a significant antidepressant effect and good tolerability. LIMITATIONS Clinical studies are heterogeneous for population and treatment parameters, and most lack an appropriate control. CONCLUSIONS Preliminary evidence supports the potential of non-retinal PBM as a novel treatment for MDD. Future studies should clarify the ideal stimulation parameters as well as the overall efficacy, effectiveness and safety profile of this treatment.
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Affiliation(s)
- Marco A Caldieraro
- Serviço de Psiquiatria, Hospital de Clínicas de Porto Alegre. Rua Ramiro Barcelos 2350, Porto Alegre, RS 90035-903, Brazil.
| | - Paolo Cassano
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital. 1 Bowdoin Square, Boston, MA 02114, USA; Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston. 1 Bowdoin Square, MA 02114, USA
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314
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Gazdag G, Ungvari GS. Electroconvulsive therapy: 80 years old and still going strong. World J Psychiatry 2019; 9:1-6. [PMID: 30631748 PMCID: PMC6323557 DOI: 10.5498/wjp.v9.i1.1] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/29/2018] [Accepted: 12/11/2018] [Indexed: 02/05/2023] Open
Abstract
Electroconvulsive therapy (ECT), which is among the oldest and most controversial treatments in the field of psychiatry, has its 80th birthday this year. In this brief historical overview, the discovery of the therapeutic effects of convulsive therapy by Laszló Meduna, and the circumstances that motivated Ugo Cerletti and Lucio Bini to use electricity as a means of seizure induction are described. Meduna’s original theory about the antagonism between epilepsy and schizophrenia has been replaced by hypotheses on the mechanism of action of ECT. The position of ECT in modern psychiatry is also discussed with special attention to its most important clinical indications, including catatonia, and pre- and postpartum affective and psychotic states that are responsive to ECT and in which ECT may even be lifesaving. Adverse effects and comparison of ECT with recently developed brain stimulation methods are also reviewed. The negative media portrayal of ECT and its earlier misuse may have contributed to its negative professional and public perceptions indicated repeatedly in attitude surveys. This negative attitude has played an important role in the decreasing use of ECT in the developed world and a reduction in access to ECT, which constitutes a violation of psychiatric patients’ right to an effective treatment.
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Affiliation(s)
- Gábor Gazdag
- First Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
- Department of Psychiatry and Psychotherapy, Semmelweis University Medical School, 1083 Budapest, Hungary
| | - Gabor S Ungvari
- University of Notre Dame, Fremantle, WA 6009, Australia
- Division of Psychiatry, School of Medicine, University of Western Australia, Crawley, WA 6009, Australia
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315
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Zilles D. Vagus Nerve Stimulation as a Treatment for Catatonia: A Hypothesis. Front Psychiatry 2019; 10:86. [PMID: 30873050 PMCID: PMC6402369 DOI: 10.3389/fpsyt.2019.00086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 02/07/2019] [Indexed: 11/28/2022] Open
Abstract
Background: Catatonia is a syndrome comprising psychomotor, behavioral, and autonomous symptoms which may occur in the context of severe schizophrenic, affective, and other mental disorders or medical conditions. Treatment options include high dose benzodiazepines (lorazepam) and electroconvulsive therapy (ECT) with some evidence for the effectiveness of glutamate antagonists. However, due to a lack of randomized controlled studies in this severely ill population, evidence base is weak. Methods: On occasion of the case of a patient with treatment resistant catatonia in schizoaffective disorder, we developed the hypothesis of vagus nerve stimulation (VNS) being a potential therapy for treatment resistant catatonia. Results: Based on a selective literature search, we found a remarkable overlap of the pathophysiology of catatonia on the one hand and the putative mechanisms of action of VNS on the other hand in several domains: functional brain imaging, involved neurotransmitter systems, clinical, and theoretical. We thus decided to use VNS as a single subject clinical trial. During the 1-year-follow-up, we observed a fluctuating, but ultimately marked improvement of both catatonic symptoms and general psychopathology. Conclusions: We assume there is a sufficient hypothetical corroboration for the potential effectiveness of VNS as a long-term treatment in predominantly catatonic syndromes. This hypothesis could be tested in proof-of-concept clinical trials.
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Affiliation(s)
- David Zilles
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
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316
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Doshi PK, Arumugham SS, Bhide A, Vaishya S, Desai A, Singh OP, Math SB, Gautam S, Satyanarayana Rao TS, Mohandas E, Srinivas D, Avasthi A, Grover S, Reddy YCJ. Indian guidelines on neurosurgical interventions in psychiatric disorders. Indian J Psychiatry 2019; 61:13-21. [PMID: 30745649 PMCID: PMC6341921 DOI: 10.4103/psychiatry.indianjpsychiatry_536_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Neurosurgery for psychiatric disorders (NPD) has been practiced for >80 years. However, the interests have waxed and waned, from 1000s of surgeries in 1940-1950s to handful of surgery in 60-80s. This changed with the application of deep brain stimulation surgery, a surgery, considered to be "reversible" there has been a resurgence in interest. The Indian society for stereotactic and functional neurosurgery (ISSFN) and the world society for stereotactic and functional neurosurgery took the note of the past experiences and decided to form the guidelines for NPD. In 2011, an international task force was formed to develop the guidelines, which got published in 2013. In 2018, eminent psychiatrists from India, functional neurosurgeon representing The Neuromodulation Society and ISSFN came-together to deliberate on the current status, need, and legal aspects of NPD. In May 2018, Mental Health Act also came in to force in India, which had laid down the requirements to be fulfilled for NPD. In light of this after taking inputs from all stakeholders and review of the literature, the group has proposed the guidelines for NPD that can help to steer these surgery and its progress in India.
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Affiliation(s)
- Paresh K Doshi
- Department of Neurosurgery, Jaslok Hospital and Research Centre, Mumbai, Maharastra, India
| | - Shyam S Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ajit Bhide
- Department of Psychiatry, St. Martha's Hospital, Bengaluru, Karnataka, India
| | - Sandeep Vaishya
- Consultant Neurosurgeon, Department of Neurosurgery, Fortis Hospital, Gurgaon, Haryana, India
| | - Amit Desai
- Department of Psychiatry, Jaslok Hospital and Research Centre, Mumbai, Maharastra, India
| | - Om Prakash Singh
- Department of Psychiatry, Nilratan Sirchar Medical College, Kolkata, West Bengal, India
| | - Suresh B Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Shiv Gautam
- Consultant Psychiatrist, Gautam Hospital and Research Centre, Civil Lines, Jaipur, Rajasthan, India
| | - T S Satyanarayana Rao
- Department of Psychiatry, J.S.S Medical College and Hospital, J.S.S University, Mysore, Karnataka, India
| | - E Mohandas
- Consultant Psychiatrist, Sun Medical and Research Centre, Trichur, Kerala, India
| | - Dwarkanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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317
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Kucia K, Merk W, Zapalowicz K, Medrala T. Vagus Nerve Stimulation For Treatment Resistant Depression: Case Series Of Six Patients - Retrospective Efficacy And Safety Observation After One Year Follow Up. Neuropsychiatr Dis Treat 2019; 15:3247-3254. [PMID: 31819452 PMCID: PMC6883943 DOI: 10.2147/ndt.s217816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/15/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE One year observation and evaluation of the VNS (vagus nerve stimulation) efficacy and safety for patients with treatment resistant depression in Polish conditions. METHODS An open label, uncontrolled and one center retrospective study of VNS therapy was implemented with stable pharmacotherapy in 6 patients with treatment resistant depression (TRD). For the first 3 months, only VNS parameters were altered but the pharmacological treatment was unchanged and in the following 9 months, medication and VNS dosing parameters were altered according to the clinical state of the patients. RESULTS The baseline 24-item Hamilton Depression Rating Scale (HAMD-24) score averaged 24. Both response (>50% reduction in baseline scores) and remission rates after 3 months of treatment were only 40%. After 1 year of VNS therapy, the response rates increased to 86%. Most frequent side-effects were voice alteration (86% at 3 months of stimulation) and headaches (40%). CONCLUSION VNS treatment was safe and effective in TRD patients and its efficacy increased with time. Efficacy ratings are similar to the previously reported studies using a congenial protocol.
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Affiliation(s)
- Krzysztof Kucia
- Department of Psychiatry and Psychotherapy, School of Medicine in Katowice, Medical University of Silesia, GCM, Katowice 40-635, Poland
| | - Wojciech Merk
- Department of Psychiatry and Psychotherapy, School of Medicine in Katowice, Medical University of Silesia, GCM, Katowice 40-635, Poland
| | | | - Tomasz Medrala
- Department of Psychiatry and Psychotherapy, School of Medicine in Katowice, Medical University of Silesia, GCM, Katowice 40-635, Poland
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318
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van Dun K, Mitoma H, Manto M. Cerebellar Cortex as a Therapeutic Target for Neurostimulation. THE CEREBELLUM 2018; 17:777-787. [PMID: 30276522 DOI: 10.1007/s12311-018-0976-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Non-invasive stimulation of the cerebellum is growingly applied both in the clinic and in research settings to modulate the activities of cerebello-cerebral loops. The anatomical location of the cerebellum, the high responsiveness of the cerebellar cortex to magnetic/electrical stimuli, and the implication of the cerebellum in numerous cerebello-cerebral networks make the cerebellum an ideal target for investigations and therapeutic purposes. In this mini-review, we discuss the potentials of cerebellar neuromodulation in major brain disorders in order to encourage large-scale sham-controlled research and explore this therapeutic aid further.
