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Park I, Kim HG, Do SH, Hwang JW, Yoon IY, Hong JK, Ryu JH. The Effect of Remimazolam on Seizure Profile, Hemodynamics, and Recovery in Patients With Electroconvulsive Therapy Comparison With Propofol and Etomidate: A Retrospective Study. J ECT 2024:00124509-990000000-00165. [PMID: 38857335 DOI: 10.1097/yct.0000000000001025] [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] [Indexed: 06/12/2024]
Abstract
OBJECTIVES To compare seizure-related, hemodynamic, and recovery outcomes when using remimazolam for ECT with those of other anesthetics, specifically propofol and etomidate. METHODS A total of 49 patients who underwent 405 ECT treatment sessions under general anesthesia were retrospectively analyzed. Remimazolam, propofol, and etomidate were used for 93, 138, and 174 ECT sessions, respectively. The primary outcome was durations of motor and electroencephalogram (EEG) seizure activity, whereas secondary outcomes included hemodynamics (ie, mean arterial pressure [MAP] and heart rate [HR] at various time points from induction to postanesthesia care unit [PACU] discharge), antihypertensive drugs administration after electrical stimulus, and recovery profiles (ie, length of PACU stay and incidence of postictal confusion). RESULTS Durations of motor and EEG seizures were shorter for remimazolam than etomidate (motor, P < 0.001; EEG, P = 0.003) but similar compared with propofol (motor, P = 0.191; EEG, P = 0.850). During seizure, remimazolam showed a comparable MAP and HR to etomidate (MAP: P = 0.806; HR: P = 0.116). The antihypertensive drug use was lowest for remimazolam (6.8%), followed by propofol (35.6%) and etomidate (65.6%), and the mean length of PACU stay was comparable for remimazolam (19.7 min), propofol (22.8 min), and etomidate (24.5 min). The occurrence of postictal confusion did not differ among the 3 agents (P > 0.050). CONCLUSIONS Remimazolam is a promising anesthetic option for ECT because of its comparable seizure profiles, stable hemodynamics, and comparable PACU stay when compared with propofol and etomidate without additional adverse events.
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Affiliation(s)
- Insun Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicines, Seoul, Republic of Korea
| | - Hyeong Geun Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sang-Hwan Do
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicines, Seoul, Republic of Korea
| | - Jung Won Hwang
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicines, Seoul, Republic of Korea
| | - In-Young Yoon
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung Kyung Hong
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jung-Hee Ryu
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicines, Seoul, Republic of Korea
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Tolentino A, Santaella F, Barros FMR, Barnes L, Torre OD, Schlittler L, Oliveira KD, Dos Santos Junior A, Dalgalarrondo P, Banzato CEM. Extreme Agitation in Mania Treated With Intravenous Continuous Infusion of Dexmedetomidine and ECT. J ECT 2024:00124509-990000000-00158. [PMID: 38587401 DOI: 10.1097/yct.0000000000001007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Affiliation(s)
- Arthur Tolentino
- Department of Psychiatry, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
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Ekstrand J, Takamiya A, Nordenskjold A, Kirov G, Sienaert P, Kellner CH, Movahed Rad P. Ketamine or ECT? What Have We Learned From the KetECT and ELEKT-D Trials? Int J Neuropsychopharmacol 2024; 27:pyad065. [PMID: 38114073 PMCID: PMC10829070 DOI: 10.1093/ijnp/pyad065] [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: 10/22/2023] [Accepted: 12/18/2023] [Indexed: 12/21/2023] Open
Abstract
1. Two recent clinical trials, KetECT and ELEKT-D, compared the effectiveness of ketamine and electroconvulsive therapy (ECT) for major depressive disorder. Notably, these trials reported marked differences in ECT's clinical outcomes of, with remission rates of 63% for KetECT and a strikingly lower rate of 22% for ELEKT-D, while the remission rates for ketamine were 46% and 38%, respectively. Considering that the primary objective of both trials was to compare the standard treatment (ECT) with an experimental intervention (ketamine), it is crucial to highlight the pronounced disparities in ECT's clinical outcomes. This article offers a comprehensive comparison of these trials while also exploring how patient characteristics, treatment protocols, and study designs may contribute to such pronounced outcome discrepancies. These differences highlight the heterogeneous nature of depression and underscore the need for personalized treatments. These studies also provide valuable insights into identifying the most suitable candidates for ketamine and ECT.
