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Sellevåg K, Bartz-Johannessen CA, Oedegaard KJ, Nordenskjöld A, Mohn C, Bjørke JS, Kessler U. Unmasking patient diversity: Exploring cognitive and antidepressive effects of electroconvulsive therapy. Eur Psychiatry 2024; 67:e12. [PMID: 38214065 DOI: 10.1192/j.eurpsy.2024.1] [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] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is an established treatment for depression, but more data on effectiveness and safety in clinical practice is needed. The aim of this register-based study was to investigate short-term effectiveness and cognitive safety after ECT, evaluated by clinicians and patients. Secondary, we investigated predictors for remission and cognitive decline. METHODS The study included 392 patients from the Regional Register for Neurostimulation Treatment in Western Norway. Depressive symptoms and cognitive function were assessed with Montgomery-Åsberg Depression Rating Scale and Mini-Mental State Examination (clinician-rated) and Beck Depression Inventory and Everyday Memory Questionnaire (patient-rated). Assessments were done prior to ECT-series and a mean of 1.7 days after (range 6 days before and 12 days after) end of ECT-series. Paired samples t-tests were extended by detailed, clinically relevant subgroups. Predictors were examined using logistic regression. RESULTS Clinician- and patient-rated remission rates were 49.5 and 41.0%, respectively. There was a large reduction in depressive symptoms and a small improvement in cognition after ECT, but we also identified subgroups with non-response of ECT in combination with cognitive decline (4.6% clinician-rated, 15.7% patient-rated). Positive predictors for patient- and clinician-rated remission were increasing age, shorter duration of depressive episode, and psychotic features. Antipsychotic medication at the commencement of treatment and previous ECT-treatment gave higher odds of clinician-rated remission, whereas higher pretreatment subjective depression level was associated with lower odds for patient-rated remission. Clinician-rated cognitive decline was predicted by higher pretreatment MMSE scores, whereas psychotic features, increasing age, and greater pretreatment subjective memory concerns were associated with lower odds for patient-rated cognitive decline. CONCLUSIONS Our study supports ECT as an effective and safe treatment, although subgroups have a less favorable outcome. ECT should be considered at an early stage for older patients suffering from depression with psychotic features. Providing comprehensive and balanced information from clinicians and patients perspectives on effects and side effects, may assist in a joint consent process.
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Affiliation(s)
- Kjersti Sellevåg
- NKS Olaviken Gerontopsychiatric Hospital, Askøy, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christoffer A Bartz-Johannessen
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ketil J Oedegaard
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Axel Nordenskjöld
- The University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Christine Mohn
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- National Centre for Suicide Research and Prevention (NSSF), Department of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jeanette S Bjørke
- Psychiatric Division, Stavanger University Hospital, Stavanger, Norway
| | - Ute Kessler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Adachi R, Yang C. Electroconvulsive Therapy for Traumatic Brain Injury and Schizoaffective Disorder. Cureus 2021; 13:e16390. [PMID: 34408943 PMCID: PMC8362861 DOI: 10.7759/cureus.16390] [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] [Accepted: 07/14/2021] [Indexed: 11/05/2022] Open
Abstract
Traumatic brain injury (TBI) is a source of disability and mortality with high rates of psychiatric disorders. Patients with comorbid TBI and psychiatric disorders may be safely treated with electroconvulsive therapy (ECT). In this case report, we present a 34-year-old man with the diagnosis of major neurocognitive disorder due to traumatic brain injury and schizoaffective disorder, bipolar type. He received an index course of 19 ECT treatments with clinical improvements in his psychosis, mood, and cognition. This case may support the utilization of ECT for patients with comorbid TBI and schizoaffective disorder.