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Affiliation(s)
- Kim van Dun
- Clinical and Experimental Neurolinguistics, CLIN, Vrije Universiteit Brussels, Pleinlaan 2, 1050, Brussels, Belgium.
| | - Hiroshi Mitoma
- Medical Education Promotion Center, Tokyo Medical University, Tokyo, Japan
| | - Mario Manto
- Service de Neurologie, Médiathèque Jean Jacquy, CHU-Charleroi, Charleroi, Belgium.,Service des Neurosciences, UMons, Mons, Belgium
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319
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Monteiro DC, Cantilino A. Use of a Double-Cone Coil in Transcranial Magnetic Stimulation for Depression Treatment. Neuromodulation 2018; 22:867-870. [PMID: 30506758 DOI: 10.1111/ner.12896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/18/2018] [Accepted: 09/26/2018] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Approximately 15% of all people will experience a depressive episode throughout their lives, and by 2020, depression will be the second largest cause of disability around the world. Transcranial magnetic stimulation (TMS) has been shown to be an effective option for treating this condition. Devices such as the double-cone coil may bring new insights regarding depression treatment. METHODS A literature search was performed on PubMed, ScienceDirect, Cochrane, LILACS, and Google Scholar by applying the descriptors "depression" AND "transcranial magnetic stimulation" AND "double cone-coil." RESULTS Six studies were considered eligible (three clinical trials, two case series, and one isolated case report). All of them described treatments with transcranial magnetic stimulation by double-cone coil (DC-TMS) at 10 Hz over the dorsomedial prefrontal cortex, achieving response and remission rates of 40-52.4% and 34.7-47.6%, respectively. Two clinical trials investigated both intermittent theta-burst stimulation and 10 Hz TMS, suggesting a slight advantage of the latter. They also found no additional gains by combining both techniques. CONCLUSION Despite the small number of controlled clinical trials and the small sample sizes, which limit the generalization of the obtained results, the collected data provide an optimistic perspective on the effectiveness of using DC-TMS for depression treatment.
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Affiliation(s)
- Dennison Carreiro Monteiro
- Neuropsychiatry, Behavioral Science Postgraduate Program at the Universidade Federal de Pernambuco, Recife, Brazil
| | - Amaury Cantilino
- Neuropsychiatry, Behavioral Science Postgraduate Program at the Universidade Federal de Pernambuco, Recife, Brazil
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320
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Wu C, Liu P, Fu H, Chen W, Cui S, Lu L, Tang C. Transcutaneous auricular vagus nerve stimulation in treating major depressive disorder: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e13845. [PMID: 30593183 PMCID: PMC6314717 DOI: 10.1097/md.0000000000013845] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Transcutaneous auricular vagus nerve stimulation (taVNS), as a noninvasive intervention, has beneficial effects on major depressive disorder based on clinical observations. However, the potential benefits and clinical role of taVNS in the treatment of major depressive disorder are still uncertain and have not been systematically evaluated. Therefore, we performed a systematic review and meta-analysis to evaluate the effectiveness and safety of taVNS in treating major depressive disorder. METHODS Four electronic databases, namely, Embase, MEDLINE, the Cochrane Library and PsycINFO, were searched for all related trials published through May 1, 2018. We extracted the basic information and data of the included studies and evaluated the methodological quality with the Cochrane risk of bias tool and the nonrandomized studies-of interventions (ROBINS-I) tool. A meta-analysis of the comparative effects was conducted using the Review Manager 5.3 software. RESULTS A total of 423 citations from the databases were searched, and 4 studies with 222 individuals were included in the meta-analysis. The taVNS technique could decrease 24-item HAMD scores more than the sham intervention (MD: -4.23, 95% CI: -7.15, -1.31; P = .005) and was also more effective in decreasing Self-Rating Depression Scale scores ((MD: -10.34, 95% CI: -13.48, -7.20; P < .00001), Beck Depression Inventory scores (MD: -10.3, 95% CI: -18.1, -2.5; P = .01) and Self-Rating Anxiety Scale scores (MD: -6.57, 95% CI: -9.30, -3.84; P < .00001). However, there was no significant difference in the Hamilton Anxiety Rating Scale scores between the taVNS and sham taVNS groups (MD: -1.12, 95% CI: -2.56, 0.32; P = .13). No obvious adverse effects of taVNS treatment were reported in the included studies. CONCLUSION The results of the analysis preliminarily demonstrated that taVNS therapy can effectively ameliorate the symptoms of major depressive disorder, providing an alternative technique for addressing depression. However, more well-designed RCTs with larger sample sizes and follow-ups are needed in future studies to confirm our findings.
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Affiliation(s)
- Chunxiao Wu
- Medical College of Acu-Moxi and Rehabilitation
| | - Peihui Liu
- Medical College of Acu-Moxi and Rehabilitation
| | - Huaili Fu
- Medical College of Acu-Moxi and Rehabilitation
| | - Wentao Chen
- Medical College of Acu-Moxi and Rehabilitation
| | - Shaoyang Cui
- Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong Province, PR China
| | - Liming Lu
- Clinical Research Center, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou
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321
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Drobisz D, Damborská A. Deep brain stimulation targets for treating depression. Behav Brain Res 2018; 359:266-273. [PMID: 30414974 DOI: 10.1016/j.bbr.2018.11.004] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 09/10/2018] [Accepted: 11/05/2018] [Indexed: 12/18/2022]
Abstract
Deep brain stimulation (DBS) is a new therapeutic approach for treatment-resistant depression (TRD). There is a preliminary evidence of the efficacy and safety of DBS for TRD in the subgenual anterior cingulate cortex, the ventral capsule/ventral striatum, the nucleus accumbens, the lateral habenula, the inferior thalamic peduncle, the medial forebrain bundle, and the bed nucleus of the stria terminalis. Optimal stimulation targets, however, have not yet been determined. Here we provide updated knowledge substantiating the suitability of each of the current and potential future DBS targets for treating depression. In this review, we discuss the future outlook for DBS treatment of depression in light of the fact that antidepressant effects of DBS can be achieved using different targets.
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Affiliation(s)
- Dominik Drobisz
- Department of Psychiatry, University Hospital and Masaryk University, Brno, Czech Republic
| | - Alena Damborská
- Department of Psychiatry, University Hospital and Masaryk University, Brno, Czech Republic; Department of Basic Neurosciences, University of Geneva, Campus Biotech, Geneva, Switzerland; CEITEC - Central European Institute of Technology, Brain and Mind Research Program, Masaryk University, Brno, Czech Republic.
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322
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Shalbaf R, Brenner C, Pang C, Blumberger DM, Downar J, Daskalakis ZJ, Tham J, Lam RW, Farzan F, Vila-Rodriguez F. Non-linear Entropy Analysis in EEG to Predict Treatment Response to Repetitive Transcranial Magnetic Stimulation in Depression. Front Pharmacol 2018; 9:1188. [PMID: 30425640 PMCID: PMC6218964 DOI: 10.3389/fphar.2018.01188] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/28/2018] [Indexed: 12/12/2022] Open
Abstract
Background: Biomarkers that predict clinical outcomes in depression are essential for increasing the precision of treatments and clinical outcomes. The electroencephalogram (EEG) is a non-invasive neurophysiological test that has promise as a biomarker sensitive to treatment effects. The aim of our study was to investigate a novel non-linear index of resting state EEG activity as a predictor of clinical outcome, and compare its predictive capacity to traditional frequency-based indices. Methods: EEG was recorded from 62 patients with treatment resistant depression (TRD) and 25 healthy comparison (HC) subjects. TRD patients were treated with excitatory repetitive transcranial magnetic stimulation (rTMS) to the dorsolateral prefrontal cortex (DLPFC) for 4 to 6 weeks. EEG signals were first decomposed using the empirical mode decomposition (EMD) method into band-limited intrinsic mode functions (IMFs). Subsequently, Permutation Entropy (PE) was computed from the obtained second IMF to yield an index named PEIMF2. Receiver Operator Characteristic (ROC) curve analysis and ANOVA test were used to evaluate the efficiency of this index (PEIMF2) and were compared to frequency-band based methods. Results: Responders (RP) to rTMS exhibited an increase in the PEIMF2 index compared to non-responders (NR) at F3, FCz and FC3 sites (p < 0.01). The area under the curve (AUC) for ROC analysis was 0.8 for PEIMF2 index for the FC3 electrode. The PEIMF2 index was superior to ordinary frequency band measures. Conclusion: Our data show that the PEIMF2 index, yields superior outcome prediction performance compared to traditional frequency band indices. Our findings warrant further investigation of EEG-based biomarkers in depression; specifically entropy indices applied in band-limited EEG components. Registration in ClinicalTrials.Gov; identifiers NCT02800226 and NCT01887782.