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Affiliation(s)
- Joakim Ekstrand
- Department of Clinical Sciences, Division of Adult Psychiatry Faculty of Medicine, Lund University, Lund, Sweden
| | - Akihiro Takamiya
- KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry, Leuven, Belgium
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan. Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan
| | - Axel Nordenskjold
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - George Kirov
- Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Division of Psychological Medicine and Clinical Neuroscience, Cardiff, UK
| | - Pascal Sienaert
- Department of Neurosciences, University Psychiatric Center KU Leuven, Research Group Psychiatry, Academic Center for ECT and Neuromodulation (AcCENT), KU Leuven, Leuven, Belgium
| | - Charles H Kellner
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Pouya Movahed Rad
- Department of Clinical Sciences, Division of Adult Psychiatry Faculty of Medicine, Lund University, Lund, Sweden
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Tsuboi T, Takaesu Y, Hasegawa N, Ochi S, Fukumoto K, Ohi K, Muraoka H, Okada T, Kodaka F, Igarashi S, Iida H, Kashiwagi H, Hori H, Ichihashi K, Ogasawara K, Hashimoto N, Iga JI, Nakamura T, Usami M, Nagasawa T, Kido M, Komatsu H, Yamagata H, Atake K, Furihata R, Kikuchi S, Horai T, Takeshima M, Hirano Y, Makinodan M, Matsumoto J, Miura K, Hishimoto A, Numata S, Yamada H, Yasui-Furukori N, Inada K, Watanabe K, Hashimoto R. Effects of electroconvulsive therapy on the use of anxiolytics and sleep medications: a propensity score-matched analysis. Psychiatry Clin Neurosci 2023; 77:30-37. [PMID: 36215112 DOI: 10.1111/pcn.13489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/24/2022] [Accepted: 09/30/2022] [Indexed: 01/06/2023]
Abstract
AIM We investigated the association of electroconvulsive therapy (ECT) with anxiolytic and sleep medication use in patients with major depressive disorder (MDD) and schizophrenia (SZ). METHODS This nationwide observational study analyzed data from 3483 MDD inpatients and 6663 SZ inpatients. Patients with MDD and SZ were classified into those who underwent ECT during hospitalization and those who did not. A propensity score-matching method was performed to adjust for preadmission characteristics and clinical information, which were expected bias between the two groups. Rates of anxiolytic and sleep medication use at discharge were compared in the matched sample. RESULTS 500 MDD patients were assigned to both groups. In the matched MDD sample, the rate of anxiolytic and sleep medication use at discharge was significantly lower in the ECT group than in the non-ECT group (64.9% vs. 75.8%, P = 1.7 × 10-4 ). In the ECT group, the rate of anxiolytic and sleep medication use at discharge was significantly lower than that prior to admission (64.9% vs. 73.2%, P = 1.2 × 10-14 ). 390 SZ patients were allocated. In the matched SZ sample, the ECT group was not significantly different from the non-ECT group in the rate of anxiolytics and sleep medications use at discharge (61.3% vs. 68.2%, P = 4.3 × 10-2 ). In the ECT group, the rate of anxiolytics and sleep medications use at discharge was significantly lower than that before admission (61.3% vs. 70.5%, P = 4.4 × 10-4 ), although this was not the primary outcome. CONCLUSION Reduction of anxiolytic and sleep medication use may be considered positively when ECT is indicated for treatment of MDD.
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Affiliation(s)
- Takashi Tsuboi
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Naomi Hasegawa
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Shinichiro Ochi
- Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Toon, Japan
| | - Kentaro Fukumoto
- Department of Neuropsychiatry, Iwate Medical University, Morioka, Japan
| | - Kazutaka Ohi
- Department of Psychiatry, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hiroyuki Muraoka
- Department of Psychiatry, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tsuyoshi Okada
- Department of Psychiatry, Jichi Medical University, Yakushiji, Japan
| | - Funitoshi Kodaka
- Department of Psychiatry, the Jikei University School of Medicine, Minato-ku, Japan
| | - Shun Igarashi
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan.,Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hitoshi Iida
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hiroko Kashiwagi
- Department of Forensic Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hikaru Hori
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kayo Ichihashi
- Department of Neuropsychiatry, University of Tokyo Hospital, Bunkyo-ku, Japan
| | - Kazuyoshi Ogasawara
- Center for Postgraduate Clinical Training and Career Development, Nagoya University Hospital, Nagoya, Japan
| | - Naoki Hashimoto
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Jun-Ichi Iga
- Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Toon, Japan
| | - Toshinori Nakamura
- Department of Psychiatry, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masahide Usami
- Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Japan
| | - Tatsuya Nagasawa
- Department of NeuroPsychiatry, Kanazawa Medical University, Kahoku-gun, Japan
| | - Mikio Kido
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Hiroshi Komatsu
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan
| | - Hirotaka Yamagata
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University School of Medicine, Ube, Japan
| | - Kiyokazu Atake
- Nippon Telegraph and Telephone West Corporation Kyushu Health Administration Center, Fukuoka, Japan
| | - Ryuji Furihata
- Agency for Student Support and Disability Resources, Kyoto University, Kyoto, Japan
| | - Saya Kikuchi
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan
| | - Tadasu Horai
- Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoji Hirano
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Manabu Makinodan
- Department of Psychiatry, Nara Medical University, Kashihara, Japan
| | - Junya Matsumoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kenichiro Miura
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Akitoyo Hishimoto
- Department of Psychiatry, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shusuke Numata
- Department of Psychiatry, Graduate School of Biomedical Science, Tokushima University, Tokushima, Japan
| | - Hisashi Yamada
- Department of Neuropsychiatry, Hyogo Medical University, Nishinomiya, Japan
| | - Norio Yasui-Furukori
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Japan
| | - Ken Inada
- Department of Psychiatry, Kitasato University School of Medicine, Sagamihara, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Ryota Hashimoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
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Cinderella MA, Nichols NA, Munjal S, Yan J, Kimball JN, Gligorovic P. Antiepileptics in Electroconvulsive Therapy: A Mechanism-Based Review of Recent Literature. J ECT 2022; 38:133-137. [PMID: 34739420 DOI: 10.1097/yct.0000000000000805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Although prior conventional wisdom strongly recommended complete discontinuation of medications increasing the seizure threshold before electroconvulsive therapy (ECT), more recent literature suggests that anticonvulsants should be considered a relative rather than an absolute contraindication to proceeding with therapy. Most literature regarding the use of use antiepileptic drugs in ECT focuses on antiepileptic mood stabilizers with which most psychiatrists are familiar. However, there is considerably less information available about the use of newer antiepileptics in conjunction with ECT, which may be prescribed to a patient with epilepsy or off-label for psychiatric reasons.In this article, we provide a mechanism-based review of recent available literature concerning the use of antiepileptics during ECT and discuss which medications have the most robust evidence supporting their continued use in select patients. Finally, we highlight important considerations for psychiatrists when deciding how to proceed with patients on antiepileptics who require ECT.
