1
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Lambrichts S, Wagenmakers MJ, Vansteelandt K, Obbels J, Schouws SNTM, Verwijk E, van Exel E, Bouckaert F, Vandenbulcke M, Schrijvers D, Veltman DJ, Beekman ATF, Oudega ML, Sienaert P, Dols A. Long-term Outcome Following Electroconvulsive Therapy for Late-Life Depression: Five-Year Follow-up Data From the MODECT Study. Am J Geriatr Psychiatry 2022; 30:1283-1294. [PMID: 35667960 DOI: 10.1016/j.jagp.2022.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is the most effective treatment for late-life depression (LLD). Research addressing long-term outcome following an acute course of ECT for LLD is limited. We aimed to describe relapse, cognitive impairment and survival 5 years after a treatment with ECT for severe LLD, and assess the association of clinical characteristics with all three outcome measures. METHODS This cohort study was part of the Mood Disorders in Elderly treated with ECT (MODECT) study, which included patients aged 55 years and older with major depressive disorder. Data regarding clinical course, cognitive impairment and mortality were collected 5 years after the index ECT course. We used multivariable Cox proportional hazards models and logistic regression models to assess the association of clinical characteristics with relapse and survival, and cognitive impairment, respectively. RESULTS We studied 110 patients with a mean age of 72.9 years. 67.1% of patients who showed response at the end of the index ECT course relapsed, and the included clinical characteristics were not significantly associated with the risk of relapse. 38.8% of patients with available data showed cognitive impairment at five-year follow-up. 27.5% were deceased; higher age and a higher number of previous psychiatric admissions were significantly associated with increased risk of mortality. CONCLUSIONS Five-year outcome after a course of ECT for severe LLD seems to be in line with long-term outcome following other acute treatments for severe LLD in terms of relapse, cognitive impairment and survival. Additional studies aimed at improving long-term outcome in severe LLD are warranted.
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Affiliation(s)
- Simon Lambrichts
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Kortenberg, Belgium.
| | - Margot J Wagenmakers
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry, Amsterdam, The Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, The Netherlands
| | - Kristof Vansteelandt
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Kortenberg, Belgium
| | - Jasmien Obbels
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Kortenberg, Belgium
| | - Sigfried N T M Schouws
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry, Amsterdam, The Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, The Netherlands
| | - Esmée Verwijk
- Amsterdam UMC location University of Amsterdam, Medical Psychology, Amsterdam, The Netherlands; Department of Psychology, Brain & Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Eric van Exel
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry, Amsterdam, The Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, The Netherlands
| | - Filip Bouckaert
- Geriatric Psychiatry, University Psychiatric Center KU Leuven (UPC KU Leuven), and Leuven Brain Institute, KU Leuven
| | - Mathieu Vandenbulcke
- Geriatric Psychiatry, University Psychiatric Center KU Leuven (UPC KU Leuven), and Leuven Brain Institute, KU Leuven
| | - Didier Schrijvers
- UAntwerp, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University Psychiatric Hospital Duffel, Duffel, Belgium
| | - Dick J Veltman
- Amsterdam Public Health Research Institute, Mental Health, Amsterdam, The Netherlands
| | - Aartjan T F Beekman
- Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, The Netherlands
| | - Mardien L Oudega
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, The Netherlands
| | - Pascal Sienaert
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Kortenberg, Belgium
| | - Annemiek Dols
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry, Amsterdam, The Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, The Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress program, Amsterdam, The Netherlands
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2
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The Neurobiological Basis of Cognitive Side Effects of Electroconvulsive Therapy: A Systematic Review. Brain Sci 2021; 11:brainsci11101273. [PMID: 34679338 PMCID: PMC8534116 DOI: 10.3390/brainsci11101273] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022] Open
Abstract
Decades of research have consistently demonstrated the efficacy of electroconvulsive therapy (ECT) for the treatment of major depressive disorder (MDD), but its clinical use remains somewhat restricted because of its cognitive side effects. The aim of this systematic review is to comprehensively summarize current evidence assessing potential biomarkers of ECT-related cognitive side effects. Based on our systematic search of human studies indexed in PubMed, Scopus, and Web of Knowledge, a total of 29 studies evaluating patients with MDD undergoing ECT were reviewed. Molecular biomarkers studies did not consistently identify concentration changes in plasma S-100 protein, neuron-specific enolase (NSE), or Aβ peptides significantly associated with cognitive performance after ECT. Importantly, these findings suggest that ECT-related cognitive side effects cannot be explained by mechanisms of neural cell damage. Notwithstanding, S-100b protein and Aβ40 peptide concentrations, as well as brain-derived neurotrophic factor (BDNF) polymorphisms, have been suggested as potential predictive biomarkers of cognitive dysfunction after ECT. In addition, recent advances in brain imaging have allowed us to identify ECT-induced volumetric and functional changes in several brain structures closely related to memory performance such as the hippocampus. We provide a preliminary framework to further evaluate neurobiological cognitive vulnerability profiles of patients with MDD treated with ECT.