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Affiliation(s)
- Reza Shalbaf
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Colleen Brenner
- Department of Psychology, Loma Linda University, Loma Linda, CA, United States
| | - Christopher Pang
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jonathan Downar
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,MRI-Guided rTMS Clinic and Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Joseph Tham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Faranak Farzan
- School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, BC, Canada
| | - Fidel Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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323
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Cassano P, Petrie SR, Mischoulon D, Cusin C, Katnani H, Yeung A, De Taboada L, Archibald A, Bui E, Baer L, Chang T, Chen J, Pedrelli P, Fisher L, Farabaugh A, Hamblin MR, Alpert JE, Fava M, Iosifescu DV. Transcranial Photobiomodulation for the Treatment of Major Depressive Disorder. The ELATED-2 Pilot Trial. Photomed Laser Surg 2018; 36:634-646. [PMID: 30346890 DOI: 10.1089/pho.2018.4490] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objective: Our objective was to test the antidepressant effect of transcranial photobiomodulation (t-PBM) with near-infrared (NIR) light in subjects suffering from major depressive disorder (MDD). Background: t-PBM with NIR light is a new treatment for MDD. NIR light is absorbed by mitochondria; it boosts cerebral metabolism, promotes neuroplasticity, and modulates endogenous opioids, while decreasing inflammation and oxidative stress. Materials and methods: We conducted a double-blind, sham-controlled study on the safety and efficacy [change in Hamilton Depression Rating Scale (HAM-D17) total score at end-point] of adjunct t-PBM NIR [823 nm; continuous wave (CW); 28.7 × 2 cm2; 36.2 mW/cm2; up to 65.2 J/cm2; 20-30 min/session], delivered to dorsolateral prefrontal cortex, bilaterally and simultaneously, twice a week, for 8 weeks, in subjects with MDD. Baseline observation carried forward (BOCF), last observation carried forward (LOCF), and completers analyses were performed. Results: The effect size for the antidepressant effect of t-PBM, based on change in HAM-D17 total score at end-point, was 0.90, 0.75, and 1.5 (Cohen's d), respectively for BOCF (n = 21), LOCF (n = 19), and completers (n = 13). Further, t-PBM was fairly well tolerated, with no serious adverse events. Conclusions: t-PBM with NIR light demonstrated antidepressant properties with a medium to large effect size in patients with MDD. Replication is warranted, especially in consideration of the small sample size.
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Affiliation(s)
- Paolo Cassano
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, Massachusetts
| | - Samuel R Petrie
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - David Mischoulon
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Cristina Cusin
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Husam Katnani
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Albert Yeung
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Abigal Archibald
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Eric Bui
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, Massachusetts
| | - Lee Baer
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Trina Chang
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Justin Chen
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Paola Pedrelli
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Lauren Fisher
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Amy Farabaugh
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael R Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Dermatology, Harvard Medical School, Boston, Massachusetts.,Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts
| | - Jonathan E Alpert
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Maurizio Fava
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Dan V Iosifescu
- Adult Psychopharmacology Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
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324
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Brunoni AR, Sampaio-Junior B, Moffa AH, Aparício LV, Gordon P, Klein I, Rios RM, Razza LB, Loo C, Padberg F, Valiengo L. Noninvasive brain stimulation in psychiatric disorders: a primer. ACTA ACUST UNITED AC 2018; 41:70-81. [PMID: 30328957 PMCID: PMC6781710 DOI: 10.1590/1516-4446-2017-0018] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 01/11/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Noninvasive brain stimulation (NIBS) techniques, such as transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), are increasingly being used to treat mental disorders, particularly major depression. The aim of this comprehensive review is to summarize the main advances, limitations, and perspectives of the field. METHODS We searched PubMed and other databases from inception to July 2017 for articles, particularly systematic reviews and meta-analyses, evaluating the use of NIBS in psychiatric disorders. RESULTS We reviewed the mechanisms of action, safety, tolerability, efficacy, and relevant clinical parameters of NIBS. Repetitive TMS is already an established technique for the treatment of depression, and there is theoretically room for further methodological development towards a high-end therapeutic intervention. In contrast, tDCS is a technically easier method and therefore potentially suitable for wider clinical use. However the evidence of its antidepressant efficacy is less sound, and a recent study found tDCS to be inferior to antidepressant pharmacotherapy. Clinical trials using rTMS for other mental disorders produced mixed findings, whereas tDCS use has not been sufficiently appraised. CONCLUSION The most promising results of NIBS have been obtained for depression. These techniques excel in safety and tolerability, although their efficacy still warrants improvement.
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Affiliation(s)
- Andre R Brunoni
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Bernardo Sampaio-Junior
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Adriano H Moffa
- Black Dog Institute, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Luana V Aparício
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Pedro Gordon
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Department of Neurology and Stroke, Eberhard Karls University, Tübingen, Germany
| | - Izio Klein
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Rosa M Rios
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Lais B Razza
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Colleen Loo
- Black Dog Institute, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Frank Padberg
- Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Leandro Valiengo
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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325
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Shahane AD, Fagundes CP, Denny BT. Mending the heart and mind during times of loss: A review of interventions to improve emotional well-being during spousal bereavement. BEREAVEMENT CARE : FOR ALL THOSE WHO HELP THE BEREAVED 2018; 37:44-54. [PMID: 31548757 PMCID: PMC6756769 DOI: 10.1080/02682621.2018.1493640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Spousal loss is one of life's greatest stressors. Bereaved spouses are at risk for aberrant cognitive and affective processing. Recent work in psychoneuroimmunology and cognitive neuroscience reveals physiological biomarkers and neural mechanisms underlying acute distress and grief during bereavement that may represent targets for future interventions. We review evidence from existing pharmacological and psychotherapeutic treatment approaches for normal bereavement, complicated grief, and bereavement-related depression. We propose promising future directions, namely the development and empirical validation of novel, personalised cognitive and neurostimulatory interventions to promote adaptive emotion regulation and reduce depressive symptoms following spousal loss. Future work may substantiate which interventions to improve emotional and physical health will be best matched to the needs of a particular surviving spouse.
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Affiliation(s)
| | - Christopher P. Fagundes
- Rice University, Houston, TX
- The University of Texas MD Anderson Cancer Center, Houston, TX
- Baylor College of Medicine, Houston, TX
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326
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Noda Y, Zomorrodi R, Daskalakis ZJ, Blumberger DM, Nakamura M. Enhanced theta-gamma coupling associated with hippocampal volume increase following high-frequency left prefrontal repetitive transcranial magnetic stimulation in patients with major depression. Int J Psychophysiol 2018; 133:169-174. [PMID: 30318052 DOI: 10.1016/j.ijpsycho.2018.07.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 12/21/2022]
Abstract
The underlying mechanism of repetitive transcranial magnetic stimulation (rTMS) effects on cognition has not been fully examined. Previously, we have reported the left hippocampal volume increase and theta-gamma coupling (TGC) enhancement associated with working memory improvement following rTMS in depression. This study was aimed to examine whether there is a structure-function relationship in hippocampal neuroplasticity induced by prefrontal rTMS. Thirty-one patients with major depression underwent longitudinal MRI scans and resting-state EEG recordings with the 10-20 system using averaged ear-lobes reference, following 10 sessions of high-frequency rTMS over the left dorsolateral prefrontal cortex. Pearson's correlation analyses were applied for the longitudinal changes among the left and right hippocampal volumes as measured by manual volumetry, theta and gamma spectral powers, and TGC as measured by resting-state EEG. The analyses demonstrated that the left hippocampus volume increases correlated with TGC increases at the left central area (r = 0.576, p = 0.001, N = 31), whereas no significant correlations were observed among changes of right hippocampal volume, right central TGC, bilateral gamma or theta powers. These finding suggests structure-function relationship in rTMS-induced neuroplastic changes mediated through the hippocampus and prefrontal network at the stimulated side. Therefore, high-frequency prefrontal rTMS may exert its cognitive effect through the hippocampal structural-functional neuroplasticity.
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Affiliation(s)
- Yoshihiro Noda
- Department of Neuropsychiatry, Keio University School of Medicine, Japan.
| | - Reza Zomorrodi
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Canada
| | - Zafiris J Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Canada
| | - Motoaki Nakamura
- Medical Institute of Developmental Disabilities Research, Showa University, Japan; Laboratory of Neuromodulation, Kanagawa Psychiatric Center, Japan
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327
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Lemasson M, Haesebaert J, Rochette L, Pelletier E, Lesage A, Patry S. Electroconvulsive Therapy Practice in the Province of Quebec: Linked Health Administrative Data Study from 1996 to 2013. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:465-473. [PMID: 29069982 PMCID: PMC6099779 DOI: 10.1177/0706743717738492] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE As part of a quality improvement process, we propose a model of routinely monitoring electroconvulsive therapy (ECT) in Canadian provinces using linked health administrative databases to generate provincial periodic reports, influence policy, and standardise ECT practices. METHODS ECT practice in Quebec was studied from 1996 to 2013, using longitudinal data from the Quebec Integrated Chronic Disease Surveillance System of the Institut National de Santé Publique du Québec, which links 5 health administrative databases. The population included all persons, aged 18 y and over, eligible for the health insurance registry, who received an ECT treatment at least once during the year. RESULTS Among recorded cases, 75% were identified by physician claims and hospitalisation files, 19% exclusively by physician claims, and 6% by hospitalisation files. From 1996 to 2013, 8,149 persons in Quebec received ECT with an annual prevalence rate of 13 per 100,000. A decline was observed, which was more pronounced in women and in older persons. On average, each patient received 9.7 treatments of ECT annually. The proportion of acute ECT decreased whereas maintenance treatment proportions increased. A wide variation in the use of ECT was observed among regions and psychiatrists. CONCLUSION This study demonstrates the profitable use of administrative data to monitor ECT use in Quebec, and provides a reliable method that could be replicated in other Canadian provinces. Although Quebec has one of the lowest utilisation rates reported in industrialized countries, regional disparities highlighted the need for a deeper examination of the quality and monitoring of ECT care and services.
