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Yrondi A, Blanc O, Anguill L, Arbus C, Boudieu L, Patoz MC, Arnould A, Charpeaud T, Genty JB, Abidine R, Redon M, Rey R, Aouizerate B, Bennabi D, El-Hage W, Etain B, Holtzmann J, Leboyer M, Molière F, Richieri RM, Stéphan F, Vaiva G, Sauvaget A, Poulet E, Haffen E, Courtet P, Fossati P, Llorca PM, Samalin L. Adherence to clinical practice guidelines for using electroconvulsive therapy in elderly depressive patients. BMC Psychiatry 2024; 24:487. [PMID: 38961386 PMCID: PMC11223384 DOI: 10.1186/s12888-024-05933-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 06/25/2024] [Indexed: 07/05/2024] Open
Abstract
OBJECTIVES Electroconvulsive therapy (ECT) is one of the most effective treatments in mood disorders, mainly in major depressive episode (MDE) in the context of either unipolar (MDD) or bipolar disorder (BD). However, ECT remains a neglected and underused treatment. Older people are at high risk patients for the development of adverse drug reactions. In this context, we sought to determine the duration of MDEs and the number of lines of treatment before the initiation of ECT in patients aged 65 years or over according to the presence or absence of first-line indications for using ECT from international guidelines. METHODS In this multicenter, retrospective study including patients aged 65 years or over with MDEs in MDD or BD who have been treated with ECT for MDEs, data on the duration of MDEs and the number of lines of treatment received before ECT were collected. The reasons for using ECT, specifically first-line indications (suicidality, urgency, presence of catatonic and psychotic features, previous ECT response, patient preference) were recorded. Statistical comparisons between groups used standard statistical tests. RESULTS We identified 335 patients. The mean duration of MDEs before ECT was about 9 months. It was significantly shorter in BD than in MDD- about 7 and 10 months, respectively. The co-occurrence of chronic medical disease increased the duration before ECT in the MDD group. The presence of first-line indications for using ECT from guidelines did not reduce the duration of MDEs before ECT, except where there was a previous response to ECT. The first-line indications reduced the number of lines of treatment before starting ECT. CONCLUSION Even if ECT seems to be a key treatment in the elderly population due to its efficacity and safety for MDEs, the delay before this treatment is still too long.
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Affiliation(s)
- Antoine Yrondi
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France.
- Service de Psychiatrie Et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse, INSERM, UPS, 330 Avenue de Grande Bretagne, 31059, Toulouse, France.
| | - Olivier Blanc
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - Loic Anguill
- Service de Psychiatrie Et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse, INSERM, UPS, 330 Avenue de Grande Bretagne, 31059, Toulouse, France
| | - Christophe Arbus
- Service de Psychiatrie Et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse, INSERM, UPS, 330 Avenue de Grande Bretagne, 31059, Toulouse, France
| | - Ludivine Boudieu
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - Marie-Camille Patoz
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - Adeline Arnould
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | | | - Jean-Baptiste Genty
- Université Paris-Est, UMR_S955, UPEC, Créteil, France Inserm, U955, Equipe 15 Psychiatrie Génétique, Créteil, France AP-HP, Hôpital H. Mondor-A. Chenevier, Pôle de Psychiatrie, Créteil, France Fondation FondaMental, Fondation de Cooperation Scientifique, Créteil, France
| | - Racan Abidine
- Service de Psychiatrie Et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse, INSERM, UPS, 330 Avenue de Grande Bretagne, 31059, Toulouse, France
| | - Maximilien Redon
- Service de Psychiatrie Et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse, INSERM, UPS, 330 Avenue de Grande Bretagne, 31059, Toulouse, France
| | - Romain Rey
- INSERM U1028, CNRS UMR5292, University Lyon 1, Lyon Neuroscience Research Centre, Psychiatric Disorders: From Resistance to Response ΨR2 Team, Centre Hospitalier Le Vinatier, Bron, France
| | - Bruno Aouizerate
- Pôle de Psychiatrie Générale Et Universitaire, Centre de Référence Régional Des Pathologies Anxieuses Et de La Dépression, Centre Expert Dépression Résistante FondaMental, CH Charles Perrens, Bordeaux, Laboratoire Nutrition Et Neurobiologie Intégrée (UMR INRAE 1286), Université de Bordeaux, Bordeaux, France
| | - Djamila Bennabi