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Affiliation(s)
- Margaret A Cinderella
- From the Department of Psychiatry and Behavioral Health, Wake Forest School of Medicine and Wake Forest Baptist Health, Winston-Salem, NC
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Factors Predicting Ictal Quality in Bilateral Electroconvulsive Therapy Sessions. Brain Sci 2021; 11:brainsci11060781. [PMID: 34204783 PMCID: PMC8231613 DOI: 10.3390/brainsci11060781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/04/2021] [Accepted: 06/10/2021] [Indexed: 11/16/2022] Open
Abstract
In electroconvulsive therapy (ECT), ictal characteristics predict treatment response and can be modified by changes in seizure threshold and in the ECT technique. We aimed to study the impact of ECT procedure-related variables that interact during each session and might influence the seizure results. Two hundred and fifty sessions of bilateral ECT in forty-seven subjects were included. Seizure results were evaluated by two different scales of combined ictal EEG parameters (seizure quality index (SQI) and seizure adequacy markers sum (SAMS) scores) and postictal suppression rating. Repeated measurement regression analyses were performed to identify predictors of each session’s three outcome variables. Univariate models identified age, physical status, hyperventilation, basal oxygen saturation, days between sessions, benzodiazepines, lithium, and tricyclic antidepressants as predictors of seizure quality. Days elapsed between sessions, higher oxygen saturation and protocolized hyperventilation application were significant predictors of better seizure quality in both scales used in multivariate models. Additionally, lower ASA classification influenced SQI scores as well as benzodiazepine use and lithium daily doses were predictors of SAMS scores. Higher muscle relaxant doses and lower applied stimulus intensities significantly influenced the postictal suppression rating. The study found several modifiable procedural factors that impacted the obtained seizure characteristics; they could be adjusted to optimize ECT session results.
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Psychotropic Medication Effects on Seizure Threshold and Seizure Duration During Electroconvulsive Therapy Stimulus Titration. J ECT 2020; 36:115-122. [PMID: 31609275 DOI: 10.1097/yct.0000000000000621] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Decisions about psychotropic medication administration before electroconvulsive therapy (ECT) are central to management of a very psychiatrically ill patient population. Given that many psychotropic medications are thought to either promote or prevent seizures, there is ongoing concern about concurrent psychotropic medication and ECT administration. This study examined the effect of psychotropic medications on seizure threshold and duration during ECT stimulus titration. METHODS The study sample consisted of 550 patients receiving ECT stimulus titration at a single site during a 27-month period. Systematic chart review provided clinical data, including patients' demographics, psychiatric diagnoses, medications administered in the 48 hours before ECT, and information on the ECT procedure. Referring psychiatrists were advised to discontinue lithium before ECT but otherwise managed psychotropic medications as clinically indicated. A fixed charge titration schedule was used to estimate seizure threshold. Electroconvulsive therapy motor seizure duration was estimated by the cuff method, and electroencephalogram seizure duration was estimated by review of a 2-lead strip. RESULTS Administration of psychotropic medications, including benzodiazepines, antiepileptics, selective serotonin reuptake inhibitors, tricyclic and tetracyclic antidepressants, bupropion, and stimulants, was not associated with seizure threshold as estimated by electrical charge eliciting a generalized seizure or duration during the initial ECT titration. Tricyclic and tetracyclic antidepressant dosage was associated with seizure threshold. CONCLUSIONS Psychotropic medications may have little effect on seizure threshold and duration during titration of electrical dose at ECT initiation. Integrating this work with other literature supports making recommendations for medication discontinuation before ECT on an individual basis.