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Affiliation(s)
- Morgane Lemasson
- 1 Centre d'Excellence en Électroconvulsivothérapie du Québec, Institut universitaire en santé mentale de Montréal, Montreal, Quebec.,2 Department of Psychiatry, University of Montreal, Montreal. Quebec.,3 Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Quebec.,4 Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, Quebec
| | - Julie Haesebaert
- 4 Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, Quebec
| | - Louis Rochette
- 4 Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, Quebec
| | - Eric Pelletier
- 4 Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, Quebec
| | - Alain Lesage
- 1 Centre d'Excellence en Électroconvulsivothérapie du Québec, Institut universitaire en santé mentale de Montréal, Montreal, Quebec.,2 Department of Psychiatry, University of Montreal, Montreal. Quebec.,3 Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Quebec.,4 Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, Quebec
| | - Simon Patry
- 1 Centre d'Excellence en Électroconvulsivothérapie du Québec, Institut universitaire en santé mentale de Montréal, Montreal, Quebec.,2 Department of Psychiatry, University of Montreal, Montreal. Quebec
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328
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Ross EL, Zivin K, Maixner DF. Cost-effectiveness of Electroconvulsive Therapy vs Pharmacotherapy/Psychotherapy for Treatment-Resistant Depression in the United States. JAMA Psychiatry 2018; 75:713-722. [PMID: 29800956 PMCID: PMC6145669 DOI: 10.1001/jamapsychiatry.2018.0768] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Electroconvulsive therapy (ECT) is a highly effective treatment for depression but is infrequently used owing to stigma, uncertainty about indications, adverse effects, and perceived high cost. OBJECTIVE To assess the cost-effectiveness of ECT compared with pharmacotherapy/psychotherapy for treatment-resistant major depressive disorder in the United States. DESIGN, SETTING, AND PARTICIPANTS A decision analytic model integrating data on clinical efficacy, costs, and quality-of-life effects of ECT compared with pharmacotherapy/psychotherapy was used to simulate depression treatment during a 4-year horizon from a US health care sector perspective. Model input data were drawn from multiple meta-analyses, randomized trials, and observational studies of patients with depression. Where possible, data sources were restricted to US-based studies of nonpsychotic major depression. Data were analyzed between June 2017 and January 2018. INTERVENTIONS Six alternative strategies for incorporating ECT into depression treatment (after failure of 0-5 lines of pharmacotherapy/psychotherapy) compared with no ECT. MAIN OUTCOMES AND MEASURES Remission, response, and nonresponse of depression; quality-adjusted life-years; costs in 2013 US dollars; and incremental cost-effectiveness ratios. Strategies with incremental cost-effectiveness ratios of $100 000 per quality-adjusted life-year or less were designated cost-effective. RESULTS Based on the Sequenced Treatment Alternatives to Relieve Depression trial, we simulated a population with a mean (SD) age of 40.7 (13.2) years, and 62.2% women. Over 4 years, ECT was projected to reduce time with uncontrolled depression from 50% of life-years to 33% to 37% of life-years, with greater improvements when ECT is offered earlier. Mean health care costs were increased by $7300 to $12 000, with greater incremental costs when ECT was offered earlier. In the base case, third-line ECT was cost-effective, with an ICER of $54 000 per quality-adjusted life-year. Third-line ECT remained cost-effective in a range of univariate, scenario, and probabilistic sensitivity analyses. Incorporating all input data uncertainty, we estimate a 74% to 78% likelihood that at least 1 of the ECT strategies is cost-effective and a 56% to 58% likelihood that third-line ECT is the optimal strategy. CONCLUSIONS AND RELEVANCE For US patients with treatment-resistant depression, ECT may be an effective and cost-effective treatment option. Although many factors influence the decision to proceed with ECT, these data suggest that, from a health-economic standpoint, ECT should be considered after failure of 2 or more lines of pharmacotherapy/psychotherapy.
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Affiliation(s)
- Eric L. Ross
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor
| | - Kara Zivin
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor,Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor,Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor
| | - Daniel F. Maixner
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor
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329
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Vagus Nerve Stimulation: A Treatment in Evolution. Cogn Behav Neurol 2018; 31:99-100. [PMID: 29927801 DOI: 10.1097/wnn.0000000000000155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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330
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Pridmore S. Transcranial magnetic stimulation: an item number is justified. Med J Aust 2018; 208:468. [PMID: 29902398 DOI: 10.5694/mja17.00849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 01/23/2018] [Indexed: 11/17/2022]
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331
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Mansouri F, Mir-Moghtadaei A, Niranjan V, Wu JS, Akhmedjanov D, Nuh M, Cairo T, Giacobbe P, Zariffa J, Downar J. Development and validation of a 3D-printed neuronavigation headset for therapeutic brain stimulation. J Neural Eng 2018; 15:046034. [PMID: 29888708 DOI: 10.1088/1741-2552/aacb96] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Accurate neuronavigation is essential for optimal outcomes in therapeutic brain stimulation. MRI-guided neuronavigation, the current gold standard, requires access to MRI and frameless stereotaxic equipment, which is not available in all settings. Scalp-based heuristics depend on operator skill, with variable reproducibility across operators and sessions. An intermediate solution would offer superior reproducibility and ease-of-use to scalp measurements, without requiring MRI and frameless stereotaxy. OBJECTIVE We present and assess a novel neuronavigation method using commercially-available, inexpensive 3D head scanning, computer-aided design, and 3D-printing tools to fabricate form-fitted headsets for individuals that hold a stimulator, such as an rTMS coil, in the desired position over the scalp. METHODS 20 individuals underwent scanning for fabrication of individualized headsets designed for rTMS of the left dorsolateral prefrontal cortex (DLPFC). An experienced operator then performed three trials per participant of three neuronavigation methods: MRI-guided, scalp-measurement (BeamF3 method), and headset placement, and marked the sites obtained. Accuracy (versus MRI-guidance) and reproducibility were measured for each trial of each method. RESULTS Within-subject accuracy (against a gold-standard centroid of three MRI-guided localizations) for MRI-guided, scalp-measurement, and headset methods was 3.7 ± 1.6 mm, 14.8 ± 7.1 mm, and 9.7 ± 5.2 mm respectively, with headsets significantly more accurate (M = 5.1, p = 0.008) than scalp-measurement methods. Within-subject reproducibility (against the centroid of 3 localizations in the same modality) was 3.7 ± 1.6 mm (MRI), 4.2 ± 1.4 (scalp-measurement), and 1.4 ± 0.7 mm (headset), with headsets achieving significantly better reproducibility than either other method (p < 0.0001). CONCLUSIONS 3D-printed headsets may offer good accuracy, superior reproducibility and greater ease-of-use for stimulator placement over DLPFC, in settings where MRI-guidance is impractical.
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Affiliation(s)
- Farrokh Mansouri
- Institute of Biomaterial and Biomedical Engineering, University of Toronto, Toronto, Canada
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332
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Abstract
INTRODUCTION Although the antidepressant efficacy of ECT is well documented, patient-reported outcomes after this treatment are less well characterized. The aims of the current meta-analysis are to quantify the impact of an acute course of ECT on health-related quality of life (HRQoL) and to identify related moderators, specifically post-ECT depressive symptom remission and patient age. METHODS We searched PubMed, PsycINFO, and Web of Science databases for randomized and nonrandomized studies that report on changes in HRQoL measures after an acute course of ECT. Only studies that used the Medical Outcomes Study Short Form 36 (SF-36) instrument were included. A random effects model using the Hedges' g effect size was used in calculating the pre-post ECT outcomes on all 8 SF-36 subscales and the SF-36 total scores including the physical and mental composite scores. Subgroup analyses were conducted using remission status and age as moderators. RESULTS Four studies contributed to this analysis. Significant improvements across all subscales of the SF-36 were observed. Large and very large effect sizes were present for both the SF-36 physical component score (PCS) and mental health component score (MCS), with the change in MCS being statistically superior to the PCS (MCS, Hedges' g = 1.28; 95% confidence interval, 1.15-1.42; PCS, Hedges' g = 0.97; 95% confidence interval, 0.86-1.07). Medium, large, and very large effect sizes were observed for SF-36 subscales scores. Post-ECT depression remission status was related to HRQoL improvement, with statistically significant differences present between remitters and nonremitters for PCS, MCS, and most SF-36 subscale scores. No significant differences were observed in improvement in HRQoL with ECT based on patient age. CONCLUSIONS An acute course of ECT for depressive symptoms produces medium to very large effect size improvements in HRQoL across multiple components and subscales measured by the SF-36. The magnitude of the effects reported by ECT patients is greater than those that have been reported in other open-label studies of brain stimulation techniques. This study confirms that ECT plays a vital role in the treatment of the most severely ill patients with depressive disorders.
