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Alves M, Durães D, Afonso P. Letter to the Editor concerning "Electroconvulsive therapy in the maintenance phase of psychotic unipolar depression". Acta Psychiatr Scand 2024; 150:245-246. [PMID: 38987925 DOI: 10.1111/acps.13732] [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] [Received: 06/25/2024] [Accepted: 06/29/2024] [Indexed: 07/12/2024]
Affiliation(s)
- Margarida Alves
- Department of Psychiatry and Mental Health, Setúbal Hospital Centre, Setúbal, Portugal
| | - Diana Durães
- Department of Psychiatry and Mental Health, Setúbal Hospital Centre, Setúbal, Portugal
| | - Pedro Afonso
- Department of Psychiatry and Mental Health, Setúbal Hospital Centre, Setúbal, Portugal
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Jørgensen A, Gronemann FH, Rozing MP, Jørgensen MB, Osler M. Clinical Outcomes of Continuation and Maintenance Electroconvulsive Therapy. JAMA Psychiatry 2024:2823669. [PMID: 39292447 PMCID: PMC11411446 DOI: 10.1001/jamapsychiatry.2024.2360] [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: 09/19/2024]
Abstract
Importance Large-scale evidence for the efficacy of continuation and maintenance electroconvulsive therapy (c/mECT) is lacking. Objective To provide an exhaustive and naturalistic insight into the real-world outcomes and the cost-effectiveness of c/mECT in a large dataset. Design, Setting, and Participants This cohort study included all patients in the Danish National Patient Registry who initiated treatment with ECT from 2003 through 2022. The data were analyzed from October 2023 to February 2024. Exposures ECT. An algorithm to identify c/mECTs in the dataset was developed: (>3 treatments with ≥7 and <90 days between adjacent treatments, occurring within a time frame of 180 days [cECT] or more [mECT] after an acute [aECT] series). Main Outcomes and Measures The association of c/mECT with subsequent 6- to 12-month risk of hospitalization or suicidal behavior using Cox proportional hazard regression with multiple adjustments and aECT only as a reference, propensity score matching, and self-controlled case series analysis using a Poisson regression model. A cost-effectiveness analysis based on hospitalization and ECT expenses was made. Results A total of 19 944 individuals were treated with ECT (12 157 women [61%], 7787 men [39%]; median [IQR] age, 55 [41-70] years). Of these, 1533 individuals (7.7%) received c/mECT at any time point (1017 [5.1%] cECT only and 516 [2.6%] mECT). Compared with patients receiving aECT only, c/mECT patients more frequently experienced schizophrenia (odds ratio [OR], 2.14; 95% CI, 1.86-2.46) and schizoaffective disorder (OR, 2.42; 95% CI, 1.90-3.09) and less frequently unipolar depression (OR, 0.56; 95% CI, 0.51-0.62). In all models, c/mECT was associated with a lower rate of hospitalization after finishing aECT (eg, 6-month adjusted hazard ratio, 0.68; 95% CI, 0.60-0.78 [Cox regression]; 6-month incidence rate ratio, 0.51; 95% CI, 0.41-0.62 [Poisson regression]). There was no significant difference in the risk of suicidal behavior. Compared with the periods before the end of aECT, c/mECT was associated with a substantial reduction in total treatment costs. Conclusions and Relevance In a nationwide and naturalistic setting, c/mECT after aECT was infrequently used but associated with a lower risk of readmission than aECT alone. The totality of the evidence indicates that c/mECT should be considered more often to prevent relapse after successful aECT in patients whose condition does not respond sufficiently to other interventions.
