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Li B, Zhao N, Tang N, Friston KJ, Zhai W, Wu D, Liu J, Chen Y, Min Y, Qiao Y, Liu W, Shu W, Liu M, Zhou P, Guo L, Qi S, Cui LB, Wang H. Targeting suicidal ideation in major depressive disorder with MRI-navigated Stanford accelerated intelligent neuromodulation therapy. Transl Psychiatry 2024; 14:21. [PMID: 38199983 PMCID: PMC10781692 DOI: 10.1038/s41398-023-02707-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/16/2023] [Accepted: 12/07/2023] [Indexed: 01/12/2024] Open
Abstract
High suicide risk represents a serious problem in patients with major depressive disorder (MDD), yet treatment options that could safely and rapidly ameliorate suicidal ideation remain elusive. Here, we tested the feasibility and preliminary efficacy of the Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) in reducing suicidal ideation in patients with MDD. Thirty-two MDD patients with moderate to severe suicidal ideation participated in the current study. Suicidal ideation and depression symptoms were assessed before and after 5 days of open-label SAINT. The neural pathways supporting rapid-acting antidepressant and suicide prevention effects were identified with dynamic causal modelling based on resting-state functional magnetic resonance imaging. We found that 5 days of SAINT effectively alleviated suicidal ideation in patients with MDD with a high response rate of 65.63%. Moreover, the response rates achieved 78.13% and 90.63% with 2 weeks and 4 weeks after SAINT, respectively. In addition, we found that the suicide prevention effects of SAINT were associated with the effective connectivity involving the insula and hippocampus, while the antidepressant effects were related to connections of the subgenual anterior cingulate cortex (sgACC). These results show that SAINT is a rapid-acting and effective way to reduce suicidal ideation. Our findings further suggest that distinct neural mechanisms may contribute to the rapid-acting effects on the relief of suicidal ideation and depression, respectively.
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Affiliation(s)
- Baojuan Li
- School of Biomedical Engineering, Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Na Zhao
- Center for Cognition and Brain Disorders, the Affiliated Hospital of Hangzhou Normal University, 310015, Hangzhou, Zhejiang, China
- Institute of Psychological Sciences, Hangzhou Normal University, 311121, Hangzhou, Zhejiang, China
- Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, 310015, Hangzhou, Zhejiang, China
| | - Nailong Tang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
- Department of Psychiatry, 907 Hospital of Joint Logistics Team, 353000, Nanping, Fujian, China
| | - Karl J Friston
- The Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, WC1N 3AR, UK
| | - Wensheng Zhai
- School of Biomedical Engineering, Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Di Wu
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
| | - Junchang Liu
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
| | - Yihuan Chen
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
| | - Yan Min
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
| | - Yuting Qiao
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
| | - Wenming Liu
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
| | - Wanqing Shu
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
| | - Min Liu
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
| | - Ping Zhou
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
| | - Li Guo
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
| | - Shun Qi
- Brain Modulation and Scientific Research Center, 710043, Xi'an, China
- Neuromodulation Lab of Brain Science and Humanoid Intelligence Research Center, Xi'an Jiaotong University, 710049, Xi'an, China
| | - Long-Biao Cui
- Shaanxi Provincial Key Laboratory of Clinic Genetics, Fourth Military Medical University, 710032, Xi'an, China.
- Department of Radiology, The Second Medical Center, Chinese PLA General Hospital, 100856, Beijing, China.
| | - Huaning Wang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China.
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Su Y, Ye C, Xin Q, Si T. Major depressive disorder with suicidal ideation or behavior in Chinese population: A scoping review of current evidence on disease assessment, burden, treatment and risk factors. J Affect Disord 2023; 340:732-742. [PMID: 37619652 DOI: 10.1016/j.jad.2023.08.106] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/28/2023] [Accepted: 08/21/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Identifying and managing major depressive disorder (MDD) patients with suicidal ideation or behavior (MDSI) is critical for reducing the disease burden. This scoping review aims to map the existing evidence related to MDSI in the Chinese population. METHOD A scoping review was conducted to summarize the published evidence regarding epidemiology or disease burden, evaluation, diagnosis, management, and prognosis of MDSI. The search strategy imposed restriction on English or Chinese publications between 1 January 2011 and 28 February 2022. RESULTS Of the 14,005 identified records, 133 met the eligibility criteria and were included for analysis. The included studies were characterized as high heterogeneity in evaluation of suicidal ideation or behavior. Compared with MDD patients without suicidal ideation or behavior, MDSI patients were more likely to suffer from psychological and somatic symptoms, social function impairment, and lower quality of life. Younger age, female gender, longer disease course, and comorbid psychological or physical symptoms were consistently found to be risk factors of suicidal ideation or behavior. Relevant research gaps remain regarding comprehensive evaluation of standard clinical diagnosis, disease burden, social-cultural risk factors, and effectiveness of interventions targeting MDSI. Studies with large sample size, representative population are warranted to provide high-quality evidence. CONCLUSIONS MDD patients with suicidal ideation or behavior should be prioritized in treatment and resource allocation. Heterogeneity exists in the definition and evaluation of MDSI in different studies. To better inform clinical practice, it is imperative to establish a unified standard for evaluation and diagnosis of suicidal ideation or behavior among MDD population.