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333
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Bayes AJ, Parker GB. Comparison of guidelines for the treatment of unipolar depression: a focus on pharmacotherapy and neurostimulation. Acta Psychiatr Scand 2018; 137:459-471. [PMID: 29577229 DOI: 10.1111/acps.12878] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine the level of agreement across a set of evidence-based guidelines for management of the unipolar depressive disorders and with a focus on physical treatments. METHOD A literature search was undertaken using the terms 'depression', 'depressive' and 'guidelines', using PubMed, Cochrane Database of Systematic Reviews and the National Guideline Clearinghouse. Twelve national psychiatric or professional guideline-producing organizations were identified from the period 2007-2017, with guidelines qualitatively reviewed by two assessors. RESULTS For major depressive disorder (MDD), there was general consensus to use an antidepressant (AD) in cases of greater severity, although disagreement on AD use in mild to moderate depression. There was some agreement on choice of AD class in first-line treatment recommendations, though great variability in second- and third-line management particularly in recommended augmentation and combined AD strategies. Electroconvulsive therapy was considered in all but one guideline, with other neurostimulation treatments being less consistently covered and with variable recommendations. Finally, there was low consistency in the management of dysthymia, persistent depressive disorder and treatment resistant depression. CONCLUSION Our review identifies varying levels of consistency in guideline recommendations. Strategies to improve reliability in guideline formulation should also improve their validity.
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Affiliation(s)
- A J Bayes
- School of Psychiatry, UNSW, Sydney, NSW, Australia
| | - G B Parker
- School of Psychiatry, UNSW, Sydney, NSW, Australia.,Black Dog Institute, Sydney, NSW, Australia
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334
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Duriez P. [Not Available]. Soins Psychiatr 2018; 39:45-47. [PMID: 29753439 DOI: 10.1016/j.spsy.2018.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Philibert Duriez
- CMME Groupe hospitalier Sainte-Anne, 100, rue de la Santé, 75014 Paris, France; Université Paris-Descartes, 12, rue de l'École de Médecine, 75006 Paris, France; Inserm UMR894, Centre de psychiatrie et neurosciences, 2 ter, rue d'Alésia, 75014 Paris, France.
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335
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Kisely S, Li A, Warren N, Siskind D. A systematic review and meta-analysis of deep brain stimulation for depression. Depress Anxiety 2018; 35:468-480. [PMID: 29697875 DOI: 10.1002/da.22746] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 02/09/2018] [Accepted: 02/10/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Deep brain stimulation is increasingly being used for treatment-resistant depression. Blinded, randomized controlled trials of active versus sham treatment have been limited to small numbers. METHOD We performed a systematic review and meta-analysis on the effectiveness of deep brain stimulation (DBS) in depression. Cochrane Central Register of Controlled Trials, PubMed/Medline, Embase and PsycINFO, Chinese Biomedical Literature Service System, and China Knowledge Resource Integrated Database were searched for single- or double placebo-controlled, crossover, and parallel-group trials in which DBS was compared with sham treatment using validated scales. RESULTS Ten papers from nine studies met inclusion criteria, all but two of which were double-blinded RCTs. The main outcome was a reduction in depressive symptoms. It was possible to combine data for 190 participants. Patients on active, as opposed to sham, treatment had a significantly higher response (OR = 5.50; 95% CI = 2.79, 10.85; p < .0001) and reductions in mean depression score (SMD = -0.42; 95% CI = -0.72, -0.12; p = .006). However, the effect was attenuated on some of the subgroup and sensitivity analyses, and there were no differences for most other outcomes. In addition, 84 participants experienced a total of 131 serious adverse effects, although not all could be directly associated with the device or surgery. Finally, publication bias was possible. CONCLUSIONS DBS may show promise for treatment-resistant depression but remains an experimental treatment until further data are available.
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Affiliation(s)
- Steve Kisely
- The University of Queensland Southern Clinical School, Queensland, Australia.,Metro South Health Service, Woolloongabba, Australia.,Griffith Institute of Health, Griffith University, Queensland, Australia.,Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Nova Scotia, Canada
| | - Amy Li
- The University of Queensland Southern Clinical School, Queensland, Australia
| | - Nicola Warren
- The University of Queensland Southern Clinical School, Queensland, Australia.,Metro South Health Service, Woolloongabba, Australia
| | - Dan Siskind
- The University of Queensland Southern Clinical School, Queensland, Australia.,Metro South Health Service, Woolloongabba, Australia
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336
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Blumberger DM, Vila-Rodriguez F, Thorpe KE, Feffer K, Noda Y, Giacobbe P, Knyahnytska Y, Kennedy SH, Lam RW, Daskalakis ZJ, Downar J. Effectiveness of theta burst versus high-frequency repetitive transcranial magnetic stimulation in patients with depression (THREE-D): a randomised non-inferiority trial. Lancet 2018; 391:1683-1692. [PMID: 29726344 DOI: 10.1016/s0140-6736(18)30295-2] [Citation(s) in RCA: 651] [Impact Index Per Article: 108.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Treatment-resistant major depressive disorder is common; repetitive transcranial magnetic stimulation (rTMS) by use of high-frequency (10 Hz) left-side dorsolateral prefrontal cortex stimulation is an evidence-based treatment for this disorder. Intermittent theta burst stimulation (iTBS) is a newer form of rTMS that can be delivered in 3 min, versus 37·5 min for a standard 10 Hz treatment session. We aimed to establish the clinical effectiveness, safety, and tolerability of iTBS compared with standard 10 Hz rTMS in adults with treatment-resistant depression. METHODS In this randomised, multicentre, non-inferiority clinical trial, we recruited patients who were referred to specialty neurostimulation centres based at three Canadian university hospitals (Centre for Addiction and Mental Health and Toronto Western Hospital, Toronto, ON, and University of British Columbia Hospital, Vancouver, BC). Participants were aged 18-65 years, were diagnosed with a current treatment-resistant major depressive episode or could not tolerate at least two antidepressants in the current episode, were receiving stable antidepressant medication doses for at least 4 weeks before baseline, and had an HRSD-17 score of at least 18. Participants were randomly allocated (1:1) to treatment groups (10 Hz rTMS or iTBS) by use of a random permuted block method, with stratification by site and number of adequate trials in which the antidepressants were unsuccessful. Treatment was delivered open-label but investigators and outcome assessors were masked to treatment groups. Participants were treated with 10 Hz rTMS or iTBS to the left dorsolateral prefrontal cortex, administered on 5 days a week for 4-6 weeks. The primary outcome measure was change in 17-item Hamilton Rating Scale for Depression (HRSD-17) score, with a non-inferiority margin of 2·25 points. For the primary outcome measure, we did a per-protocol analysis of all participants who were randomly allocated to groups and who attained the primary completion point of 4 weeks. This trial is registered with ClinicalTrials.gov, number NCT01887782. FINDINGS Between Sept 3, 2013, and Oct 3, 2016, we randomly allocated 205 participants to receive 10 Hz rTMS and 209 participants to receive iTBS. 192 (94%) participants in the 10 Hz rTMS group and 193 (92%) in the iTBS group were assessed for the primary outcome after 4-6 weeks of treatment. HRSD-17 scores improved from 23·5 (SD 4·4) to 13·4 (7·8) in the 10 Hz rTMS group and from 23·6 (4·3) to 13·4 (7·9) in the iTBS group (adjusted difference 0·103 [corrected], lower 95% CI -1·16; p=0·0011), which indicated non-inferiority of iTBS. Self-rated intensity of pain associated with treatment was greater in the iTBS group than in the 10 Hz rTMS group (mean score on verbal analogue scale 3·8 [SD 2·0] vs 3·4 [2·0] out of 10; p=0·011). Dropout rates did not differ between groups (10 Hz rTMS: 13 [6%] of 205 participants; iTBS: 16 [8%] of 209 participants); p=0·6004). The most common treatment-related adverse event was headache in both groups (10 Hz rTMS: 131 [64%] of 204; iTBS: 136 [65%] of 208). INTERPRETATION In patients with treatment-resistant depression, iTBS was non-inferior to 10 Hz rTMS for the treatment of depression. Both treatments had low numbers of dropouts and similar side-effects, safety, and tolerability profiles. By use of iTBS, the number of patients treated per day with current rTMS devices can be increased several times without compromising clinical effectiveness. FUNDING Canadian Institutes of Health Research.