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Trevizol AP, Downar J, Vila-Rodriguez F, Thorpe KE, Daskalakis ZJ, Blumberger DM. Predictors of remission after repetitive transcranial magnetic stimulation for the treatment of major depressive disorder: An analysis from the randomised non-inferiority THREE-D trial. EClinicalMedicine 2020; 22:100349. [PMID: 32382720 PMCID: PMC7200243 DOI: 10.1016/j.eclinm.2020.100349] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 03/25/2020] [Accepted: 04/03/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Although repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for major depressive disorder (MDD), treatment selection is still mainly a process of trial-and-error. The present study aimed to identify clinical predictors of remission after a course of rTMS delivered to the left DLPFC to improve patient selection. METHODS Data from a large randomised non-inferiority trial comparing standard 10 Hz and intermittent theta burst stimulation (iTBS) for the treatment of MDD were used for the exploratory analyses. Individual variables were assessed for their association with remission and then included in a logistic regression model to determine odds ratios (OR) and corresponding 95% confidence intervals. Model discrimination (internal validation) was carried out to assess model optimism using the c-index. ClinicalTrials.gov identifier: NCT01887782. FINDINGS 388 subjects were included in the analysis (199-iTBS and 189-10 Hz, respectively). Higher baseline severity of both depressive and anxiety symptoms were associated with a lower chance of achieving remission (OR=0.64, 95% CI 0.46-0.88; and 0.78, 95% CI 0·60-0.98, respectively). Current employment was a positive predictor for remission (OR=1.69, 95% CI 1.06-2.7), while greater number of treatment failures was associated with lower odds of achieving remission (OR=0.51, 95% CI 0.27-0.98). A non-linear effect of age and remission was observed. An analysis to allow an estimate of the probability of remission using all variables was assessed. The c-index for the fitted model was 0.687. INTERPRETATION Our results suggest that measuring depression symptom severity, employment status, and refractoriness are important in prognosticating outcome to a course of rTMS in MDD. FUNDING Canadian Institutes of Health Research MOP-136801.
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Affiliation(s)
- Alisson P. Trevizol
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, 1001 Queen St. W., Unit 4-115, Toronto, ON M6J1H4, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jonathan Downar
- Institute of Medical Science, University of Toronto, Canada
- MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto, Canada
- Krembil Research Institute, University Health Network, Toronto, Canada
| | - Fidel Vila-Rodriguez
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
- Non-Invasive Neurostimulation Therapies Laboratory, University of British Columbia, Vancouver, Canada
| | - Kevin E. Thorpe
- Dalla Lana School of Public Health, University of Toronto, Canada
| | - Zafiris J. Daskalakis
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, 1001 Queen St. W., Unit 4-115, Toronto, ON M6J1H4, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Canada
| | - Daniel M. Blumberger
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, 1001 Queen St. W., Unit 4-115, Toronto, ON M6J1H4, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Canada
- Corresponding author at: Department of Psychiatry, University of Toronto, 1001 Queen St. W., Unit 4-115, Toronto, ON M6J1H4, Canada.
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van Diermen L, Vanmarcke S, Walther S, Moens H, Veltman E, Fransen E, Sabbe B, van der Mast R, Birkenhäger T, Schrijvers D. Can psychomotor disturbance predict ect outcome in depression? J Psychiatr Res 2019; 117:122-128. [PMID: 31382133 DOI: 10.1016/j.jpsychires.2019.07.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/18/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
Abstract
Psychomotor symptoms are core features of melancholic depression. This study investigates whether psychomotor disturbance predicts the outcome of electroconvulsive therapy (ECT) and how the treatment modulates psychomotor disturbance. In 73 adults suffering from major depressive disorder psychomotor functioning was evaluated before, during and after ECT using the observer-rated CORE measure and objective measures including accelerometry and a drawing task. Regression models were fitted to assess the predictive value of melancholic depression (CORE ≥ 8) and the psychomotor variables on ECT outcome, while effects on psychomotor functioning were evaluated through linear mixed models. Patients with CORE-defined melancholic depression (n = 41) had a 4.9 times greater chance of reaching response than those (n = 24) with non-melancholic depression (Chi-Square = 7.5, P = 0.006). At baseline, both higher total CORE scores (AUC = 0.76; P = 0.001) and needing more cognitive (AUC = 0.78; P = 0.001) and motor time (AUC = 0.76; P = 0.003) on the drawing task corresponded to superior ECT outcomes, as did lower daytime activity levels (AUC = 0.76) although not significantly so after Bonferroni correction for multiple testing. A greater CORE-score reduction in the first week of ECT was associated with higher ECT effectiveness. ECT reduced CORE-assessed psychomotor symptoms and improved activity levels only in those patients showing the severer baseline retardation. Although the sample was relatively small, psychomotor symptoms were clearly associated with beneficial outcome of ECT in patients with major depression, indicating that monitoring psychomotor deficits can help personalise treatment.
