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Lin CH, Yang WC, Chan MH, Chen CC. The Relationship Between Depression and Pain During Acute Electroconvulsive Therapy and Follow-Up Period for Patients With Treatment-Resistant Depression. J ECT 2022; 38:192-199. [PMID: 35220359 DOI: 10.1097/yct.0000000000000830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We explored the relationships between depression and pain during acute electroconvulsive therapy (ECT) and the follow-up period for patients with treatment-resistant depression and concomitant pain. METHODS During the acute ECT phase, treatment-resistant depression patients (N = 97) were randomized to receive ECT plus agomelatine 50 mg/d, or ECT plus placebo. Depression and pain severities were measured using the 17-item Hamilton Depression Rating Scale (HAMD-17), and the pain subscale of the Depression and Somatic Symptoms Scale at baseline, after every 3 ECT treatments, and after acute ECT. If patients achieved response (ie, a ≥ 50 % reduction in HAMD-17) or received at least 6 ECT treatments, they were prescribed agomelatine 50 mg/d and participated in a 12-week follow-up trial. The HAMD-17 and pain subscale were assessed at 4-week intervals. Both HAMD-17 and pain subscale scores were converted to T score units to compare the degrees of changes between depression and pain during acute ECT and the follow-up period. RESULTS Eighty-two patients completing at least the first 3 ECT treatments entered the analysis. Both HAMD-17 and pain subscale decreased significantly after acute ECT. Changes of HAMD-17 T scores were significantly greater than changes of pain subscale T scores during acute ECT and follow-up period. CONCLUSIONS Pain changed more slowly than did depression while measuring both during acute ECT and the follow-up period. Pain can, therefore, be considered a separate entity from depression.
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Affiliation(s)
| | - Wei-Cheng Yang
- From the Kaohsiung Municipal Kai-Syuan Psychiatric Hospital
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Ferrier IN, Waite J, Sivasanker V. Recent advances in electroconvulsive therapy and physical treatments for depression. BJPSYCH ADVANCES 2021. [DOI: 10.1192/bja.2021.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
SUMMARYThis article gives an update for practitioners on recent developments in the use of electroconvulsive therapy (ECT) and related treatment modalities in the contemporary treatment of depression in the UK. Details are provided on new information on the efficacy and side-effects of ECT both in research studies and in the real world, together with recent research on ECT's mode of delivery. There is a focus on the safe administration of ECT in clinical practice. An update on the regulatory framework for ECT in the UK is provided, together with up-to-date information on the legal situation regarding its prescription. Finally, brief summaries of the current position for other neuromodulatory treatment modalities are given.
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Tsolaki E, Narr KL, Espinoza R, Wade B, Hellemann G, Kubicki A, Vasavada M, Njau S, Pouratian N. Subcallosal Cingulate Structural Connectivity Differs in Responders and Nonresponders to Electroconvulsive Therapy. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 6:10-19. [PMID: 32741703 DOI: 10.1016/j.bpsc.2020.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/21/2020] [Accepted: 05/24/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Subcallosal cingulate (SCC) activity is associated with treatment response in major depressive disorder (MDD). Using electroconvulsive therapy (ECT) as a treatment model in this exploratory study, we addressed whether pretreatment SCC structural connectivity with corticolimbic-striatal circuitry relates to therapeutic outcome and whether these connectivity patterns change with treatment. METHODS Diffusion magnetic resonance imaging scans were acquired in 43 patients with MDD (mean [SD] age = 41 [13] years; men/women: 18/25) before and within 1 week of completing an ECT index series and in 31 healthy control subjects scanned twice (mean [SD] age = 38 [11] years; men/women: 17/18). Probabilistic tractography from subject-specific anatomically defined SCC seed regions to the ventral striatum (VS), anterior cingulate cortex (ACC), and bilateral medial prefrontal cortex (mPFC) was used to estimate structural connectivity in the target network. RESULTS SCC-mPFC connectivity was lower in responders (>50% symptom improvement) than nonresponders both before (p < .014) (difference 37%-96% left and right hemispheres) and after (p = .023) (difference 100% right hemisphere) treatment. SCC-mPFC connectivity in responders was also decreased compared with control subjects both at baseline (p = .012) and after ECT (p = .006), whereas nonresponders had SCC-right mPFC connectivity similar to that of control subjects. Subjects with MDD also showed decreased SCC-ACC connectivity compared with control subjects (baseline: p < .003, after ECT: p = .001), although SCC-ACC connectivity did not distinguish responders from nonresponders. Bilateral SCC-VS connectivity decreased (11%) with ECT (p = .021) regardless of treatment response. CONCLUSIONS While SCC-ACC connectivity may be a hallmark of MDD compared with control subjects, lower pretreatment SCC-mPFC connectivity in ECT responders (compared with nonresponders and control subjects) suggests that connectivity in this pathway may serve as a potential biomarker of therapeutic outcome and be relevant for treatment selection.