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Affiliation(s)
- Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention at the Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
| | - Fidel Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, University of British Columbia, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Kevin E Thorpe
- Faculty of Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Applied Health Research Centre (AHRC), St Michael's Hospital, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Kfir Feffer
- Shalvata Mental Health Centre, Hod-Hasharon, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoshihiro Noda
- Department of Neuropsychiatry, School of Medicine, Keio University, Japan
| | - Peter Giacobbe
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Centre for Mental Health, University Health Network, Toronto, ON, Canada
| | - Yuliya Knyahnytska
- Temerty Centre for Therapeutic Brain Intervention at the Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Zafiris J Daskalakis
- Temerty Centre for Therapeutic Brain Intervention at the Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Jonathan Downar
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Centre for Mental Health, University Health Network, Toronto, ON, Canada; MRI-Guided rTMS Clinic, University Health Network, Toronto, ON, Canada; Krembil Research Institute, University Health Network, Toronto, ON, Canada
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337
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Affiliation(s)
- Paul R Albert
- From the UOttawa Brain and Mind Research Insitute, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont., Canada
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338
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Blumberger DM. Can Repetitive Transcranial Magnetic Stimulation Enhance Cognitive Control in Late-Life Depression? Am J Geriatr Psychiatry 2018; 26:347-349. [PMID: 29305239 DOI: 10.1016/j.jagp.2017.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 11/27/2017] [Indexed: 01/15/2023]
Affiliation(s)
- Daniel M Blumberger
- Department of Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry and Division of Geriatric Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Seo JS, Bahk WM, Wang HR, Woo YS, Park YM, Jeong JH, Kim W, Shim SH, Lee JG, Jon DI, Min KJ. Korean Medication Algorithm for Depressive Disorders 2017: Third Revision. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2018; 16:67-87. [PMID: 29397669 PMCID: PMC5810446 DOI: 10.9758/cpn.2018.16.1.67] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 08/01/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE In 2002, the Korean Society for Affective Disorders developed the guidelines for the treatment of major depressive disorder (MDD), and revised it in 2006 and 2012. The third revision of these guidelines was undertaken to reflect advances in the field. METHODS Using a 44-item questionnaire, an expert consensus was obtained on pharmacological treatment strategies for MDD 1) without or 2) with psychotic features, 3) depression subtypes, 4) maintenance, 5) special populations, 6) the choice of an antidepressant (AD) regarding safety and adverse effects, and 7) non-pharmacological biological therapies. Recommended first, second, and third-line strategies were derived statistically. RESULTS AD monotherapy is recommended as the first-line strategy for non-psychotic depression in adults, children/adolescents, elderly adults, patient with persistent depressive disorder, and pregnant women or patients with postpartum depression or premenstrual dysphoric disorder. The combination of AD and atypical antipsychotics (AAP) was recommended for psychotic depression in adult, child/adolescent, postpartum depression, and mixed features or anxious distress. Most experts recommended stopping the ongoing initial AD and AAP after a certain period in patients with one or two depressive episodes. As an MDD treatment modality, 92% of experts are considering electroconvulsive therapy and 46.8% are applying it clinically, while 86% of experts are considering repetitive transcranial magnetic stimulation but only 31.6% are applying it clinically. CONCLUSION The pharmacological treatment strategy in 2017 is similar to that of Korean Medication Algorithm for Depressive Disorder 2012. The preference of AAPs was more increased.
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Affiliation(s)
- Jeong Seok Seo
- Department of Psychiatry, Konkuk University School of Medicine, Cheongju,
Korea
| | - Won-Myong Bahk
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Hee Ryung Wang
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Young Sup Woo
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Young-Min Park
- Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang,
Korea
| | - Jong-Hyun Jeong
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Won Kim
- Department of Psychiatry, Seoul Paik Hospital, Inje University College of Medicine, Seoul,
Korea
- Korea/Stress Research Institute, Inje University, Seoul,
Korea
| | - Se-Hoon Shim
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan,
Korea
| | - Jung Goo Lee
- Department of Psychiatry, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan,
Korea
- Paik Institute for Clinical Research, Department of Health Science and Technology, Graduate School of Inje University, Busan,
Korea
| | - Duk-In Jon
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang,
Korea
| | - Kyung Joon Min
- Department of Psychiatry, Chung-Ang University College of Medicine, Seoul,
Korea
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340
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Hathaway EE, Walkup JT, Strawn JR. Antidepressant Treatment Duration in Pediatric Depressive and Anxiety Disorders: How Long is Long Enough? Curr Probl Pediatr Adolesc Health Care 2018; 48:31-39. [PMID: 29337001 PMCID: PMC5828899 DOI: 10.1016/j.cppeds.2017.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Anxiety and depressive disorders are common in the pediatric primary care setting, and respond to both psychotherapeutic and psychopharmacologic treatment. However, there are limited data regarding the optimal treatment duration. This article systematically reviews guidelines and clinical trial data related to antidepressant treatment duration in pediatric patients with depressive and anxiety disorders. The extant literature suggests 9-12 months of antidepressant treatment for youth with major depressive disorder. For generalized, separation and social anxiety disorders, 6-9 months of antidepressant treatment may be sufficient, though many clinicians extend treatment to 12 months based on extrapolation of data from adults with anxiety disorders. Such extended treatment periods may decrease the risk of long-term morbidity and recurrence; however, the goal of treatment is ultimately remission, rather than duration of antidepressant pharmacotherapy. Moreover, while evidence-based guidelines represent a starting point, appropriate treatment duration varies and patient-specific response, psychological factors, and timing of discontinuation must be considered for individual pediatric patients.
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Affiliation(s)
| | - John T Walkup
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Jeffrey R Strawn
- Department of Psychiatry, University of Cincinnati College of Medicine, Box 0559, Cincinnati, OH 45267-0559.
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341
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van Diermen L, van den Ameele S, Kamperman AM, Sabbe BCG, Vermeulen T, Schrijvers D, Birkenhäger TK. Prediction of electroconvulsive therapy response and remission in major depression: meta-analysis. Br J Psychiatry 2018; 212:71-80. [PMID: 29436330 DOI: 10.1192/bjp.2017.28] [Citation(s) in RCA: 180] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is considered to be the most effective treatment in severe major depression. The identification of reliable predictors of ECT response could contribute to a more targeted patient selection and consequently increased ECT response rates. Aims To investigate the predictive value of age, depression severity, psychotic and melancholic features for ECT response and remission in major depression. METHOD A meta-analysis was conducted according to the PRISMA statement. A literature search identified recent studies that reported on at least one of the potential predictors. RESULTS Of the 2193 articles screened, 34 have been included for meta-analysis. Presence of psychotic features is a predictor of ECT remission (odds ratio (OR) = 1.47, P = 0.001) and response (OR = 1.69, P < 0.001), as is older age (standardised mean difference (SMD) = 0.26 for remission and 0.35 for response (P < 0.001)). The severity of depression predicts response (SMD = 0.19, P = 0.001), but not remission. Data on melancholic symptoms were inconclusive. CONCLUSIONS ECT is particularly effective in patients with depression with psychotic features and in elderly people with depression. More research on both biological and clinical predictors is needed to further evaluate the position of ECT in treatment protocols for major depression. Declaration of interest None.
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Affiliation(s)
- Linda van Diermen
- Collaborative Antwerp Psychiatric Research Institue (CAPRI),Department of Biomedical Sciences,University of Antwerp,Belgium
| | - Seline van den Ameele
- CAPRI,Department of Biomedical Sciences,University of Antwerp,Belgium and University Department,Psychiatric Hospital Duffel,VZW Emmaüs,Duffel,Belgium
| | - Astrid M Kamperman
- Epidemiological and Social Psychiatric Research Institute (ESPRi),Department of Psychiatry,Erasmus University Medical Centre,Rotterdam,the Netherlands
| | - Bernard C G Sabbe
- CAPRI,Department of Biomedical Sciences,University of Antwerp,Belgium and University Department,Psychiatric Hospital Duffel,VZW Emmaüs,Duffel,Belgium
| | - Tom Vermeulen
- CAPRI,Department of Biomedical Sciences,University of Antwerp,Belgium and University Department,Psychiatric Hospital Duffel,VZW Emmaüs,Duffel,Belgium
| | - Didier Schrijvers
- CAPRI,Department of Biomedical Sciences,University of Antwerp,Belgium and University Department,Psychiatric Hospital Duffel,VZW Emmaüs,Duffel,Belgium
| | - Tom K Birkenhäger
- Department of Psychiatry,Erasmus University Medical Center,Rotterdam,the NetherlandsandCAPRI,Department of Biomedical Sciences,University of Antwerp,Belgium
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342
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Liew TM, Lee CS. Comparative efficacy and acceptability of interventions for major depression in older persons: protocol for Bayesian network meta-analysis. BMJ Open 2018; 8:e019819. [PMID: 29358451 PMCID: PMC5988061 DOI: 10.1136/bmjopen-2017-019819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Major depression is a leading cause of disability and has been associated with adverse effects in older persons. While many pharmacological and non-pharmacological interventions have been shown to be effective to address major depression in older persons, there has not been a meta-analysis that consolidates all the available interventions and compare the relative benefits of these available interventions. In this study, we aim to conduct a systematic review and network meta-analysis to compare the efficacy and acceptability of all the known pharmacological and non-pharmacological interventions for major depression in older persons. METHODS AND ANALYSIS We will search Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health, Cochrane Central Register of Controlled Trials and references of other review articles for articles related to the keywords of 'randomised trial', 'major depression', 'older persons' and 'treatments'. Two reviewers will independently select the eligible articles. For each included article, the two reviewers will independently extract the data and assess the risk of bias using the Cochrane revised tool for risk of bias. Bayesian network meta-analyses will be conducted to pool the depression scores (based on standardised mean difference) and the all-cause discontinuation across all included studies. The ranking probabilities for all interventions will be estimated and the hierarchy of each intervention will be summarised as surface under the cumulative ranking curve (SUCRA). Meta-regression and sub-group analyses will also be performed to evaluate the effect of study-level covariates. The quality of the evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. ETHICS AND DISSEMINATION The results will be disseminated through conference presentations and peer-reviewed publications. They will provide the consolidated evidence to inform clinicians on the best choice of intervention to address major depression in older persons. PROSPERO REGISTRATION NUMBER CRD42017075756.