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Affiliation(s)
- Anders Jørgensen
- Psychiatric Center Copenhagen, Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Frederikke Hoerdam Gronemann
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Maarten P Rozing
- Psychiatric Center Copenhagen, Frederiksberg, Copenhagen, Denmark
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Martin B Jørgensen
- Psychiatric Center Copenhagen, Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Merete Osler
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Petrucci ABC, Fernandes JVA, Reis IA, da Silva GHS, Recla BMF, de Mendonça JC, Pedro VCS, D'Assunção LEN, Valiengo LDCL. Ketamine versus electroconvulsive therapy for major depressive episode: An updated systematic review and non-inferiority meta-analysis. Psychiatry Res 2024; 339:115994. [PMID: 38865906 DOI: 10.1016/j.psychres.2024.115994] [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: 02/06/2024] [Revised: 05/12/2024] [Accepted: 05/28/2024] [Indexed: 06/14/2024]
Abstract
We conducted a systematic review and meta-analysis to investigate the comparative effectiveness of ketamine versus electroconvulsive therapy (ECT) for the treatment of major depressive episodes (MDEs). PubMed, EMBASE and Cochrane Library databases were systematically searched for randomized controlled trials (RCTs) comparing ketamine and ECT for MDE. The primary outcome was response rate, for which we prespecified a non-inferiority margin of -0.1, based on the largest and most recent RCT. Response was defined as a reduction of at least 50 % in the depression scale score. Six RCTs met the inclusion criteria, comprising 655 patients. In the overall population, ketamine was not non-inferior to ECT in response rate (RD -0.10; 95 % CI -0.26 to 0.05; p = 0.198; I2 = 72 %). The ECT group had a higher reduction in depression scores, but without difference in remission and relapse rates. Regarding safety outcomes, ketamine had better posttreatment cognition scores and reduced muscle pain rate compared with ECT, albeit with an increased rate of dissociative symptoms. In a subanalysis with only inpatients, ketamine was inferior to ECT in response rate (RD -0.15; 95 % CI -0.27 to -0.03; p = 0.014; I2 = 25 %), remission, and change in depression scores. These findings support the use of ECT over ketamine for inpatients. Further RCTs are warranted to clarify the comparative effect of these treatments for outpatients.
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Affiliation(s)
- Arthur Bezerra Cavalcanti Petrucci
- Center of Medical Sciences, Federal University of Paraíba, University City, n/a, President Castelo Branco III. Complex, João Pessoa, Paraíba, Brazil
| | - João Vitor Andrade Fernandes
- Center of Medical Sciences, Federal University of Paraíba, University City, n/a, President Castelo Branco III. Complex, João Pessoa, Paraíba, Brazil
| | - Isabelle Albuquerque Reis
- Center of Medical Sciences, Federal University of Paraíba, University City, n/a, President Castelo Branco III. Complex, João Pessoa, Paraíba, Brazil
| | | | - Brenda Maria Folli Recla
- Multivix Vitória University Center, José Alves Street, 301, Goiabeiras, Vitória, Espírito Santo, Brazil
| | - Juliana Celga de Mendonça
- Multivix Vitória University Center, José Alves Street, 301, Goiabeiras, Vitória, Espírito Santo, Brazil
| | - Victória Carvalho Souto Pedro
- Center of Medical Sciences, Federal University of Paraíba, University City, n/a, President Castelo Branco III. Complex, João Pessoa, Paraíba, Brazil
| | - Luís Eduardo Negreiros D'Assunção
- Center of Medical Sciences, Federal University of Paraíba, University City, n/a, President Castelo Branco III. Complex, João Pessoa, Paraíba, Brazil
| | - Leandro da Costa Lane Valiengo
- Laboratory of Neurosciences (LIM-27), Institute of Psychiatry, University Hospital, University of São Paulo, Doctor Ovídio Pires de Campos Street, 785, Cerqueira César, São Paulo, São Paulo, Brazil.