- Université de Franche-Comté, UMR INSERM 1322 LINC, Service de Psychiatrie de L'adulte, CIC-1431 INSERM, CHU de Besançon, F-25030, Besançon, France
| | - Wissam El-Hage
- Clinique Psychiatrique Universitaire, Centre Expert Dépression Résistante FondaMental, CHRU de Tours, Tours, France
| | - Bruno Etain
- Département de Psychiatrie Et de Médecine Addictologique, Lariboisière-Fernand Widal GHU APHP Nord Université Paris Cité Paris, Paris, France
| | - Jérôme Holtzmann
- Service de Psychiatrie de L'adulte, CS 10217, Centre Expert Dépression Résistante FondaMental, CHU de Grenoble, Hôpital Nord, Grenoble, France
| | - Marion Leboyer
- Université Paris-Est, UMR_S955, UPEC, Créteil, France Inserm, U955, Equipe 15 Psychiatrie Génétique, Créteil, France AP-HP, Hôpital H. Mondor-A. Chenevier, Pôle de Psychiatrie, Créteil, France Fondation FondaMental, Fondation de Cooperation Scientifique, Créteil, France
| | - Fanny Molière
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, INSERM U1061, Montpellier University, Montpellier, France
| | - Raphaelle Marie Richieri
- Pôle Psychiatrie, Centre Expert Dépression Résistante FondaMental, CHU La Conception, Marseille, France
| | - Florian Stéphan
- Service Hospitalo-Universitaire de Psychiatrie Générale Et de Réhabilitation Psycho Sociale 29G01 Et 29G02, Centre Expert Depression Résistante FondaMental, EA 7479, CHRU de Brest, Hôpital de Bohars, Brest, France
| | - Guillaume Vaiva
- University Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition & Centre National de Ressources Et Résilience Pour Les Psychotraumatismes (Cn2r Lille Paris), F-59000, Lille, France
| | - Anne Sauvaget
- Nantes Université, CHU Nantes, Movement, Interactions, Performance, MIP, UR 4334, 44000, Nantes, France
- French Society for Biological Psychiatry and Neuropsychopharmacology, STEP Section (Stimulation Transcrânienne en Psychiatrie), Saint-Germain-en-Laye, France
| | - Emmanuel Poulet
- Psychiatric Emergency Service, Hospices Civils de Lyon, F-69005, Lyon, France
- France Centre Hospitalier Le Vinatier, Bron; INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, PSYR2 Team, F-69000, Lyon, France
- University Lyon 1, Villeurbanne, F-69000, Villeurbanne, France
| | - Emmanuel Haffen
- Université de Franche-Comté, UMR INSERM 1322 LINC, Service de Psychiatrie de L'adulte, CIC-1431 INSERM, CHU de Besançon, F-25030, Besançon, France
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, INSERM U1061, Montpellier University, Montpellier, France
| | - Philippe Fossati
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France
- Control-Interoception Attention Team, Paris Brain Institute (ICM), Sorbonne University, INSERM, CNRS, APHP, Hôpital de La Pitié-Salpêtrière, DMU Neuroscience, Paris, France
| | - Pierre-Michel Llorca
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - Ludovic Samalin
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
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Xu SX, Xie XH, Yao L, Chen LC, Wan Q, Chen ZH, Liu Z. Trajectories of Efficacy and Cognitive Function During Electroconvulsive Therapy Course in Young Adults with Treatment-Resistant Depression. Neuropsychiatr Dis Treat 2023; 19:267-281. [PMID: 36744206 PMCID: PMC9893845 DOI: 10.2147/ndt.s394155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/13/2023] [Indexed: 01/30/2023] Open
Abstract
Objective Little is known about the effectiveness and cognitive side-effects of electroconvulsive therapy (ECT) in young adults with treatment-resistant depression (TRD). The primary aim of this prospective longitudinal observational trial was to examine the clinical features and cognitive outcomes of young adults with TRD undergoing ECT. Methods Changes in depressive symptoms and objective and subjective cognitive function were assessed using repeated evaluation at baseline, after each ECT session, and at one-month follow-up using the Montgomery-Äsberg Depression Rating Scale (MADRS) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Forward Digital Span Test (FDST), and part of the Columbia Subjective Side Effects Schedule. Results Of 41 inpatients, 35 (85.4%) and 12 (29.3%) met the criteria for response and remission after ECT, respectively. The greatest clinical improvements occurred during the first 3-4 ECT sessions. While 34 patients reported subjective cognitive impairment increased with ECT, immediate and delayed memory (RBANS) significantly increased after ECT, consistent with FDST results. Objective cognition significantly improved during follow-up, but subjective cognition remained impaired. Conclusion ECT is effective in young adults with TRD. Although subjective cognitive impairment increased during treatment, objective cognitive impairments were not observed.