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Affiliation(s)
- Linda van Diermen
- University Department, Psychiatric Hospital Duffel, Duffel, Belgium; Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Simon Vanmarcke
- University Department, Psychiatric Hospital Duffel, Duffel, Belgium; Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Herman Moens
- University Department, Psychiatric Hospital Duffel, Duffel, Belgium
| | - Eveline Veltman
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Erik Fransen
- StatUa Center for Statistics, University of Antwerp, Antwerp, Belgium
| | - Bernard Sabbe
- University Department, Psychiatric Hospital Duffel, Duffel, Belgium; Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Roos van der Mast
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Tom Birkenhäger
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Didier Schrijvers
- University Department, Psychiatric Hospital Duffel, Duffel, Belgium; Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Abstract
BACKGROUND Electroconvulsive therapy (ECT) is one of the most effective treatments for major depressive disorder (MDD), especially in cases of treatment-resistant MDD. Because of their pharmacological profiles, benzodiazepines (BZDs) are suspected to decrease the efficacy of ECT. This study investigated the effect of BZDs on ECT-induced clinical outcomes and ECT course parameters in patients with MDD. METHOD The impact of BZDs on severity of depression (Montgomery-Asberg Depression Rating Scale scores) and on ECT course parameters (seizure threshold, clinical and electroencephalographic seizure duration) was investigated in 70 patients with MDD who received an ECT course using dose-titration method (22 received concomitant BZDs). RESULTS Lower remission rates (52.0%) and smaller decreases in Montgomery-Asberg Depression Rating Scale scores were observed in the non-BZD group than in the BZD group (81.2%, P = 0.02). There were no significant differences between the 2 groups regarding seizure duration and seizure threshold. LIMITATIONS This was a retrospective study. Impact of BZDs on anxiety and cognition was not assessed. CONCLUSIONS Benzodiazepines increased the clinical efficacy of ECT when delivered using dose-titration method and bitemporal stimulation. Further studied are needed to understand the interaction between BZDs and ECT on clinical outcomes.
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Jeong SH, Youn T, Lee Y, Jang JH, Jeong YW, Kim YS, Chung IW. Initial Seizure Threshold in Brief-Pulse Bilateral Electroconvulsive Therapy in Patients with Schizophrenia or Schizoaffective Disorder. Psychiatry Investig 2019; 16:704-712. [PMID: 31429220 PMCID: PMC6761792 DOI: 10.30773/pi.2019.06.20.2] [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: 03/03/2019] [Accepted: 06/20/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The present study aimed to report the initial seizure threshold (IST) of a brief-pulse bilateral electroconvulsive therapy (BP-BL ECT) in Korean patients with schizophrenia/schizoaffective disorder and to identify IST predictors. METHODS Among 67 patients who received ECT and diagnosed with schizophrenia/schizoaffective disorder based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, we included 56 patients who received 1-millisecond BP-BL ECT after anesthesia with sodium thiopental between March 2012 and June 2018. Demographic and clinical information was gathered from electronic medical records, and a multiple regression analysis was conducted to identify predictors of the IST. RESULTS The mean age of the patients was 36.9±12.0 years and 30 (53.6%) patients were male. The mean and median IST were 105.9±54.5 and 96 millicoulombs (mC), respectively. The IST was predicted by age, gender, and dose (mg/kg) of sodium thiopental. Other physical and clinical variables were not associated with the IST. CONCLUSION The present study demonstrated that the IST of 1-ms BP-BL ECT following sodium thiopental anesthesia in Korean patients was comparable to those reported in previous literature. The IST was associated with age, gender, and dose of sodium thiopental.
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Affiliation(s)
- Seong Hoon Jeong
- Department of Psychiatry, Eulji University Hospital, Daejeon, Republic of Korea
| | - Tak Youn
- Department of Psychiatry and Electroconvulsive Therapy Center, Dongguk University International Hospital, Goyang, Republic of Korea.,Institute of Clinical Psychopharmacology, Dongguk University College of Medicine, Goyang, Republic of Korea
| | - Younsuk Lee
- Department of Anesthesiology and Pain Medicine, Dongguk University International Hospital, Goyang, Republic of Korea
| | - Jin Hyeok Jang
- Department of Psychiatry and Electroconvulsive Therapy Center, Dongguk University International Hospital, Goyang, Republic of Korea
| | - Young Wook Jeong
- Department of Psychiatry and Electroconvulsive Therapy Center, Dongguk University International Hospital, Goyang, Republic of Korea
| | - Yong Sik Kim
- Department of Psychiatry and Electroconvulsive Therapy Center, Dongguk University International Hospital, Goyang, Republic of Korea.,Institute of Clinical Psychopharmacology, Dongguk University College of Medicine, Goyang, Republic of Korea
| | - In Won Chung
- Department of Psychiatry and Electroconvulsive Therapy Center, Dongguk University International Hospital, Goyang, Republic of Korea.,Institute of Clinical Psychopharmacology, Dongguk University College of Medicine, Goyang, Republic of Korea
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Weiss A, Hussain S, Ng B, Sarma S, Tiller J, Waite S, Loo C. Royal Australian and New Zealand College of Psychiatrists professional practice guidelines for the administration of electroconvulsive therapy. Aust N Z J Psychiatry 2019; 53:609-623. [PMID: 30966782 DOI: 10.1177/0004867419839139] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To provide guidance for the optimal administration of electroconvulsive therapy, in particular maintaining the high efficacy of electroconvulsive therapy while minimising cognitive side-effects, based on scientific evidence and supplemented by expert clinical consensus. METHODS Articles and information were sourced from existing guidelines and the published literature. Information was revised and discussed by members of the working group of the Royal Australian and New Zealand College of Psychiatrists' Section for Electroconvulsive Therapy and Neurostimulation, and findings were then formulated into consensus-based recommendations and guidance. The guidelines were subjected to rigorous successive consultation and external review within the Royal Australian and New Zealand College of Psychiatrists, involving the full Section for Electroconvulsive Therapy and Neurostimulation membership, and expert and clinical advisors and professional bodies with an interest in electroconvulsive therapy administration. RESULTS The Royal Australian and New Zealand College of Psychiatrists' professional practice guidelines for the administration of electroconvulsive therapy provide up-to-date advice regarding the use of electroconvulsive therapy in clinical practice and are informed by evidence and clinical experience. The guidelines are intended for use by psychiatrists and also others with an interest in the administration of electroconvulsive therapy. The guidelines are not intended as a directive about clinical practice or instructions as to what must be done for a given patient, but provide guidance to facilitate best practice to help optimise outcomes for patients. The outcome is guidelines that strive to find the appropriate balance between promoting best evidence-based practice and acknowledging that electroconvulsive therapy is a continually evolving practice. CONCLUSION The guidelines provide up-to-date advice for psychiatrists to promote optimal standards of electroconvulsive therapy practice.