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Liu HL, Sun J, Meng SF, Sun N. Physiotherapy for patients with depression: Recent research progress. World J Psychiatry 2024; 14:635-643. [PMID: 38808078 PMCID: PMC11129148 DOI: 10.5498/wjp.v14.i5.635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/15/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024] Open
Abstract
Depression, a common mental illness, seriously affects the health of individuals and has deleterious effects on society. The prevention and treatment of depression has drawn the attention of many researchers and has become an important social issue. The treatment strategies for depression include drugs, psychotherapy, and physiotherapy. Drug therapy is ineffective in some patients and psychotherapy has treatment limitations. As a reliable adjuvant therapy, physiotherapy compensates for the shortcomings of drug and psychotherapy and effectively reduces the disease recurrence rate. Physiotherapy is more scientific and rigorous, its methods are diverse, and to a certain extent, provides more choices for the treatment of depression. Physiotherapy can relieve symptoms in many ways, such as by improving the levels of neurobiochemical molecules, inhibiting the inflammatory response, regulating the neuroendocrine system, and increasing neuroplasticity. Physiotherapy has biological effects similar to those of antidepressants and may produce a superimposed impact when combined with other treatments. This article summarizes the findings on the use of physiotherapy to treat patients with depression over the past five years. It also discusses several methods of physiotherapy for treating depression from the aspects of clinical effect, mechanism of action, and disadvantages, thereby serving as a reference for the in-depth development of physiotherapy research.
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Affiliation(s)
- Hui-Ling Liu
- Department of Mental Health, First Clinical Medical College of Shanxi Medical University, Taiyuan 030000, Shanxi Province, China
- Department of Rehabilitation, First Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi Province, China
| | - Jing Sun
- Department of Rehabilitation, First Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi Province, China
| | - Shi-Feng Meng
- Department of Rehabilitation, First Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi Province, China
| | - Ning Sun
- Department of Mental Health, First Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi Province, China
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Li Y, Liu X. Efficacy and safety of non-invasive brain stimulation in combination with antidepressants in adolescents with depression: a systematic review and meta-analysis. Front Psychiatry 2024; 15:1288338. [PMID: 38426000 PMCID: PMC10902042 DOI: 10.3389/fpsyt.2024.1288338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
Objective Non-invasive brain stimulation (NIBS) is beneficial to adult patients with depression, but its safety and efficacy in combination with antidepressants in children and adolescents with depression are not clear. We conducted a preliminary meta-analysis to objectively evaluate its clinical effect and provide information for future research and clinical practice. Methods PubMed, Cochrane Library, Embase, and Web of Science were searched systematically to find clinical trials published in English before April 11, 2023. Stata software was used for meta-analysis, and random or fixed effect models were used to combine effect sizes. Results Nine studies were eligible and included (n = 393). No articles about children were included in the analysis. The results showed that the remission rate was 40% (95% confidence interval [CI]: 13% to 71%). The scores of Children's Depression Rating Scale (CRDS) and Hamilton's depression scale (HAMD) significantly decreased compared to baseline value (MD = -27.04, 95% CI: -30.95, -23.12 and MD = -12.78, 95% CI: -19.55 to -6.01). In addition, the incidence of all adverse events was 13% (95% CI: 5%, 23%), and all were minor pain-related events. Conclusion The combination of NIBS and antidepressants has been shown to notably alleviate depressive symptoms in adolescents, offering a considerable level of safety. This therapeutic synergy is particularly effective in patients with major depressive disorder, where repetitive transcranial magnetic stimulation augmented with antidepressants can enhance the amelioration of depressive symptoms. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023442215, PROSPERO CRD42023442215.
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Affiliation(s)
| | - Xiaoyan Liu
- Department of Psychiatry, Affiliated Mental Health Center & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Choudhary D, Kumar B, Kaur R. Nitrogen-containing heterocyclic compounds: A ray of hope in depression? Chem Biol Drug Des 2024; 103:e14479. [PMID: 38361139 DOI: 10.1111/cbdd.14479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/12/2024] [Accepted: 01/31/2024] [Indexed: 02/17/2024]
Abstract
Depression is not similar to daily mood fluctuations and temporary emotional responses to day-to-day activities. Depression is not a passing problem; it is an ongoing problem. It deals with different episodes consisting of several symptoms that last for at least 2 weeks. It can be seen for several weeks, months, or years. At its final stage, or can say, in its worst condition, it can lead to suicide. Antidepressants are used to inhibit the reuptake of the neurotransmitters by some selective receptors, which increase the concentration of specific neurotransmitters around the nerves in the brain. Drugs that are currently being used for the management of various types of depression include selective serotonin reuptake inhibitors, tricyclic antidepressants, atypical antidepressants, serotonin, noradrenaline reuptake inhibitors, etc. In this review, we have outlined different symptoms, causes, and recent advancements in nitrogen-containing heterocyclic drug candidates for the management of depression. This article highlights the various structural features along with the structure-activity relationship (SAR) of nitrogen-containing heterocyclics that play a key role in binding at target sites for potential antidepressant action. The in silico studies were carried out to determine the binding interactions of the target ligands with the receptor site to determine the potential role of substitution patterns at core pharmacophoric features. This article will help medicinal chemists, biochemists, and other interested researchers in identifying the potential pharmacophores as lead compounds for further development of new potent antidepressants.