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Meyer JP, Swetter SK, Kellner CH. Electroconvulsive Therapy in Geriatric Psychiatry: A Selective Review. Clin Geriatr Med 2019; 36:265-279. [PMID: 32222301 DOI: 10.1016/j.cger.2019.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Electroconvulsive therapy (ECT) remains an important treatment of geriatric patients. ECT treats severe depression, mania, psychosis, catatonia, and comorbid depression and agitation in dementia. ECT also serves a crucial role in treating urgent illness requiring expedient recovery, such as catatonia, or in patients with severe suicidal ideation or intent. ECT is even more effective in the elderly than in mixed-age adult populations. ECT is a safe treatment option with few medical contraindications. Cognitive effects are largely transient, even in patients with preexisting cognitive impairment.
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Affiliation(s)
- Justin P Meyer
- SUNY Upstate Medical University, 4900 Broad Rd Syracuse, NY 13215 United States.
| | - Samantha K Swetter
- Dartmouth's Geisel School of Medicine, 36 Clinton Street, Concord, NH 03301, USA
| | - Charles H Kellner
- Department of Electroconvulsive Therapy (ECT), New York Community Hospital, 2525 Kings Highway, Brooklyn, NY 11229, USA
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4
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Obbels J, Vansteelandt K, Verwijk E, Dols A, Bouckaert F, Oudega ML, Vandenbulcke M, Stek M, Sienaert P. MMSE Changes During and After ECT in Late-Life Depression: A Prospective Study. Am J Geriatr Psychiatry 2019; 27:934-944. [PMID: 31104967 DOI: 10.1016/j.jagp.2019.04.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/17/2019] [Accepted: 04/17/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE There is ongoing concern about the impact of electroconvulsive therapy (ECT) on cognition in patients with late-life depression (LLD), especially in patients for whom pretreatment Mini-Mental State Exam (MMSE) scores are low. Our aim was to examine the evolution of cognitive effects of ECT, using the MMSE in a large group of patients with LLD. METHODS One hundred nine patients aged 55 years and older with unipolar depression, referred for ECT, were included in our study. The MMSE was assessed before, during, immediately after, and 6 months after ECT. RESULTS MMSE scores improved significantly during the course of ECT and remained stable during the 6-month period after ending ECT for the total group. In the group of patients with a low MMSE score (<24) at baseline, the MMSE score improved significantly during ECT, whereas in the group of patients with a normal MMSE score (≥24) at baseline, the score did not change significantly during ECT. In both groups, MMSE scores still increased slightly after ECT was discontinued. CONCLUSION ECT does not cause deleterious cognitive effects, as measured with the MMSE, during and for 6 months after the ECT course in patients with LLD. In the event of a baseline cognitive impairment, MMSE scores tend to improve significantly during and for 6 months after the ECT course. The presence of pretreatment cognitive impairment should not lead clinicians to withhold ECT in older patients with severe depression.
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Affiliation(s)
- Jasmien Obbels
- Academic Center for ECT and Neuromodulation (AcCENT) (JO, KV, FB, PS), University Psychiatric Center, KU Leuven-University of Leuven, Kortenberg, Belgium.