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Affiliation(s)
- Ryan Adachi
- College of Osteopathic Medicine, Touro University California, Vallejo, USA
| | - Chong Yang
- Psychiatry, California Department of State Hospitals, Napa, USA
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Li H, Cui L, Li J, Liu Y, Chen Y. Comparative efficacy and acceptability of neuromodulation procedures in the treatment of treatment-resistant depression: a network meta-analysis of randomized controlled trials. J Affect Disord 2021; 287:115-124. [PMID: 33780827 DOI: 10.1016/j.jad.2021.03.019] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Nearly half of the patients with depression experience suboptimal benefits from antidepressants. Neuromodulation therapies, a kind of technology that can regulate neuronal firing activity by electrical or magnetic stimulation, were introduced to improve this situation. However, the results from clinical trials have been inconsistent. METHODS We followed the extension of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to perform this network meta-analysis (NMA). The results were evaluated by relative risk (RR) for the response, remission, and discontinuation rates. RESULTS In total, 49 trials with 2,941 patients were included in this study. Bilateral theta burst stimulation (TBS, RR 5.00, 95% CI 1.11-22.44), priming transcranial magnetic stimulation (pTMS, RR 2.97, 95% CI 1.20-7.39), low-frequency right repetitive transcranial magnetic stimulation (TMS) (LFR-rTMS, RR 2.62, 95% CI 1.56-4.39), high-frequency left repetitive TMS (HFL-rTMS, RR 2.18, 95% CI 1.52-3.13), and bilateral repetitive TMS (BL-rTMS, RR 3.08, 95% CI 1.78-5.31) were demonstrated to have higher response rates than sham control. BL-rTMS (RR 3.12, 95% CI 1.06-9.09) was found to have a higher response rate than deep brain stimulation in this NMA. All measures had the non-inferiority acceptability than the sham-control. BL-rTMS was more acceptable than bitemporal ECT (BT-ECT, RR 0.18, 95% CI 0.03-0.89), while pTMS was more acceptable than BT-ECT (RR 0.08, 95% CI 0.01-0.55), HFL-rTMS (RR 0.34, 95% CI 0.12-0.93), and deep TMS (RR 0.15, 95% CI 0.02-0.96). CONCLUSION Besides electroconvulsive therapy (ECT), rTMS, priming TMS, and bilateral TBS proved effective for patients with treatment-resistant depression (TRD). BL-rTMS showed high efficacy and acceptability, and bilateral TBS had the potential to be the most efficacious neuromodulation measures.
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Affiliation(s)
- Hao Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No.58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Liqian Cui
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No.58 Zhongshan Road 2, Guangzhou, 510080, China.
| | - Jinbiao Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No.58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Yueheng Liu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Chinese National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, China
| | - Yue Chen
- The eighth Hospital Affiliated, Sun Yat-sen University, Shenzhen, 518101, Guangdong, China
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Gbyl K, Støttrup MM, Mitta Raghava J, Xue Jie S, Videbech P. Hippocampal volume and memory impairment after electroconvulsive therapy in patients with depression. Acta Psychiatr Scand 2021; 143:238-252. [PMID: 33251575 DOI: 10.1111/acps.13259] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/21/2020] [Accepted: 11/23/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Patients hesitate to consent to electroconvulsive therapy (ECT) because of the fear of memory impairment. The mechanisms underlying this impairment are unclear, but several observations suggest hippocampal alterations may be involved. We investigated whether ECT-induced change in hippocampal volume correlates with memory impairment. METHODS Using a 3 T MRI scanner, we acquired brain images and assessed cognitive performance in 22 severely depressed patients at three time points: (1) before ECT series, (2) within one week after the series, and (3) at six-month follow-up. The hippocampus was segmented into subregions using FreeSurfer. The dentate gyri (DG) were the primary regions of interest (ROIs) and major hippocampal subregions secondary ROIs. Cognitive performance was assessed using the Screen for Cognitive Impairment in Psychiatry and verbal memory using the Verbal Learning subtest. The linear mixed model and the repeated-measures correlation were used for statistical analyses. RESULTS ECT induced an increase in the right and left DG volume with co-occurring worsening in verbal memory, and these changes were within-patients negatively correlated (right DG, rrm = -0.85, df = 18, p = 0.0000002; left DG, rrm = -0.58, df = 18, p = 0.008). At a six-month follow-up, the volume of both DG decreased with a co-occurring improvement in verbal memory, and these changes were negatively correlated in the right DG (rrm = -0.64, df = 15, p = 0.005). Volume increases in 14 secondary ROIs were also negatively correlated with memory impairment. CONCLUSION ECT-related transient increases in the volume of major hippocampal subregions within-patients are associated with memory impairment. Hippocampal alterations following ECT should be the focus in searching for causes of the cognitive side effects.
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Affiliation(s)
- Krzysztof Gbyl
- Center for Neuropsychiatric Depression Research, Psychiatric Center Glostrup, Glostrup, Denmark
| | - Mette Marie Støttrup
- Center for Neuropsychiatric Depression Research, Psychiatric Center Glostrup, Glostrup, Denmark
| | - Jayachandra Mitta Raghava
- Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Psychiatric Center Glostrup, Glostrup, Denmark.,Functional Imaging Unit, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Glostrup, Denmark
| | - Song Xue Jie
- Department of Clinical Psychiatry, Psychiatric Center Glostrup, Glostrup, Denmark
| | - Poul Videbech
- Center for Neuropsychiatric Depression Research, Psychiatric Center Glostrup, Glostrup, Denmark
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Kellner CH, Obbels J, Sienaert P. When to consider electroconvulsive therapy (ECT). Acta Psychiatr Scand 2020; 141:304-315. [PMID: 31774547 DOI: 10.1111/acps.13134] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To familiarize the reader with the role of electroconvulsive therapy (ECT) in current psychiatric medicine. METHOD We review clinical indications for ECT, patient selection, contemporary ECT practice, maintenance treatment and ECT in major treatment guidelines. RESULTS ECT is underutilized largely due to persisting stigma and lack of knowledge about modern ECT technique. CONCLUSION ECT remains a vital treatment for patients with severe mood disorders, psychotic illness and catatonia.