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Affiliation(s)
- Yun'Ai Su
- Peking University Sixth Hospital, Beijing, China; Peking University Institute of Mental Health, Beijing, China; NHC Key Laboratory of Mental Health (Peking University), Beijing, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Chong Ye
- Xi'an Janssen Pharmaceutical Ltd, Beijing, China
| | - Qin Xin
- Xi'an Janssen Pharmaceutical Ltd, Beijing, China
| | - Tianmei Si
- Peking University Sixth Hospital, Beijing, China; Peking University Institute of Mental Health, Beijing, China; NHC Key Laboratory of Mental Health (Peking University), Beijing, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
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Li H, Hou L, Wang D, Wu Q, Li H, He W, Li S, Pang J, Zhang Y, Ma Q, Li C, Cheng J. Response rate and safety of antidepressants combined with electroconvulsive therapy in adolescent depression: Real-world clinical application. J Affect Disord 2023; 339:98-103. [PMID: 37390926 DOI: 10.1016/j.jad.2023.06.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/25/2023] [Accepted: 06/26/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND METHODS: This study included 210 depression patients receiving antidepressants and ECT. The symptoms of depression were examined with the Hamilton Depression Scale (HAMD) and Clinical Global Impressions Scale (CGI) at baseline and the end of treatment. Response and safety were compared among adolescent and adult patients. RESULTS For adolescents, the response rate (much improved or very much improved) was 80.9 %, and CGI-Severity (CGI-S), HAMD, and suicide factor scores were significantly changed as compared to baseline (P < 0.001), results of which were similar to the adult group. There were no significant differences in HAMD, CGI scores between adolescent and adult depression before or after treatment (P > 0.05). Notably, adolescents expressed stronger suicidal intent than adults, and ECT observably relieved it. Side effects (memory problems, headache, nausea/vomiting, muscle soreness) in adolescents were not statistically different from those in adults (P > 0.05). LIMITATIONS As data were derived from a single center, the generalizability of results may be limited, and the potential factors affecting the efficacy of ECT were not further explored. CONCLUSION Antidepressants combined with ECT are associated with high response rate and safety for treating depression, regardless of age. A stronger expression of suicide ideation was observed in depressed adolescents, and side effects of ECT were similar to the adults.
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Affiliation(s)
- Hong Li
- Department of Psychiatry, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
| | - Lingzhi Hou
- Department of Psychiatry, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Dong Wang
- Department of Geriatric Psychiatry, Suzhou Mental Health Center, Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou 215000, China
| | - Qijin Wu
- Department of Psychiatry, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Haijin Li
- Department of Psychiatry, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Wen He
- Department of Psychiatry, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Sheng Li
- Department of Psychiatry, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Jianyue Pang
- Department of Psychiatry, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Yanyan Zhang
- Department of Psychiatry, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Quangang Ma
- Department of Psychiatry, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Cai Li
- Department of Pharmacy, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou 450052, China.
| | - Jun Cheng
- Department of Psychiatry, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
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Sienaert P, Brus O, Lambrichts S, Lundberg J, Nordanskog P, Obbels J, Verspecht S, Vansteelandt K, Nordenskjöld A. Suicidal ideation and ECT, ECT and suicidal ideation: A register study. Acta Psychiatr Scand 2022; 146:74-84. [PMID: 35279825 PMCID: PMC9313798 DOI: 10.1111/acps.13425] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Although electroconvulsive therapy (ECT) is anti-suicidal, it is not known whether the presence of suicidal ideation (SI) at baseline predicts response and remission after ECT. The aim of the study was to analyze the impact of baseline SI on response and remission following ECT treatment in a large sample of patients with depression and to assess SI before and after ECT. METHODS This population-based register study used data from the Swedish National Quality Register for ECT and the Swedish Patient Register. Patients aged 18 years or older who had received ECT for a unipolar or bipolar depressive episode between 2011 and 2018 were included in the study. SI was defined as a score of ≥4 on the last item of the Montgomery-Åsberg Depression Rating Scale - Self Assessment (MADRS-S). Using a logistic regression model, SI at baseline was used to predict response and remission following ECT, while controlling for depression severity, psychotic symptoms, presence of a comorbid personality disorder, age, sex, electrode position, unipolar or bipolar disorder, and number of previous suicide attempts at baseline. RESULTS In patients who exhibited SI at baseline, 53.7% (N = 632) of cases showed a response to ECT, whereas 68.4% (N = 690) of patients without SI showed a response. In addition, 27.2% (N = 320) of cases with SI achieved remission, whereas 48.5% (N = 489) of cases without SI achieved remission. The odds of achieving response and remission for patients with SI were 0.75 and 0.58 times, respectively, those for patients without SI. Of the 1178 patients with pre-treatment SI, 75.64% (N = 891) exhibited no SI at the end of treatment. Moreover, in this subgroup, the presence of a personality disorder, higher MADRS-S-score, and younger age were associated with persistent SI. CONCLUSION The presence of SI was associated with lower ECT response and remission rates. Nevertheless, depressive symptoms and SI were reduced in a large proportion of patients across both patient groups. Clinicians should be aware of the lower likelihood of achieving a successful outcome following ECT in younger patients who present with a non-psychotic depressive episode, SI, and (suspected) personality disorders. More research is warranted regarding if these patients can achieve similar or better results with other treatments.