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Affiliation(s)
- Alan Weiss
- 1 School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Australia, Callaghan, NSW, Australia
| | - Salam Hussain
- 2 School of Psychiatry, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
- 3 Sir Charles Gairdner Hospital Mental Health Service, Perth, WA, Australia
| | - Bradley Ng
- 4 Mental Health and Specialist Services, Robina Hospital, Robina, QLD, Australia
| | - Shanthi Sarma
- 5 Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - John Tiller
- 6 Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
- 7 Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, VIC, Australia
| | - Susan Waite
- 8 Department of Mental Health Services, The Queen Elizabeth Hospital, Adelaide, SA, Australia
- 9 Discipline of Psychiatry, The University of Adelaide, Adelaide, SA, Australia
| | - Colleen Loo
- 10 School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
- 11 Sydney Neurostimulation Centre, Black Dog Institute, Randwick, NSW, Australia
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13
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Kaster TS, Downar J, Vila-Rodriguez F, Thorpe KE, Feffer K, Noda Y, Giacobbe P, Knyahnytska Y, Kennedy SH, Lam RW, Daskalakis ZJ, Blumberger DM. Trajectories of Response to Dorsolateral Prefrontal rTMS in Major Depression: A THREE-D Study. Am J Psychiatry 2019; 176:367-375. [PMID: 30764649 DOI: 10.1176/appi.ajp.2018.18091096] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for refractory major depressive disorder, yet no studies have characterized trajectories of rTMS response. The aim of this study was to characterize response trajectories for patients with major depression undergoing left dorsolateral prefrontal cortex rTMS and to determine associated baseline clinical characteristics. METHODS This was a secondary analysis of a randomized noninferiority trial (N=388) comparing conventional 10-Hz rTMS and intermittent theta burst stimulation (iTBS) rTMS. Participants were adult outpatients who had a primary diagnosis of major depressive disorder, had a score ≥18 on the 17-item Hamilton Depression Rating Scale (HAM-D), and did not respond to one to three adequate antidepressant trials. Treatment was either conventional 10-Hz rTMS or iTBS rTMS applied to the dorsolateral prefrontal cortex, 5 days/week over 4-6 weeks (20-30 sessions). Group-based trajectory modeling was applied to identify HAM-D response trajectories, and regression techniques were used to identify associated characteristics. RESULTS Four trajectories were identified: nonresponse (N=43, 11%); rapid response (N=73, 19%); higher baseline symptoms, linear response (N=118, 30%); and lower baseline symptoms, linear response (N=154, 40%). Significant differences in response and remission rates between trajectories were detectable by week 1. There was no association between treatment protocol and response trajectory. Higher baseline scores on the HAM-D and the Quick Inventory of Depression Symptomatology-Self-Report (QIDS-SR) were associated with the nonresponse trajectory, and older age, lower QIDS-SR score, and lack of benzodiazepine use were associated with the rapid response trajectory. CONCLUSIONS Major depression shows distinct response trajectories to rTMS, which are associated with baseline clinical characteristics but not treatment protocol. These response trajectories with differential response to rTMS raise the possibility of developing individualized treatment protocols.