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Affiliation(s)
- Tau Ming Liew
- Department of Geriatric Psychiatry, Institute of Mental Health, Singapore
- Psychotherapy Unit, Institute of Mental Health, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore
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343
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Early symptom improvement at 10 sessions as a predictor of rTMS treatment outcome in major depression. Brain Stimul 2018; 11:181-189. [DOI: 10.1016/j.brs.2017.10.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 09/27/2017] [Accepted: 10/15/2017] [Indexed: 11/17/2022] Open
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344
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Dell'Osso B, Oldani L, Grancini B, Dario A, Altamura AC. Ten-year outcome of vagus nerve stimulation-implanted patients with treatment-resistant depression: two Italian cases. Neuropsychiatr Dis Treat 2018; 14:915-918. [PMID: 29636616 PMCID: PMC5880414 DOI: 10.2147/ndt.s161062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Over the last 15 years, vagus nerve stimulation (VNS) has been used as an augmentative therapeutic intervention in patients with treatment-resistant depression (TRD), whether with a lifetime diagnosis of major depressive disorder or bipolar disorder. From being a potentially effective treatment in the acute phase of TRD, recently published treatment guidelines seemed to converge on the indication that VNS's greatest benefit may be seen mostly beyond the short term. However, with the exception of a recent multicenter American report, very few studies have assessed the long-term efficacy of VNS in TRD patients. Herein, we present the cases of two Italian patients with TRD, with 10-year VNS follow-up evaluation. Both patients were found to benefit from augmentative VNS, and the latency of their stimulation response, tolerability, associated pharmacological treatment, number and duration of recurrences, and overall level of functioning are described and discussed. Further reports with larger samples are needed to support the long-term efficacy and tolerability of VNS in TRD patients, particularly beyond 5 years of follow-up.
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Affiliation(s)
- Bernardo Dell'Osso
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford Medical School, Stanford University, Stanford, CA, USA.,CRC "Aldo Ravelli" for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy
| | - Lucio Oldani
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Benedetta Grancini
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Dario
- Department of Neurosurgery, Macchi Foundation Hospital, Varese, Italy
| | - A Carlo Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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345
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Moirand R, Galvao F, Lecompte M, Poulet E, Haesebaert F, Brunelin J. Usefulness of the Montreal Cognitive Assessment (MoCA) to monitor cognitive impairments in depressed patients receiving electroconvulsive therapy. Psychiatry Res 2018; 259:476-481. [PMID: 29149717 DOI: 10.1016/j.psychres.2017.11.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/27/2017] [Accepted: 11/06/2017] [Indexed: 01/03/2023]
Abstract
There is a lack of consensual tools for evaluating the cognitive side-effects in patients with depression who are treated with electroconvulsive therapy (ECT). The objective of this study was to evaluate the usefulness of the Montreal Cognitive Assessment (MoCA) and of the Mini Mental State Examination (MMSE) to monitor cognitive changes in patients with depression receiving ECT. Cognitive functioning was assessed prospectively in 48 patients with unipolar or bipolar depression before and after an ECT course. ECT-induced cognitive impairments were defined as a decrease of at least 2 points on the MoCA and the MMSE total scores and of at least one point on each sub-score. At baseline, the MoCA detected a higher number of patients with cognitive deficits than the MMSE. After ECT, the MoCA and MMSE total scores were comparable, but the MoCA detected more impairments than did the MMSE for visuo-executive, memory and language subscores. ECT significantly decreased the language capacities but improved the visuo-executive and abstraction performances measured by MoCA. In remitters, the MoCA total score and visuo-executive and abstraction performances were significantly improved, while other cognitive functions remained unchanged. The MoCA is a useful screening tool for monitoring cognitive functioning during an ECT course.
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Affiliation(s)
- Rémi Moirand
- INSERM, U1028, Lyon Neuroscience Research Center, PSY-R2 Team, Lyon F-69000, France; CNRS, UMR5292, Lyon Neuroscience Research Center, PSY-R2 Team, Lyon F-69000, France; University Lyon, F-69000, France; Centre Hospitalier le Vinatier, Batiment 416, 95 Bd Pinel, 69678 Bron, France.
| | - Filipe Galvao
- INSERM, U1028, Lyon Neuroscience Research Center, PSY-R2 Team, Lyon F-69000, France; CNRS, UMR5292, Lyon Neuroscience Research Center, PSY-R2 Team, Lyon F-69000, France; University Lyon, F-69000, France; Centre Hospitalier le Vinatier, Batiment 416, 95 Bd Pinel, 69678 Bron, France
| | - Maxime Lecompte
- Centre Hospitalier le Vinatier, Batiment 416, 95 Bd Pinel, 69678 Bron, France
| | - Emmanuel Poulet
- INSERM, U1028, Lyon Neuroscience Research Center, PSY-R2 Team, Lyon F-69000, France; CNRS, UMR5292, Lyon Neuroscience Research Center, PSY-R2 Team, Lyon F-69000, France; University Lyon, F-69000, France; Centre Hospitalier le Vinatier, Batiment 416, 95 Bd Pinel, 69678 Bron, France; Department of Emergency Psychiatry, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Haesebaert
- INSERM, U1028, Lyon Neuroscience Research Center, PSY-R2 Team, Lyon F-69000, France; CNRS, UMR5292, Lyon Neuroscience Research Center, PSY-R2 Team, Lyon F-69000, France; University Lyon, F-69000, France; Centre Hospitalier le Vinatier, Batiment 416, 95 Bd Pinel, 69678 Bron, France
| | - Jerome Brunelin
- INSERM, U1028, Lyon Neuroscience Research Center, PSY-R2 Team, Lyon F-69000, France; CNRS, UMR5292, Lyon Neuroscience Research Center, PSY-R2 Team, Lyon F-69000, France; University Lyon, F-69000, France; Centre Hospitalier le Vinatier, Batiment 416, 95 Bd Pinel, 69678 Bron, France
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346
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Should Benzodiazepines and Anticonvulsants Be Used During Electroconvulsive Therapy?: A Case Study and Literature Review. J ECT 2017; 33:237-242. [PMID: 28767528 DOI: 10.1097/yct.0000000000000441] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This study aims to investigate the clinical effects of benzodiazepines or anticonvulsant use during a course of electroconvulsive therapy (ECT). METHOD A case report study of a patient who received ECT with and without concomitant flurazepam and pregabalin is presented. The literature on the use of benzodiazepines and anticonvulsants during ECT is reviewed. RESULTS A woman with treatment resistant depression received a course of ECT while taking flurazepam and pregabalin, but seizures were of short duration and symptomatic improvement was minimal. After discontinuation of flurazepam and pregabalin, a course of right unilateral ultrabrief ECT was associated with adequate seizures and remission of depression and suicidal ideation. Our literature review suggests that benzodiazepines decrease seizure duration, but most evidence shows no association with increased seizure threshold. One prospective RCT and 3 large retrospective studies found that benzodiazepines compromise the efficacy of unilateral but not bilateral ECT. Regarding anticonvulsants, several studies had varied and contradictory results on their effect on seizure duration and seizure threshold. Of the 2 large retrospective studies and 3 RCTs, only 1 retrospective study showed that anticonvulsants decrease the efficacy of ECT. CONCLUSIONS Judicious assessment of all medications used in combination with ECT is recommended. Overall, published studies suggest that benzodiazepines and anticonvulsants impact the clinical outcomes of ECT less than what would be expected given their pharmacologic effects. However, there are significant gaps in the literature, including a lack of study on suprathreshold stimulation of right unilateral ECT and the possibility of a greater effect with higher medication doses.
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347
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Tavares DF, Myczkowski ML, Alberto RL, Valiengo L, Rios RM, Gordon P, de Sampaio-Junior B, Klein I, Mansur CG, Marcolin MA, Lafer B, Moreno RA, Gattaz W, Daskalakis ZJ, Brunoni AR. Treatment of Bipolar Depression with Deep TMS: Results from a Double-Blind, Randomized, Parallel Group, Sham-Controlled Clinical Trial. Neuropsychopharmacology 2017; 42:2593-2601. [PMID: 28145409 PMCID: PMC5686495 DOI: 10.1038/npp.2017.26] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/19/2017] [Accepted: 01/27/2017] [Indexed: 12/26/2022]
Abstract
Bipolar depression (BD) is a highly prevalent condition with limited therapeutic options. Deep (H1-coil) transcranial magnetic stimulation (dTMS) is a novel TMS modality with established efficacy for unipolar depression. We conducted a randomized sham-controlled trial to evaluate the efficacy and safety of dTMS in treatment-resistant BD patients. Patients received 20 sessions of active or sham dTMS over the left dorsolateral prefrontal cortex (H1-coil, 55 18 Hz 2 s 120% MT trains). The primary outcome was changes in the 17-item Hamilton Depression Rating Scale (HDRS-17) from baseline to endpoint (week 4). Secondary outcomes were changes from baseline to the end of the follow-up phase (week 8), and response and remission rates. Safety was assessed using a dTMS adverse effects questionnaire and the Young Mania Rating Scale to assess treatment-emergent mania switch (TEMS). Out of 50 patients, 43 finished the trial. There were 2 and 5 dropouts in the sham and active groups, respectively. Active dTMS was superior to sham at end point (difference favoring dTMS=4.88; 95% CI 0.43 to 9.32, p=0.03) but not at follow-up. There was also a trend for greater response rates in the active (48%) vs sham (24%) groups (OR=2.92; 95% CI=0.87 to 9.78, p=0.08). Remission rates were not statistically different. No TEMS episodes were observed. Deep TMS is a potentially effective and well-tolerated add-on therapy in resistant bipolar depressed patients receiving adequate pharmacotherapy.