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Affiliation(s)
- Pascal Sienaert
- Department of NeurosciencesUniversity Psychiatric Center KU Leuven and Research Group PsychiatryAcademic Center for ECT and Neuromodulation (AcCENT)Faculty of MedicineUniversity of LeuvenLeuvenBelgium
| | - Ole Brus
- Clinical Epidemiology and BiostatisticsFaculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| | - Simon Lambrichts
- Department of NeurosciencesUniversity Psychiatric Center KU Leuven and Research Group PsychiatryAcademic Center for ECT and Neuromodulation (AcCENT)Faculty of MedicineUniversity of LeuvenLeuvenBelgium
| | - Johan Lundberg
- Department of Clinical NeuroscienceCenter for Psychiatry ResearchKarolinska Institute and Stockholm County CouncilSweden
| | - Pia Nordanskog
- Center for Social and Affective NeuroscienceDepartment of Clinical and Experimental MedicineFaculty of Health SciencesLinköping University and Department of PsychiatryRegion ÖstergötlandSweden
| | - Jasmien Obbels
- Department of NeurosciencesUniversity Psychiatric Center KU Leuven and Research Group PsychiatryAcademic Center for ECT and Neuromodulation (AcCENT)Faculty of MedicineUniversity of LeuvenLeuvenBelgium
| | - Shauni Verspecht
- Department of NeurosciencesUniversity Psychiatric Center KU Leuven and Research Group PsychiatryAcademic Center for ECT and Neuromodulation (AcCENT)Faculty of MedicineUniversity of LeuvenLeuvenBelgium
| | - Kristof Vansteelandt
- Department of NeurosciencesUniversity Psychiatric Center KU Leuven and Research Group PsychiatryAcademic Center for ECT and Neuromodulation (AcCENT)Faculty of MedicineUniversity of LeuvenLeuvenBelgium
| | - Axel Nordenskjöld
- University Health Care Research CentreFaculty of Health and Medical SciencesÖrebro UniversityÖrebroSweden
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McCall WV. Editor's Roundup for Issue 2 of 2022: Relationship of Baseline Cognition and Ictal Electroencephalogram to Electroconvulsive Therapy Clinical Outcomes, and Encouraging Data That Intensive Transcranial Magnetic Stimulation May Relieve Suicidal Ideation. J ECT 2022; 38:69. [PMID: 35462385 DOI: 10.1097/yct.0000000000000855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- William V McCall
- From the Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA
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Park MJ, Kim H, Kim EJ, Yook V, Chung IW, Lee SM, Jeon HJ. Recent Updates on Electro-Convulsive Therapy in Patients with Depression. Psychiatry Investig 2021; 18:1-10. [PMID: 33321557 PMCID: PMC7897863 DOI: 10.30773/pi.2020.0350] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/03/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Electro-convulsive therapy (ECT) has been established as a treatment modality for patients with treatment-resistant depression and with some specific subtypes of depression. This narrative review intends to provide psychiatrists with the latest findings on the use of ECT in depression, devided into total eight sub-topics. METHODS We searched PubMed for English-language articles using combined keywords and tried to analyze journals published from 1995-2020. RESULTS Pharmacotherapy such as antidepressants or maintenance ECT is more effective than a placebo as prevention of recurrence after ECT. The use of ECT in treatment-resistant depression, depressed patients with suicidal risks, elderly depression, bipolar depression, psychotic depression, and depression during pregnancy or postpartum have therapeutic benefits. As possible mechanisms of ECT, the role of neurotransmitters such as serotonin, dopamine, gamma-aminobutyric acid (GABA), and other findings in the field of neurophysiology, neuro-immunology, and neurogenesis are also supported. CONCLUSION ECT is evolving toward reducing cognitive side effects and maximizing therapeutic effects. If robust evidence for ECT through randomized controlled studies are more established and the mechanism of ECT gets further clarified, the scope of its use in the treatment of depression will be more expanded in the future.
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Affiliation(s)
- Mi Jin Park
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyewon Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Ji Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Vidal Yook
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - In Won Chung
- Department of Psychiatry and Electroconvulsive Therapy Center, Dongguk University International Hospital, Goyang, Republic of Korea
| | - Sang Min Lee
- Department of Psychiatry, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Health Sciences & Technology, Department of Medical Device Management & Research, and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
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Editor's Roundup for Issue #4 of 2020: Racial Disparities in Access to Electroconvulsive Therapy, an Effective and Safe Treatment. J ECT 2020; 36:225. [PMID: 33122501 DOI: 10.1097/yct.0000000000000730] [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: 11/25/2022]
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