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Affiliation(s)
- Tyler S Kaster
- The Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Kaster, Knyahnytska, Daskalakis, Blumberger); the Department of Psychiatry (Kaster, Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), the Institute of Medical Science (Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), and the Dalla Lana School of Public Health (Thorpe), University of Toronto, Toronto; the MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto (Downar); the Krembil Research Institute, University Health Network, Toronto (Downar, Kennedy); the Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez, Lam); the Non-Invasive Neurostimulation Therapies Laboratory, University of British Columbia, Vancouver (Vila-Rodriguez); the Shalvata Mental Health Center, Hod-Hasharon, Israel, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv (Feffer); the Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo (Noda); the Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto (Giacobbe); and the Li Ka Shing Knowledge Institute, Saint Michael's Hospital, Toronto (Kennedy)
| | - Jonathan Downar
- The Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Kaster, Knyahnytska, Daskalakis, Blumberger); the Department of Psychiatry (Kaster, Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), the Institute of Medical Science (Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), and the Dalla Lana School of Public Health (Thorpe), University of Toronto, Toronto; the MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto (Downar); the Krembil Research Institute, University Health Network, Toronto (Downar, Kennedy); the Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez, Lam); the Non-Invasive Neurostimulation Therapies Laboratory, University of British Columbia, Vancouver (Vila-Rodriguez); the Shalvata Mental Health Center, Hod-Hasharon, Israel, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv (Feffer); the Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo (Noda); the Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto (Giacobbe); and the Li Ka Shing Knowledge Institute, Saint Michael's Hospital, Toronto (Kennedy)
| | - Fidel Vila-Rodriguez
- The Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Kaster, Knyahnytska, Daskalakis, Blumberger); the Department of Psychiatry (Kaster, Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), the Institute of Medical Science (Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), and the Dalla Lana School of Public Health (Thorpe), University of Toronto, Toronto; the MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto (Downar); the Krembil Research Institute, University Health Network, Toronto (Downar, Kennedy); the Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez, Lam); the Non-Invasive Neurostimulation Therapies Laboratory, University of British Columbia, Vancouver (Vila-Rodriguez); the Shalvata Mental Health Center, Hod-Hasharon, Israel, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv (Feffer); the Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo (Noda); the Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto (Giacobbe); and the Li Ka Shing Knowledge Institute, Saint Michael's Hospital, Toronto (Kennedy)
| | - Kevin E Thorpe
- The Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Kaster, Knyahnytska, Daskalakis, Blumberger); the Department of Psychiatry (Kaster, Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), the Institute of Medical Science (Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), and the Dalla Lana School of Public Health (Thorpe), University of Toronto, Toronto; the MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto (Downar); the Krembil Research Institute, University Health Network, Toronto (Downar, Kennedy); the Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez, Lam); the Non-Invasive Neurostimulation Therapies Laboratory, University of British Columbia, Vancouver (Vila-Rodriguez); the Shalvata Mental Health Center, Hod-Hasharon, Israel, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv (Feffer); the Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo (Noda); the Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto (Giacobbe); and the Li Ka Shing Knowledge Institute, Saint Michael's Hospital, Toronto (Kennedy)
| | - Kfir Feffer
- The Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Kaster, Knyahnytska, Daskalakis, Blumberger); the Department of Psychiatry (Kaster, Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), the Institute of Medical Science (Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), and the Dalla Lana School of Public Health (Thorpe), University of Toronto, Toronto; the MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto (Downar); the Krembil Research Institute, University Health Network, Toronto (Downar, Kennedy); the Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez, Lam); the Non-Invasive Neurostimulation Therapies Laboratory, University of British Columbia, Vancouver (Vila-Rodriguez); the Shalvata Mental Health Center, Hod-Hasharon, Israel, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv (Feffer); the Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo (Noda); the Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto (Giacobbe); and the Li Ka Shing Knowledge Institute, Saint Michael's Hospital, Toronto (Kennedy)
| | - Yoshihiro Noda
- The Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Kaster, Knyahnytska, Daskalakis, Blumberger); the Department of Psychiatry (Kaster, Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), the Institute of Medical Science (Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), and the Dalla Lana School of Public Health (Thorpe), University of Toronto, Toronto; the MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto (Downar); the Krembil Research Institute, University Health Network, Toronto (Downar, Kennedy); the Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez, Lam); the Non-Invasive Neurostimulation Therapies Laboratory, University of British Columbia, Vancouver (Vila-Rodriguez); the Shalvata Mental Health Center, Hod-Hasharon, Israel, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv (Feffer); the Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo (Noda); the Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto (Giacobbe); and the Li Ka Shing Knowledge Institute, Saint Michael's Hospital, Toronto (Kennedy)
| | - Peter Giacobbe
- The Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Kaster, Knyahnytska, Daskalakis, Blumberger); the Department of Psychiatry (Kaster, Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), the Institute of Medical Science (Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), and the Dalla Lana School of Public Health (Thorpe), University of Toronto, Toronto; the MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto (Downar); the Krembil Research Institute, University Health Network, Toronto (Downar, Kennedy); the Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez, Lam); the Non-Invasive Neurostimulation Therapies Laboratory, University of British Columbia, Vancouver (Vila-Rodriguez); the Shalvata Mental Health Center, Hod-Hasharon, Israel, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv (Feffer); the Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo (Noda); the Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto (Giacobbe); and the Li Ka Shing Knowledge Institute, Saint Michael's Hospital, Toronto (Kennedy)
| | - Yuliya Knyahnytska
