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Deng ZD, Robins PL, Regenold W, Rohde P, Dannhauer M, Lisanby SH. How electroconvulsive therapy works in the treatment of depression: is it the seizure, the electricity, or both? Neuropsychopharmacology 2024; 49:150-162. [PMID: 37488281 PMCID: PMC10700353 DOI: 10.1038/s41386-023-01677-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/27/2023] [Accepted: 07/14/2023] [Indexed: 07/26/2023]
Abstract
We have known for nearly a century that triggering seizures can treat serious mental illness, but what we do not know is why. Electroconvulsive Therapy (ECT) works faster and better than conventional pharmacological interventions; however, those benefits come with a burden of side effects, most notably memory loss. Disentangling the mechanisms by which ECT exerts rapid therapeutic benefit from the mechanisms driving adverse effects could enable the development of the next generation of seizure therapies that lack the downside of ECT. The latest research suggests that this goal may be attainable because modifications of ECT technique have already yielded improvements in cognitive outcomes without sacrificing efficacy. These modifications involve changes in how the electricity is administered (both where in the brain, and how much), which in turn impacts the characteristics of the resulting seizure. What we do not completely understand is whether it is the changes in the applied electricity, or in the resulting seizure, or both, that are responsible for improved safety. Answering this question may be key to developing the next generation of seizure therapies that lack these adverse side effects, and ushering in novel interventions that are better, faster, and safer than ECT.
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Affiliation(s)
- Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Pei L Robins
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - William Regenold
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Paul Rohde
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Moritz Dannhauer
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Sarah H Lisanby
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA.
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2
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Rosenblat JD, Kurdyak P, Cosci F, Berk M, Maes M, Brunoni AR, Li M, Rodin G, McIntyre RS, Carvalho AF. Depression in the medically ill. Aust N Z J Psychiatry 2020; 54:346-366. [PMID: 31749372 DOI: 10.1177/0004867419888576] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Depressive disorders are significantly more common in the medically ill compared to the general population. Depression is associated with worsening of physical symptoms, greater healthcare utilization and poorer treatment adherence. The present paper provides a critical review on the assessment and management of depression in the medically ill. METHODS Relevant articles pertaining to depression in the medically ill were identified, reviewed and synthesized qualitatively. A systematic review was not performed due to the large breadth of this topic, making a meaningful summary of all published and unpublished studies not feasible. Notable studies were reviewed and synthesized by a diverse set of experts to provide a balanced summary. RESULTS Depression is frequently under-recognized in medical settings. Differential diagnoses include delirium, personality disorders and depressive disorders secondary to substances, medications or another medical condition. Depressive symptoms in the context of an adjustment disorder should be initially managed by supportive psychological approaches. Once a mild to moderate major depressive episode is identified, a stepped care approach should be implemented, starting with general psychoeducation, psychosocial interventions and ongoing monitoring. For moderate to severe symptoms, or mild symptoms that are not responding to low-intensity interventions, the use of antidepressants or higher intensity psychotherapeutic interventions should be considered. Psychotherapeutic interventions have demonstrated benefits with small to moderate effect sizes. Antidepressant medications have also demonstrated benefits with moderate effect sizes; however, special caution is needed in evaluating side effects, drug-drug interactions as well as dose adjustments due to impairment in hepatic metabolism and/or renal clearance. Novel interventions for the treatment of depression and other illness-related psychological symptoms (e.g. death anxiety, loss of dignity) are under investigation. LIMITATIONS Non-systematic review of the literature. CONCLUSION Replicated evidence has demonstrated a bidirectional interaction between depression and medical illness. Screening and stepped care using pharmacological and non-pharmacological interventions is merited.
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Affiliation(s)
- Joshua D Rosenblat
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Paul Kurdyak
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy.,Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Michael Berk
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, VIC, Australia.,The University of Melbourne, Department of Psychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia.,Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia.,Centre of Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - Michael Maes
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, VIC, Australia.,Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Andre R Brunoni
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry (INBioN), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.,Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Madeline Li
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Gary Rodin
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
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Abstract
Depression risk is 2 to 3 times higher in medically ill youth compared with the general pediatric population. The relationship between medical illness and depression is bidirectional with significant contributions from psychological, developmental, illness-related, familial, and treatment factors. This article discusses the presentation, early identification, evaluation, and management of depression in medically ill youth and identifies specific risk factors and reviewing selected medical illness-specific considerations.