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Affiliation(s)
- Diego F Tavares
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- Mood Disorders Unit (GRUDA), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Martin L Myczkowski
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Rodrigo L Alberto
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Leandro Valiengo
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- Laboratory of Neuroscience (LIM27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Rosa M Rios
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Pedro Gordon
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Bernardo de Sampaio-Junior
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- University Hospital, University of São Paulo, São Paulo, Brazil
| | - Izio Klein
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- University Hospital, University of São Paulo, São Paulo, Brazil
| | - Carlos G Mansur
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Marco Antonio Marcolin
- Department and Institute of Neurology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Beny Lafer
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ricardo A Moreno
- Mood Disorders Unit (GRUDA), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Wagner Gattaz
- Laboratory of Neuroscience (LIM27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Zafiris J Daskalakis
- Centre for Addiction and Mental Health, Clarke Division, Toronto, Ontario, Canada
| | - André R Brunoni
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- Laboratory of Neuroscience (LIM27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
- University Hospital, University of São Paulo, São Paulo, Brazil
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348
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Blumberger DM, Seitz DP, Herrmann N, Kirkham JG, Ng R, Reimer C, Kurdyak P, Gruneir A, Rapoport MJ, Daskalakis ZJ, Mulsant BH, Vigod SN. Low medical morbidity and mortality after acute courses of electroconvulsive therapy in a population-based sample. Acta Psychiatr Scand 2017; 136:583-593. [PMID: 28922451 DOI: 10.1111/acps.12815] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND To determine event rates for specific medical events and mortality among individuals receiving electroconvulsive therapy (ECT). METHOD Population-based cohort study using health administrative data of acute ECT treatments delivered in Ontario, Canada, from 2003 to 2011. We measured the following medical event rates, per 10 000 ECT treatments, up to 7 and 30 days post-treatment: stroke, seizure, acute myocardial infarction, arrhythmia, pneumonia, pulmonary embolus, deep vein thrombosis, gastrointestinal bleeding, falls, hip fracture, and mortality. RESULTS A total of 135 831 ECT treatments were delivered to 8810 unique patients. Overall medical event rates were 9.1 and 16.8 per 10 000 ECT treatments respectively. The most common medical events were falls (2.7 and 5.5 per 10 000 ECT treatments) and pneumonia (1.8 and 3.8 per 10 000 ECT treatments). Fewer than six deaths occurred on the day of an ECT treatment. This corresponded to a mortality rate of less than 0.4 per 10 000 treatments. Deaths within 7 and 30 days of an ECT treatment, excluding deaths due to external causes (e.g., accidental and intentional causes of death), were 1.0 and 2.4 per 10 000 ECT treatments respectively. CONCLUSION Morbidity and mortality events after ECT treatments were relatively low, supporting ECT as a low-risk medical procedure.
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Affiliation(s)
- D M Blumberger
- Centre for Addiction and Mental Health, Campbell Family Research Institute, Toronto, ON, Canada.,Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - D P Seitz
- Department of Psychiatry, Providence Care Mental Health Services, Queen's University, Kingston, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - N Herrmann
- Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - J G Kirkham
- Department of Psychiatry, Providence Care Mental Health Services, Queen's University, Kingston, ON, Canada
| | - R Ng
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - C Reimer
- Department of Anesthesia, Providence Care Mental Health Services, Queen's University, Kingston, ON, Canada
| | - P Kurdyak
- Centre for Addiction and Mental Health, Campbell Family Research Institute, Toronto, ON, Canada.,Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - A Gruneir
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Alberta, Edmonton, AB, Canada
| | - M J Rapoport
- Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Z J Daskalakis
- Centre for Addiction and Mental Health, Campbell Family Research Institute, Toronto, ON, Canada.,Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - B H Mulsant
- Centre for Addiction and Mental Health, Campbell Family Research Institute, Toronto, ON, Canada.,Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - S N Vigod
- Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Women's College Hospital and Research Institute, Toronto, ON, Canada
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349
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Abstract
OBJECTIVES The aims of this study were to investigate the social and economic factors that contribute to global variability in electroconvulsive therapy (ECT) utilization and to contrast these to the factors associated with antidepressant medication rates. METHODS Rates of ECT and antidepressant utilization across nations and data on health, social, and economic indices were obtained from multiple international organizations including the World Health Organization and the Organization for Economic Co-operation and Development, as well as from the published literature. To assess whether relationships exist between selected indices and each of the outcome measures, a correlational analysis was conducted using Pearson correlation coefficients. Those that were significant at a level of P < 0.05 in the correlation analysis were selected for entry into the multivariate analyses. Selected predictor variables were entered into a stepwise multiple regression models for ECT and antidepressant utilization rates separately. RESULTS A stepwise multiple regression analysis indicated that government expenditure on mental health was the only significant contributor to the model, explaining 34.2% of global variation in ECT use worldwide. Human Development Index was the only variable found to be significantly correlated with global antidepressant utilization, accounting for 71% of the variation in global antidepressant utilization. CONCLUSIONS These findings suggest that across the globe ECT but not antidepressant medication utilization is associated with the degree to which a nation financially invests in mental health care for its citizens.
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Kanner AM, Scharfman H, Jette N, Anagnostou E, Bernard C, Camfield C, Camfield P, Legg K, Dinstein I, Giacobbe P, Friedman A, Pohlmann-Eden B. Epilepsy as a Network Disorder (1): What can we learn from other network disorders such as autistic spectrum disorder and mood disorders? Epilepsy Behav 2017; 77:106-113. [PMID: 29107450 PMCID: PMC9835466 DOI: 10.1016/j.yebeh.2017.09.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 09/16/2017] [Indexed: 01/16/2023]
Abstract
Epilepsy is a neurologic condition which often occurs with other neurologic and psychiatric disorders. The relation between epilepsy and these conditions is complex. Some population-based studies have identified a bidirectional relation, whereby not only patients with epilepsy are at increased risk of suffering from some of these neurologic and psychiatric disorders (migraine, stroke, dementia, autism, depression, anxiety disorders, Attention deficit hyperactivity disorder (ADHD), and psychosis), but also patients with these conditions are at increased risk of suffering from epilepsy. The existence of common pathogenic mechanisms has been postulated as a potential explanation of this phenomenon. To reassess the relationships between neurological and psychiatric conditions in general, and specifically autism, depression, Alzheimer's disease, schizophrenia, and epilepsy, a recent meeting brought together basic researchers and clinician scientists entitled "Epilepsy as a Network Disorder." This was the fourth in a series of conferences, the "Fourth International Halifax Conference and Retreat". This manuscript summarizes the proceedings on potential relations between Epilepsy on the one hand and autism and depression on the other. A companion manuscript provides a summary of the proceedings about the relation between epilepsy and Alzheimer's disease and schizophrenia, closed by the role of translational research in clarifying these relationships. The review of the topics in these two manuscripts will provide a better understanding of the mechanisms operant in some of the common neurologic and psychiatric comorbidities of epilepsy.
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Affiliation(s)
- Andres M Kanner
- Department of Neurology, University of Miami, Miller School of Medicine, 1120 NW 14th Street, Room #1324, Miami, FL 33136, USA.
| | - Helen Scharfman
- New York University Langone Medical Center, New York, NY 10016, USA; The Nathan Kline Institute, Orangeburg, NY, USA
| | - Nathalie Jette
- Icahn School of Medicine at Mount Sinai, Department of Neurology, New York, NY, USA; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Evdokia Anagnostou
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON M4G 1R8, Canada
| | - Christophe Bernard
- NS - Institute de Neurosciences des Systemes, UMR INSERM 1106, Aix-Marseille Université, Equipe Physionet, 27 Bd Jean Moulin, 13385 Marseille Cedex 05, France
| | - Carol Camfield
- Department of Pediatrics, Dalhousie University Halifax, Nova Scotia, Canada
| | - Peter Camfield
- Department of Pediatrics, Dalhousie University Halifax, Nova Scotia, Canada
| | - Karen Legg
- Division of Neurology, Department of Medicine, Halifax Infirmary, Halifax B3H4R2, Nova Scotia, Canada
| | - Ilan Dinstein
- Departments of Psychology and Brain & Cognitive Sciences, Zlotowski Centre for Neuroscience, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Peter Giacobbe
- Centre for Mental Health, University of Toronto, University Health Network, Canada
| | - Alon Friedman
- Departments of Physiology and Cell Biology, Brain & Cognitive Sciences, Zlotowski Centre for Neuroscience, Ben-Gurion University of the Negev, Be'er Sheva, Israel; Departments of Medical Neuroscience and Pediatrics, Faculty of Medicine, Dalhousie University Halifax, NS, Canada
| | - Bernd Pohlmann-Eden
- Brain Repair Center, Life Science Research Institute, Dalhousie University, Room 229, PO Box 15000, Halifax, Nova Scotia B3H4R2, Canada
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