| | - Kristof Vansteelandt
- Academic Center for ECT and Neuromodulation (AcCENT) (JO, KV, FB, PS), University Psychiatric Center, KU Leuven-University of Leuven, Kortenberg, Belgium
| | - Esmée Verwijk
- Department of Medical Psychology (EV), Neuropsychology Department, Amsterdam UMC Academic Medical Center, The Netherlands; Department of Psychology (EV), Brain & Cognition, University of Amsterdam, Amsterdam, The Netherlands; ECT Department (EV), Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Annemieke Dols
- Department of Old Age Psychiatry (AD, MLO, MS), GGZ inGeest/Amsterdam University/VU Medical Center, Amsterdam Public Health Research Institute, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Filip Bouckaert
- Academic Center for ECT and Neuromodulation (AcCENT) (JO, KV, FB, PS), University Psychiatric Center, KU Leuven-University of Leuven, Kortenberg, Belgium; Old-Age Psychiatry (FB, MV), University Psychiatric Center, KU Leuven-University of Leuven, Kortenberg, Belgium
| | - Mardien L Oudega
- Department of Old Age Psychiatry (AD, MLO, MS), GGZ inGeest/Amsterdam University/VU Medical Center, Amsterdam Public Health Research Institute, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Mathieu Vandenbulcke
- Old-Age Psychiatry (FB, MV), University Psychiatric Center, KU Leuven-University of Leuven, Kortenberg, Belgium
| | - Max Stek
- Department of Old Age Psychiatry (AD, MLO, MS), GGZ inGeest/Amsterdam University/VU Medical Center, Amsterdam Public Health Research Institute, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Pascal Sienaert
- Academic Center for ECT and Neuromodulation (AcCENT) (JO, KV, FB, PS), University Psychiatric Center, KU Leuven-University of Leuven, Kortenberg, Belgium
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Jamieson A, Goodwill AM, Termine M, Campbell S, Szoeke C. Depression related cerebral pathology and its relationship with cognitive functioning: A systematic review. J Affect Disord 2019; 250:410-418. [PMID: 30878653 DOI: 10.1016/j.jad.2019.03.042] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/26/2019] [Accepted: 03/04/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Depression's relationship with cerebral abnormalities and cognitive decline is temporally dynamic. Despite clear clinical utility, understanding depression's effect on cerebral structures, cognitive impairment and the interaction between these symptoms has had limited consideration. METHODS This review summarised studies examining a clinical depression diagnosis or validated scales measuring depressive symptoms, data concerning amyloid-beta (Aβ) levels, brain structure and function focusing on hippocampal alterations, or white matter hyperintensities (WMH), and at least one validated neuropsychological test. Online database searches of: PsycINFO, EMBASE, MEDLINE, and Scopus were conducted to identify potential articles. RESULTS While depression was consistently associated with cross-sectionally cognitive decline across multiple domains, the neuropathological basis of this dysfunction remained unclear. Hippocampal, frontal, and limbic dysfunction as well as cortical thinning, WMH, and Aβ burden all provide inconsistent findings, likely due to depression subtypes. The consistency of these findings additionally decreases when examining this relationship longitudinally, as these results are further confounded by pre-dementia states. The therapeutic interventions examined were more efficacious in the younger compared with the older samples, who were characterised by greater WMH and Aβ burden. LIMITATIONS The limited number of longitudinal and interventional studies in addition to the heterogeneity of the samples restricts their generalisability. CONCLUSIONS Symptomatological differences between early-onset and late-onset depression (EOD and LOD) appear crucial in understanding whether late-life depression is the primary or secondary source of cerebral pathology. Though severe cognitive impairments and clearer neuropathological underpinnings are more characteristic of LOD than EOD, the inconsistency of valid biomarkers remains problematic.
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Affiliation(s)
- Alec Jamieson
- Centre for Medical Research, Royal Melbourne Hospital, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Alicia M Goodwill
- Centre for Medical Research, Royal Melbourne Hospital, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia; Healthy Brain Initiative, Faculty of Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | - Mario Termine
- Centre for Medical Research, Royal Melbourne Hospital, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Stephen Campbell
- Australian Healthy Ageing Organisation (AHAO), Parkville, Victoria, Australia
| | - Cassandra Szoeke
- Centre for Medical Research, Royal Melbourne Hospital, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia; Healthy Brain Initiative, Faculty of Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia; Australian Healthy Ageing Organisation (AHAO), Parkville, Victoria, Australia.