- The Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Kaster, Knyahnytska, Daskalakis, Blumberger); the Department of Psychiatry (Kaster, Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), the Institute of Medical Science (Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), and the Dalla Lana School of Public Health (Thorpe), University of Toronto, Toronto; the MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto (Downar); the Krembil Research Institute, University Health Network, Toronto (Downar, Kennedy); the Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez, Lam); the Non-Invasive Neurostimulation Therapies Laboratory, University of British Columbia, Vancouver (Vila-Rodriguez); the Shalvata Mental Health Center, Hod-Hasharon, Israel, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv (Feffer); the Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo (Noda); the Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto (Giacobbe); and the Li Ka Shing Knowledge Institute, Saint Michael's Hospital, Toronto (Kennedy)
| | - Sidney H Kennedy
- The Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Kaster, Knyahnytska, Daskalakis, Blumberger); the Department of Psychiatry (Kaster, Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), the Institute of Medical Science (Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), and the Dalla Lana School of Public Health (Thorpe), University of Toronto, Toronto; the MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto (Downar); the Krembil Research Institute, University Health Network, Toronto (Downar, Kennedy); the Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez, Lam); the Non-Invasive Neurostimulation Therapies Laboratory, University of British Columbia, Vancouver (Vila-Rodriguez); the Shalvata Mental Health Center, Hod-Hasharon, Israel, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv (Feffer); the Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo (Noda); the Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto (Giacobbe); and the Li Ka Shing Knowledge Institute, Saint Michael's Hospital, Toronto (Kennedy)
| | - Raymond W Lam
- The Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Kaster, Knyahnytska, Daskalakis, Blumberger); the Department of Psychiatry (Kaster, Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), the Institute of Medical Science (Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), and the Dalla Lana School of Public Health (Thorpe), University of Toronto, Toronto; the MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto (Downar); the Krembil Research Institute, University Health Network, Toronto (Downar, Kennedy); the Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez, Lam); the Non-Invasive Neurostimulation Therapies Laboratory, University of British Columbia, Vancouver (Vila-Rodriguez); the Shalvata Mental Health Center, Hod-Hasharon, Israel, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv (Feffer); the Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo (Noda); the Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto (Giacobbe); and the Li Ka Shing Knowledge Institute, Saint Michael's Hospital, Toronto (Kennedy)
| | - Zafiris J Daskalakis
- The Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Kaster, Knyahnytska, Daskalakis, Blumberger); the Department of Psychiatry (Kaster, Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), the Institute of Medical Science (Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), and the Dalla Lana School of Public Health (Thorpe), University of Toronto, Toronto; the MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto (Downar); the Krembil Research Institute, University Health Network, Toronto (Downar, Kennedy); the Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez, Lam); the Non-Invasive Neurostimulation Therapies Laboratory, University of British Columbia, Vancouver (Vila-Rodriguez); the Shalvata Mental Health Center, Hod-Hasharon, Israel, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv (Feffer); the Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo (Noda); the Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto (Giacobbe); and the Li Ka Shing Knowledge Institute, Saint Michael's Hospital, Toronto (Kennedy)
| | - Daniel M Blumberger
- The Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Kaster, Knyahnytska, Daskalakis, Blumberger); the Department of Psychiatry (Kaster, Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), the Institute of Medical Science (Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), and the Dalla Lana School of Public Health (Thorpe), University of Toronto, Toronto; the MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto (Downar); the Krembil Research Institute, University Health Network, Toronto (Downar, Kennedy); the Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez, Lam); the Non-Invasive Neurostimulation Therapies Laboratory, University of British Columbia, Vancouver (Vila-Rodriguez); the Shalvata Mental Health Center, Hod-Hasharon, Israel, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv (Feffer); the Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo (Noda); the Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto (Giacobbe); and the Li Ka Shing Knowledge Institute, Saint Michael's Hospital, Toronto (Kennedy)
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Asztalos M, Matzen P, Licht RW, Hessellund KB, Sartorius A, Nielsen RE. Delaying initiation of electroconvulsive treatment after administration of the anaesthetic agent and muscle relaxant reduces the necessity of re-stimulation. Nord J Psychiatry 2018; 72:341-346. [PMID: 29658395 DOI: 10.1080/08039488.2018.1459833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To investigate the effect of delaying initiation of electroconvulsive therapy (ECT) after administration of anaesthetic agent and muscle relaxant. METHODS A retrospective cohort study utilizing a case-based analysis comparing number of re-stimulations, length of seizures, number of ECTs per series and stimulation dosage before and after introducing a new treatment regimen. In 2013, ECT was initiated approximately 60-90 seconds after administration of thiopental and succinylcholine. This interval was increased to 120 seconds in 2014. Ninety-three patients were included (40 in 2013 and 53 in 2014). Outcome measures were length of seizure, number of re-stimulations, number of ECTs per series and stimulation dosage. Regression model analyses were conducted with entering year of treatment (2013 vs. 2014), sex and age as covariates. RESULTS We showed that a lowered frequency of re-stimulation was independently associated with the 2014 treatment regimen. No effect of treatment regimen on duration of seizures as measured clinically or by EEG, on number of treatments per series or on stimulation dosage was observed. CONCLUSIONS We found an association between an increased time interval from administration of thiopental and succinylcholine to ECT and a lowered risk of re-stimulations. The current study substantially strengthens the evidence on the benefits of delaying ECT after administration of anaesthetic agent and muscle relaxant.
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Affiliation(s)
- Márton Asztalos
- a Department of Psychiatry , Aalborg University Hospital , Aalborg , Denmark.,b School of PHD Studies , Semmelweis University , Budapest , Hungary
| | - Peter Matzen
- a Department of Psychiatry , Aalborg University Hospital , Aalborg , Denmark
| | - Rasmus W Licht
- a Department of Psychiatry , Aalborg University Hospital , Aalborg , Denmark.,c Department of Clinical Medicine , Aalborg University , Aalborg , Denmark
| | | | - Alexander Sartorius
- d Department of Psychiatry and Psychotherapy , Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, University of Heidelberg , Mannheim , Germany
| | - René Ernst Nielsen
- a Department of Psychiatry , Aalborg University Hospital , Aalborg , Denmark.,c Department of Clinical Medicine , Aalborg University , Aalborg , Denmark
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