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Affiliation(s)
- C H Kellner
- New York Community Hospital, Brooklyn, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Obbels
- Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center, KU Leuven (Catholic University of Leuven), Kortenberg, Belgium
| | - P Sienaert
- Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center, KU Leuven (Catholic University of Leuven), Kortenberg, Belgium
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Decreasing Treatment Duration of Electroconvulsive Therapy (ECT) Using Daily Right Unilateral Ultrabrief Instead of Bitemporal ECT. J Psychiatr Pract 2018; 24:410-415. [PMID: 30395548 DOI: 10.1097/pra.0000000000000346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is an effective treatment for depression, but the standard 2 to 3 times weekly treatment course results in a total treatment duration of >2 weeks. We explored the viability of decreasing treatment duration by using daily right unilateral ultrabrief (RULUB) ECT instead of standard bitemporal (BT) ECT. METHODS This study involved a retrospective review of records of inpatients 18 to 64 years of age who were treated between 2012 and 2017 at a large tertiary ECT center. Lead placement/technique, treatment duration (days from first to last ECT), number of ECT treatments, and scores on the Patient Health Questionnaire-9 (PHQ-9), and the Hamilton Depression Rating Scale (HamD-24) were collected. Statistical analysis was performed using 1-way analysis of variance and t tests. RESULTS Of 214 patients, 112 started daily RULUB ECT (86 were completers and 26 were eventually switched to BT), and 83 started and completed BT ECT. Daily RULUB completers finished their course of ECT 6.5 days faster than those who received BT ECT (11.7 vs. 18.2 d, P<0.0001), while the number of ECT treatments did not significantly differ between the 2 groups (daily RULUB 8.6 treatments vs. BT 8.3 treatments, P=0.4402). There were no significant differences in the final PHQ-9 or HamD-24 depression scores between the 2 groups. One case of significant cognitive impairment was observed in the daily RULUB group. CONCLUSIONS Daily RULUB ECT compared with BT ECT allowed depression to be treated faster and with similar efficacy. Randomized controlled trials, which include the use of formal cognitive and physical side effect measures, are needed to further explore the viability of daily RULUB ECT.
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Choi J, Wang Y, Feng T, Prudic J. Cognitive training to improve memory in individuals undergoing electroconvulsive therapy: Negative findings. J Psychiatr Res 2017; 92:8-14. [PMID: 28376409 PMCID: PMC5827964 DOI: 10.1016/j.jpsychires.2017.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 03/21/2017] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
Abstract
Although electroconvulsive therapy (ECT) remains the most effective treatment for severe depression, some patients report persistent memory problems following ECT that impact their quality of life and their willingness to consent to further ECT. While cognitive training has been shown to improve memory performance in various conditions, this approach has never been applied to help patients regain their memory after ECT. In a double-blind study, we tested the efficacy of a new cognitive training program called Memory Training for ECT (Mem-ECT), specifically designed to target anterograde and retrograde memory that can be compromised following ECT. Fifty-nine patients with treatment-resistant depression scheduled to undergo ultra-brief right unilateral ECT were randomly assigned to either: (a) Mem-ECT, (b) active control comprised of nonspecific mental stimulation, or (c) treatment as usual. Participants were evaluated within one week prior to the start of ECT and then again within 2 weeks following the last ECT session. All three groups improved in global function, quality of life, depression, and self-reported memory abilities without significant group differences. While there was a decline in verbal delayed recall and mental status, there was no decline in general retrograde memory or autobiographical memory in any of the groups, with no significant memory or clinical benefit for the Mem-ECT or active control conditions compared to treatment as usual. While we report negative findings, these results continue to promote the much needed discussion on developing effective strategies to minimize the adverse memory side effects of ECT, in hopes it will make ECT a better and more easily tolerated treatment for patients with severe depression who need this therapeutic option.
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Affiliation(s)
- Jimmy Choi
- Olin Neuropsychiatry Research Center, The Institute of Living at Hartford Hospital, 200 Retreat Ave, Hartford, CT, USA.
| | - Yuanjia Wang
- Columbia Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center, NY USA,Department of Biostatistics, Mailman School of Public Health, Columbia University, NY USA,Division of Biostatistics, New York State Psychiatric Institute, NY USA
| | - Tianshu Feng
- Division of Biostatistics, New York State Psychiatric Institute, NY USA
| | - Joan Prudic
- Columbia Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center, NY USA,Division of Experimental Therapeutics, New York State Psychiatric Institute, 1051 Riverside Drive, NY 10032 USA
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