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Affiliation(s)
- Evangelia Tsolaki
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California.
| | - Katherine L Narr
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California; Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, Los Angeles, California
| | - Randall Espinoza
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Benjamin Wade
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California; Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, Los Angeles, California
| | - Gerhard Hellemann
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Antoni Kubicki
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California; Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, Los Angeles, California
| | - Megha Vasavada
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California; Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, Los Angeles, California
| | - Stephanie Njau
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California; Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, Los Angeles, California
| | - Nader Pouratian
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California
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Risk Factors of Relapse After Successful Electroconvulsive Therapy for Taiwanese Patients With Major Depression. J ECT 2020; 36:106-110. [PMID: 31348115 DOI: 10.1097/yct.0000000000000619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Major depressive disorder is a recurrent illness. Treatment strategies are generally focused on achieving remission and preventing relapse/recurrence. The aim of this study was to explore the risk factors associated with relapse for remitted patients during the 12-week follow-up. METHODS This was an open-label trial for major depressive disorder patients receiving acute treatments with electroconvulsive therapy (ECT) and continuation medication in the 12-week follow-up. Symptom severity and psychosocial functioning were assessed using the 17-item Hamilton Rating Scale for Depression (HAMD-17) and the Work and Social Adjustment Scale at each visit. Remission was defined as a HAMD-17 of 7 or less after acute treatment. Relapse was defined as a HAMD-17 of 14 or greater. Subjects achieving remission after acute treatments were included for analysis. Survival analysis was used to investigate the factors associated with relapse. RESULTS Sixty patients receiving ECT for acute treatment were enrolled for 12-week follow-up. Using Cox regression analysis, a greater number of previous major depressive episodes and greater baseline Work and Social Adjustment Scale scores were significantly associated with shorter time to relapse. CONCLUSIONS The goal of acute treatment should focus on functional remission to prevent relapse. Further studies related to more effective treatments to prevent relapse after acute ECT are required in the future.
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Eisenberg DA, Miller CR, Reti IM, Martos N, Margolis RL. Electroconvulsive therapy in conjunction with concurrent radiation treatment for laryngeal cancer. Psychooncology 2019; 28:931-933. [DOI: 10.1002/pon.5022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/01/2019] [Accepted: 02/04/2019] [Indexed: 11/08/2022]
Affiliation(s)
- David A. Eisenberg
- Wright Center for Graduate Medical EducationGeisinger Commonwealth School of Medicine Scranton PA
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of Medicine Baltimore MD
| | - Cristina R. Miller
- Department of Anesthesiology/NeuroanesthesiologyJohns Hopkins University School of Medicine Baltimore MD
| | - Irving M. Reti
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of Medicine Baltimore MD
- Department of NeuroscienceJohns Hopkins University School of Medicine Baltimore MD
| | - Natalie Martos
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of Medicine Baltimore MD
| | - Russell L. Margolis
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of Medicine Baltimore MD
- Department of Neurology and Program in Molecular and Cellular MedicineJohns Hopkins University School of Medicine Baltimore MD
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