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6
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Carlier A, van Exel E, Dols A, Bouckaert F, Sienaert P, Ten Kate M, Wattjes MP, Vandenbulcke M, Stek ML, Rhebergen D. The course of apathy in late-life depression treated with electroconvulsive therapy; a prospective cohort study. Int J Geriatr Psychiatry 2018; 33:1253-1259. [PMID: 29851173 DOI: 10.1002/gps.4917] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 04/17/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Apathy, a lack of motivation, is frequently seen in older individuals, with and without depression, with substantial impact on quality of life. This prospective cohort study of patients with severe late-life depression treated with electroconvulsive therapy (ECT) aims to study the course of apathy and the predictive value of vascular burden and in particular white matter hyperintensities on apathy course. METHODS Information on apathy (defined by a score of >13 on the Apathy Scale), depression severity, vascular burden, and other putative confounders was collected in at 2 psychiatric hospitals on patients with late-life depression (aged 55 to 87 years, N = 73). MRI data on white matter hyperintensities were available in 52 patients. Possible risk factors for apathy post-ECT were determined using regression analyses. RESULTS After treatment with ECT, 52.0% (26/50) of the depression remitters still suffered from clinically relevant apathy symptoms. In the entire cohort, more patients remained apathetic (58.9%) than depressed (31.5%). Presence of apathy post-ECT was not associated with higher age, use of benzodiazepines, or severity of apathy and depression at baseline. Less response in depressive symptomatology after ECT predicted post-treatment apathy. The presence of vascular disease, diabetes mellitus and smoking, and white matter hyperintensities in the brain was not associated with post-treatment apathy. CONCLUSIONS Apathy may perpetuate in individual patients, despite remission of depressive symptoms. In this cohort of patients with late-life depression, post-ECT apathy is not associated with white matter hyperintensities.
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Affiliation(s)
- A Carlier
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
| | - E van Exel
- Department of Old Age Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health research institute and NCA Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - A Dols
- Department of Old Age Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health research institute and NCA Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - F Bouckaert
- Old-age Psychiatry, KU Leuven, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium
- Academic Center for ECT and Neuromodulation, KU Leuven, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - P Sienaert
- Academic Center for ECT and Neuromodulation, KU Leuven, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - M Ten Kate
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - M P Wattjes
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - M Vandenbulcke
- Old-age Psychiatry, KU Leuven, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium
| | - M L Stek
- Department of Old Age Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health research institute and NCA Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - D Rhebergen
- Department of Old Age Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health research institute and NCA Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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Meyer JP, Swetter SK, Kellner CH. Electroconvulsive Therapy in Geriatric Psychiatry: A Selective Review. Psychiatr Clin North Am 2018; 41:79-93. [PMID: 29412850 DOI: 10.1016/j.psc.2017.10.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Electroconvulsive therapy (ECT) remains an important treatment of geriatric patients. ECT treats severe depression, mania, psychosis, catatonia, and comorbid depression and agitation in dementia. ECT also serves a crucial role in treating urgent illness requiring expedient recovery, such as catatonia, or in patients with severe suicidal ideation or intent. ECT is even more effective in the elderly than in mixed-age adult populations. ECT is a safe treatment option with few medical contraindications. Cognitive effects are largely transient, even in patients with preexisting cognitive impairment.
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Affiliation(s)
- Justin P Meyer
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, Box 1230, New York, NY 10029, USA.
| | - Samantha K Swetter
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, Box 1230, New York, NY 10029, USA
| | - Charles H Kellner
- Department of Electroconvulsive Therapy (ECT), New York Community Hospital, 2525 Kings Highway, Brooklyn, NY 11229, USA
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8
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Structural-functional brain changes in depressed patients during and after electroconvulsive therapy. Acta Neuropsychiatr 2018; 30:17-28. [PMID: 27876102 DOI: 10.1017/neu.2016.62] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Electroconvulsive therapy (ECT) is a non-pharmacological treatment that is effective in treating severe and treatment-resistant depression. Although the efficacy of ECT has been demonstrated to treat major depressive disorder (MDD), the brain mechanisms underlying this process remain unclear. Structural-functional changes occur with the use of ECT as a treatment for depression based on magnetic resonance imaging (MRI). For this reason, we have tried to identify the changes that were identified by MRI to try to clarify some operating mechanisms of ECT. We focus to brain changes on MRI [structural MRI (sMRI), functional MRI (fMRI) and diffusion tensor imging (DTI)] after ECT. METHODS A systematic search of the international literature was performed using the bibliographic search engines PubMed and Embase. The research focused on papers published up to 30 September 2015. The following Medical Subject Headings (MESH) terms were used: electroconvulsive therapy AND (MRI OR fMRI OR DTI). Papers published in English were included. Four authors searched the database using a predefined strategy to identify potentially eligible studies. RESULTS There were structural changes according to the sMRI performed before and after ECT treatment. These changes do not seem to be entirely due to oedema. This investigation assessed the functional network connectivity associated with the ECT response in MDD. ECT response reverses the relationship from negative to positive between the two pairs of networks. CONCLUSION We found structural-functional changes in MRI post-ECT. Because of the currently limited MRI data on ECT in the literature, it is necessary to conduct further investigations using other MRI technology.