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Affiliation(s)
- Nasuh Malas
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Sigita Plioplys
- Department of Child and Adolescent Psychiatry, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, 225 East Chicago Avenue Box# 10, Chicago, IL 60611, USA
| | - Maryland Pao
- Intramural Research Program, National Institutes of Health, National Institute of Mental Health, Clinical Research Center, NIH Building 10, CRC East 6-5340, MSC 1276, Bethesda, MD 20892-1276, USA
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MacPherson RD, Loo CK, Barrett N. Electroconvulsive Therapy in Patients with Cardiac Pacemakers. Anaesth Intensive Care 2019; 34:470-4. [PMID: 16913344 DOI: 10.1177/0310057x0603400411] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There are few contraindications to electroconvulsive therapy and it is generally well tolerated. However, electroconvulsive therapy in elderly patients with cardiac pacemakers in situ theoretically presents an increased risk of complications. We undertook a retrospective audit of all patients who received anaesthesia for electroconvulsive therapy between January 1999 and September 2005. There were ten patients who had cardiac pacemakers in situ. They underwent a total of 147 electroconvulsive therapy treatments. In 146 out of the 147 treatments, the anaesthesia proceeded uneventfully. The findings suggest that provision of anaesthesia and electroconvulsive therapy in patients with cardiac pacemakers, including rate-responsive pacemakers, is a safe undertaking, with no extra precautions being needed except for routine ECG monitoring.
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Affiliation(s)
- R D MacPherson
- Department of Anaesthesia and Pain Management, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Fernández-Candil J, Castelltort Mascó L, Fàbregas Julià N, Urretavizcaya Sarachaga M, Bernardo Arroyo M, Valero Castell R. Anaesthesia in electroconvulsive therapy. Special conditions. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2018; 13:36-46. [PMID: 30078550 DOI: 10.1016/j.rpsm.2018.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 05/20/2018] [Accepted: 05/29/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Electroconvulsive therapy (ECT) is one of the main techniques available for the treatment of such serious mental illnesses as schizophrenia and drug-resistant depression. The pre-anaesthetic assessment appropriate for patients with various mental disorders or pathologies does not differ substantially from that of any patient prior to undergoing anaesthesia for a surgical procedure. The present review aims to propose guidelines to achieve a higher level of safety and effectiveness during ECT in the most frequent situations, in accordance with the current literature. METHODS We conducted a search on the role of anaesthesia in ECT in the Ovid MEDLINE, PubMed, and SciELO (Scientific Electronic Library Online) databases, with special attention to the populations undergoing this type of therapy. The search was carried out between 1978 and December 2016. RESULTS We included the 96 articles that contained the most important recommendations for the preparation of this guide. CONCLUSIONS We propose these guidelines in order to achieve a higher level of safety and effectiveness during ECT in special conditions. We also summarize the most important attitude to be taken into account by the anaesthesiologist in these cases.
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Affiliation(s)
| | | | - Neus Fàbregas Julià
- Department of Anesthesiology, Hospital CLINIC de Barcelona, Barcelona, Spain
| | - Mikel Urretavizcaya Sarachaga
- Psychiatry Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL) Neurosciences Group-Psychiatry and Mental Health, L'Hospitalet de Llobregat, Barcelona, Spain; University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Miquel Bernardo Arroyo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Department of Medicine, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
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6
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Abstract
Electroconvulsive therapy (ECT) is an effective treatment commonly used for depression and other major psychiatric disorders. We discuss potential adverse effects (AEs) associated with ECT and strategies for their prevention and management. Common acute AEs include headache, nausea, myalgia, and confusion; these are self-limiting and are managed symptomatically. Serious but uncommon AEs include cardiovascular, pulmonary, and cerebrovascular events; these may be minimized with screening for risk factors and by physiologic monitoring. Although most cognitive AEs of ECT are short-lasting, troublesome retrograde amnesia may rarely persist. Modifications of and improvements in treatment techniques minimize cognitive and other AEs.
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Affiliation(s)
- Chittaranjan Andrade
- Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore 560 029, India.