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Affiliation(s)
- Shu-xian Xu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Xin-hui Xie
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Lihua Yao
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Li-chang Chen
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Qirong Wan
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Zhen-hua Chen
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Zhongchun Liu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
- Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan, People's Republic of China
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Subramanian S, Labonte AK, Nguyen T, Luong AH, Hyche O, Smith SK, Hogan RE, Farber NB, Palanca BJA, Kafashan M. Correlating electroconvulsive therapy response to electroencephalographic markers: Study protocol. Front Psychiatry 2022; 13:996733. [PMID: 36405897 PMCID: PMC9670172 DOI: 10.3389/fpsyt.2022.996733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/10/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction Electroconvulsive therapy (ECT) is an effective intervention for patients with major depressive disorder (MDD). Despite longstanding use, the underlying mechanisms of ECT are unknown, and there are no objective prognostic biomarkers that are routinely used for ECT response. Two electroencephalographic (EEG) markers, sleep slow waves and sleep spindles, could address these needs. Both sleep microstructure EEG markers are associated with synaptic plasticity, implicated in memory consolidation, and have reduced expression in depressed individuals. We hypothesize that ECT alleviates depression through enhanced expression of sleep slow waves and sleep spindles, thereby facilitating synaptic reconfiguration in pathologic neural circuits. Methods Correlating ECT Response to EEG Markers (CET-REM) is a single-center, prospective, observational investigation. Wireless wearable headbands with dry EEG electrodes will be utilized for at-home unattended sleep studies to allow calculation of quantitative measures of sleep slow waves (EEG SWA, 0.5-4 Hz power) and sleep spindles (density in number/minute). High-density EEG data will be acquired during ECT to quantify seizure markers. Discussion This innovative study focuses on the longitudinal relationships of sleep microstructure and ECT seizure markers over the treatment course. We anticipate that the results from this study will improve our understanding of ECT.
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Affiliation(s)
- Subha Subramanian
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Alyssa K. Labonte
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Neuroscience Graduate Program, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Thomas Nguyen
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Anhthi H. Luong
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Department of Health Policy and Management, Columbia University, New York, NY, United States
| | - Orlandrea Hyche
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - S. Kendall Smith
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Center on Biological Rhythms and Sleep, Washington University School of Medicine in St. Louis, MO, United States
| | - R. Edward Hogan
- Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Nuri B. Farber
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Ben Julian A. Palanca
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Center on Biological Rhythms and Sleep, Washington University School of Medicine in St. Louis, MO, United States
- Division of Biology and Biomedical Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, United States
- Neuroimaging Labs Research Center, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - MohammadMehdi Kafashan
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Center on Biological Rhythms and Sleep, Washington University School of Medicine in St. Louis, MO, United States
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Subramanian S, Lopez R, Zorumski CF, Cristancho P. Electroconvulsive therapy in treatment resistant depression. J Neurol Sci 2022; 434:120095. [PMID: 34979372 DOI: 10.1016/j.jns.2021.120095] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 11/02/2021] [Accepted: 12/12/2021] [Indexed: 12/28/2022]
Abstract
Electroconvulsive therapy (ECT) is a treatment modality for patients with treatment resistant depression (TRD), defined as failure of two adequate antidepressant medication trials. We provide a qualitative review of ECT's effectiveness for TRD, methods to optimize ECT parameters to improve remission rates and side effect profiles, and ECT's proposed neurobiological mechanisms. Right unilateral (RUL) electrode placement has been shown to be as effective for major depression as bilateral ECT, and RUL is associated with fewer cognitive side effects. There is mixed evidence on how to utilize ECT to sustain remission (i.e., continuation ECT, psychotropic medications alone, or a combination of ECT and psychotropic medications). Related to neurobiological mechanisms, an increase in gray matter volume in the hippocampus-amygdala complex is reported post-ECT. High connectivity between the subgenual anterior cingulate and the middle temporal gyrus before ECT is associated with better treatment response. Rodent models have implicated changes in neurotransmitters including glutamate, GABA, serotonin, and dopamine in ECT's efficacy; however, findings in humans are limited. Altogether, while ECT remains a highly effective therapy, the neurobiological underpinnings associated with improvement of depression remain uncertain.
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Affiliation(s)
- Subha Subramanian
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, MO, USA; Department of Psychiatry, University of Texas Rio Grande Valley School of Medicine, Harlingen, TX, USA.
| | - Ruthzaine Lopez
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, MO, USA; Department of Psychiatry, University of Texas Rio Grande Valley School of Medicine, Harlingen, TX, USA
| | - Charles F Zorumski
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, MO, USA; Department of Psychiatry, University of Texas Rio Grande Valley School of Medicine, Harlingen, TX, USA
| | - Pilar Cristancho
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, MO, USA; Department of Psychiatry, University of Texas Rio Grande Valley School of Medicine, Harlingen, TX, USA
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