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9
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Dols A, Bouckaert F, Sienaert P, Rhebergen D, Vansteelandt K, Ten Kate M, de Winter FL, Comijs HC, Emsell L, Oudega ML, van Exel E, Schouws S, Obbels J, Wattjes M, Barkhof F, Eikelenboom P, Vandenbulcke M, Stek ML. Early- and Late-Onset Depression in Late Life: A Prospective Study on Clinical and Structural Brain Characteristics and Response to Electroconvulsive Therapy. Am J Geriatr Psychiatry 2017; 25:178-189. [PMID: 27771245 DOI: 10.1016/j.jagp.2016.09.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The clinical profile of late-life depression (LLD) is frequently associated with cognitive impairment, aging-related brain changes, and somatic comorbidity. This two-site naturalistic longitudinal study aimed to explore differences in clinical and brain characteristics and response to electroconvulsive therapy (ECT) in early- (EOD) versus late-onset (LOD) late-life depression (respectively onset <55 and ≥55 years). METHODS Between January 2011 and December 2013, 110 patients aged 55 years and older with ECT-treated unipolar depression were included in The Mood Disorders in Elderly treated with ECT study. Clinical profile and somatic health were assessed. Magnetic resonance imaging (MRI) scans were performed before the first ECT and visually rated. RESULTS Response rate was 78.2% and similar between the two sites but significantly higher in LOD compared with EOD (86.9 versus 67.3%). Clinical, somatic, and brain characteristics were not different between EOD and LOD. Response to ECT was associated with late age at onset and presence of psychotic symptoms and not with structural MRI characteristics. In EOD only, the odds for a higher response were associated with a shorter index episode. CONCLUSION The clinical profile, somatic comorbidities, and brain characteristics in LLD were similar in EOD and LOD. Nevertheless, patients with LOD showed a superior response to ECT compared with patients with EOD. Our results indicate that ECT is very effective in LLD, even in vascular burdened patients.
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Affiliation(s)
- Annemiek Dols
- Department of Old Age Psychiatry, GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands; EMGO+ Institute of Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Filip Bouckaert
- Old-age Psychiatry, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium; Academic Center for ECT and Neuromodulation, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium
| | - Pascal Sienaert
- Academic Center for ECT and Neuromodulation, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium
| | - Didi Rhebergen
- Department of Old Age Psychiatry, GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands; EMGO+ Institute of Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Kristof Vansteelandt
- Department of Psychiatry, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium; Research Group of Quantitative Psychology and Individual Differences, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium
| | - Mara Ten Kate
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Hannie C Comijs
- Department of Old Age Psychiatry, GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands; EMGO+ Institute of Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Louise Emsell
- Old-age Psychiatry, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium; Translational MRI, Department of Imaging and Pathology, KU Leuven & Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Mardien L Oudega
- Department of Old Age Psychiatry, GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands; EMGO+ Institute of Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Eric van Exel
- Department of Old Age Psychiatry, GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands; EMGO+ Institute of Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Sigfried Schouws
- Department of Old Age Psychiatry, GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands; EMGO+ Institute of Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Jasmien Obbels
- Academic Center for ECT and Neuromodulation, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium
| | - Mike Wattjes
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Piet Eikelenboom
- Department of Old Age Psychiatry, GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands
| | - Mathieu Vandenbulcke
- Old-age Psychiatry, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium
| | - Max L Stek
- Department of Old Age Psychiatry, GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands; EMGO+ Institute of Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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10
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Abstract
This paper reviews recent research on the use of electroconvulsive therapy (ECT) in elderly depressed patients. The PubMed database was searched for literature published within the past 4 years, using the search terms: "electroconvulsive elderly," "electroconvulsive geriatric," "ECT and elderly," and "ECT elderly cognition." The studies in this review indicate excellent efficacy for ECT in geriatric patients. Adverse cognitive effects of ECT in this population are usually transient and not typically severe. In addition, continuation/maintenance ECT (C/M-ECT) may be a favorable strategy for relapse prevention in the elderly after a successful acute course of ECT. ECT is an important treatment option for depressed geriatric patients with severe and/or treatment-resistant illness. New data add to the evidence demonstrating that ECT is a highly effective, safe, and well-tolerated antidepressant treatment option for geriatric patients.
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Affiliation(s)
- Emma T Geduldig
- The Icahn School of Medicine at Mount Sinai, Department of Psychiatry, One Gustave L. Levy Place, Box 1230, New York, NY, 10029, USA.
| | - Charles H Kellner
- The Icahn School of Medicine at Mount Sinai, Department of Psychiatry, One Gustave L. Levy Place, Box 1230, New York, NY, 10029, USA.
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