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore 560 029, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore 560 029, India
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Lazaro JC, Dantas CDR. Electroconvulsive therapy and anticoagulation after pulmonary embolism: a case report. JORNAL BRASILEIRO DE PSIQUIATRIA 2014. [DOI: 10.1590/0047-2085000000023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction Electroconvulsive therapy (ECT) is considered the most effective treatment for catatonia regardless its underlying condition. The rigid fixed posture and immobility observed in catatonia may lead to several clinical complications, of which, pulmonary embolism (PE) is one of the most severe. The rapid improvement of the psychiatric condition in catatonia-related PE is essential, since immobility favors the occurrence of new thromboembolic events and further complications. In that scenario, ECT should be considered, based on a risk-benefit analysis, aiming at the faster resolution of the catatonia. Methods Case report and literature review. Results A 66-years-old woman admitted to the psychiatric ward with catatonia due to a depressive episode presented bilateral PE. Clinically stable, but still severely depressed after a trial of antidepressants, she was treated with ECT in the course of full anticoagulation with enoxaparin. After five ECT sessions, her mood was significantly better and she was walking and eating spontaneously. She did not present complications related either to PE or to anticoagulation. After the eighth ECT session, she evolved with hypomania, which was managed with oral medication adjustments. The patient was completely euthymic at discharge. Conclusion The case we presented provides further evidence to the anecdotal case reports on the safety of ECT in the course of concomitant full anticoagulant therapy after PE, and illustrates how, with the proper precautions, the benefits of ECT in such condition might outweigh its risks.
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Abstract
In medically ill patients, given the many entities the phenotype of depression may represent, clinicians must be prepared to cast their diagnostic nets widely, not settling for the obvious but frequently incorrect choice of major depressive episode and throwing antidepressants at it willy nilly. Having chosen the correct diagnosis from among a broad differential of depression “look-alikes,” clinicians can draw upon a broad swath of treatment modalities including medications, psychotherapy, social supports, and spiritual interventions. Working as a psychiatrist in the medical arena requires the curiosity and analytic skills of a detective and the breadth of knowledge of a polymath adapting therapeutic tools from across the biopsychosociospiritual spectrum to the specific needs of the patient.
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Affiliation(s)
- Sandra Rackley
- Department of Psychiatry, The George Washington University School of Medicine, 2300 I Street NW, Washington, DC 20037, USA
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Safety of electroconvulsive therapy in patients with a history of heart failure and decreased left ventricular systolic heart function. J ECT 2011; 27:207-13. [PMID: 21865957 DOI: 10.1097/yct.0b013e318223beed] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Patients with heart failure may experience psychiatric disorders for which electroconvulsive therapy (ECT) is indicated. Little is known, however, about the safety of ECT in these patients. We assessed the safety of ECT in patients with a history of heart failure and decreased left ventricular systolic heart function. METHODS We conducted a retrospective review of the medical records of 35 patients with a history of heart failure and reduced left ventricular systolic heart function who underwent ECT at Mayo Clinic in Rochester, Minnesota, between January 1995 and December 2009. RESULTS Of the 35 patients, 18 (51%) were women. The median age was 77 years (range, 54-92 years). The median left ventricular ejection fraction was 30% (range, 15%-40%). The 35 patients underwent 513 ECT sessions (median number of sessions per patient, 10; range, 1-44). The 35 patients tolerated ECT well. No patient died or experienced decompensated heart failure, myocardial ischemia, or myocardial infarction during or within 24 hours after an ECT session. Prophylactic intravenous β-blockers were given to patients who, during previous ECT sessions, had marked hypertension (eg, systolic blood pressure >180-200 mm Hg) or a heart rate greater than 100 beats per minute; overall, this prophylaxis was used in 26 patients during 413 ECT sessions (80% of the total number of ECT sessions). Three patients experienced temporary, non-life-threatening cardiac arrhythmias. CONCLUSIONS Electroconvulsive therapy was safe in 35 patients with a history of heart failure and decreased left ventricular systolic heart function treated at our institution.
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Pullen SJ, Rasmussen KG, Angstman ER, Rivera F, Mueller PS. The safety of electroconvulsive therapy in patients with prolonged QTc intervals on the electrocardiogram. J ECT 2011; 27:192-200. [PMID: 21681107 DOI: 10.1097/yct.0b013e31821d3911] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prolonged QTc intervals have been associated with increased cardiac morbidity and mortality. We investigated whether pretreatment prolongation of the QTc interval was associated with increased cardiac-related events (CREs) in electroconvulsive therapy (ECT) treatment of psychiatric disorders. METHODS The charts of 1437 ECT patients were reviewed for the presence of baseline QTc prolongation. Broadly defined CREs during the course of treatment were abstracted from patient charts. RESULTS Presence of baseline QTc prolongation was not independent of increased risk of CREs during ECT. IMPLICATIONS Careful consideration should be given to patients who have QTc prolongation on an electrocardiogram and are undergoing ECT treatment, but this should not definitively exclude patients from receiving ECT treatment.
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Affiliation(s)
- Samuel J Pullen
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
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11
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Lynch AM, Pandurangi AK, Levenson JL. Electroconvulsive Therapy in a Candidate for Heart Transplant With an Implantable Cardiovertor Defibrillator and Cardiac Contractility Modulator. PSYCHOSOMATICS 2008; 49:341-4. [DOI: 10.1176/appi.psy.49.4.341] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jayaram G, Casimir A. Major depression and the use of electroconvulsive therapy (ECT) in lung transplant recipients. PSYCHOSOMATICS 2005; 46:244-9. [PMID: 15883145 DOI: 10.1176/appi.psy.46.3.244] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of this study is to describe the potential risks and benefits of electroconvulsive therapy (ECT) for treatment of depression in lung transplant recipients. The authors performed a record review of depressed patients who underwent lung transplantation at Johns Hopkins Hospital and evaluated their treatment, including ECT. In 9 years, 131 lung transplants were performed, and four patients had been diagnosed with major depression. Of those, two were candidates for ECT, and one received it. This patient's depression did abate with ECT. ECT, an effective treatment for depression, remains a treatment method of choice for depression in the posttransplant population.
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Affiliation(s)
- Geetha Jayaram
- The Johns Hopkins Hospital, Department of Psychiatry, 600 North Wolfe St., Baltimore, MD 21287, USA
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Dolenc TJ, Barnes RD, Hayes DL, Rasmussen KG. Electroconvulsive Therapy in Patients with Cardiac Pacemakers and Implantable Cardioverter Defibrillators. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2004; 27:1257-63. [PMID: 15461716 DOI: 10.1111/j.1540-8159.2004.00617.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Electroconvulsive therapy (ECT) is used to treat major depressive illness, especially in elderly and medically frail patients. Not uncommonly, these patients have cardiac pacemakers or implantable cardioverter defibrillators (ICDs). Only a few case reports in the literature describe the use of ECT in such patients. Herein we review our ECT experience treating 26 pacemaker patients and 3 ICD patients. All patients obtained significant antidepressant benefits with ETC. Only one serious cardiac event occurred, a case of supraventricular tachycardia (SVT) requiring a stay on the cardiac intensive care unit. The SVT resolved and the patient went on to receive further uncomplicated ECT treatments. We conclude from this experience that with proper pre-ECT cardiac and pacemaker/defibrillator assessment, ECT can be safely and effectively administered to patients with an implanted cardiac device.
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Affiliation(s)
- Tamara J Dolenc
- Department of Psychiatry and Psychology, Mayo Clinic Collage of Medicine, Rochester, Minnesota, USA
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Abstract
OBJECTIVE There has been concern about persisting cardiac effects of electroconvulsive therapy (ECT). Several studies have analyzed Holter monitor recordings before and after ECT, and generally have found no significant effects. METHODS As part of a study on heart rate variability changes in ECT, we performed 2-3 hour Holter monitoring before and at least 1 hour after courses of ECT in 11 depressed patients without cardiac illness. RESULTS There was no significant difference before and after Ect in heart rate, frequency ofventricular or supraventricular events, or in ST segments. CONCLUSION These date provide further evidnece of the general cardiac safety of ECT.
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Affiliation(s)
- Keith G Rasmussen
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Abstract
Electroconvulsive therapy (ECT) has been in use since the late 1930s to treat a variety of severe mental illnesses, most notably major depression. Current research efforts focus on patient selection, memory impairment, and high posttreatment relapse rates. Psychopathological factors such as psychosis and severe psychomotor retardation predict favorable response to ECT in depression. Technical variables that affect memory include electrode placement, stimulus intensity, and treatment frequency. Strategies to reduce posttreatment relapse rates include maintenance ECT and aggressive medication combinations. In this article, I review recent research that bears on these aspects of ECT practice. Additionally, I review some findings on the neurobiological effects of ECT.
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Affiliation(s)
- Keith G Rasmussen
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota 55905, USA
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Abstract
The use of electroconvulsive therapy (ECT) in the US continues to expand in the treatment of psychiatric disorders. Electroconvulsive therapy remains the "gold standard" for the treatment of major depression and a variety of other psychiatric and neurologic disorders. Because of the effectiveness and resurgence of ECT, more patients are considered good candidates for this treatment option. Overall, these patients are medication refractory and elderly, and thus more sensitive to polypharmacy. Additionally, these patients tend to have more coexisting medical problems, and often require that a practitioner have solid clinical knowledge of the fields of medicine and psychiatry. This article will review some of the most common comorbid conditions found in patients referred for ECT.
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Affiliation(s)
- Eric J Christopher
- Departments of Internal Medicine and Psychiatry, Duke University Medical Center and Durham Veteran's Administration, 508 Fulton Street, Suite 116A, Durham, NC 27705, USA.
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