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Affiliation(s)
- Diksha Choudhary
- Chitkara College of Pharmacy, Chitkara University, Rajpura, Punjab, India
| | - Bhupinder Kumar
- Department of Pharmaceutical Sciences, HNB Garhwal University, Chauras Campus, Srinagar, Uttarakhand, India
- Department of Chemistry, Graphic Era (Deemed to be University), Dehradun, Uttarakhand, India
| | - Rajwinder Kaur
- Chitkara College of Pharmacy, Chitkara University, Rajpura, Punjab, India
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Rowland T, Mann R, Azeem S. The Efficacy and Tolerability of Continuation and Maintenance Electroconvulsive Therapy for Depression: A Systematic Review of Randomized and Observational Studies. J ECT 2023; 39:141-150. [PMID: 36961277 DOI: 10.1097/yct.0000000000000914] [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: 03/25/2023]
Abstract
ABSTRACT Electroconvulsive therapy (ECT) is a highly effective treatment for severe and treatment-resistant depression, but relapse rates remain high despite maintenance pharmacotherapy. Continuation or maintenance ECT (C/M-ECT) offers the potential to prevent relapses in the most unwell patients, but there remains disagreement among guidelines regarding its efficacy and tolerability. This review aims to summarize and assess the current evidence for the efficacy and tolerability of continuation and maintenance ECT for depression, including data from randomized and observational studies, which included an appropriate control group. Twenty studies were found meeting inclusion criteria. There was evidence from 14 studies suggesting that relapse rates are reduced in those receiving C/M-ECT. There was evidence from 6 studies suggesting that C/M-ECT had no effect on global cognitive function. Detailed neuropsychological testing was limited, but within studies that assessed specific cognitive domains, there was not consistent evidence for deficits in C/M-ECT compared with the control group. The certainty of evidence across outcomes was low or very low because of inclusion of observational studies, heterogeneity of study design, and patient populations. The findings add further weight to evidence suggesting that C/M-ECT is a viable treatment option to prevent relapse in severe depression and provides clinicians with further evidence for the benefits and risks of C/M-ECT when discussing treatment options with patients. Future research should focus on randomized or well-designed prospective studies with sufficient follow-up to determine longer-term outcomes, while including a standardized, detailed neurocognitive battery to assess potential adverse effects.
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Affiliation(s)
| | - Roshani Mann
- From the Coventry and Warwickshire NHS Partnership Trust
| | - Samina Azeem
- From the Coventry and Warwickshire NHS Partnership Trust
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Luccarelli J, Henry ME, Smith F, Beach SR, McCoy TH. Changes in Inpatient Electroconvulsive Therapy Utilization Between 2019 and 2020: A National Inpatient Sample Analysis. J ECT 2023; 39:173-178. [PMID: 37027490 PMCID: PMC10514222 DOI: 10.1097/yct.0000000000000917] [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] [Indexed: 04/09/2023]
Abstract
OBJECTIVES Electroconvulsive therapy (ECT) is an essential procedure for a range of psychiatric conditions. Multiple single-center studies have documented reduction in ECT administration in 2020 because of the coronavirus disease 2019 pandemic, but there have been little nationally representative data from the United States. The aim of this study was to examine the demographics of patients receiving ECT in 2019 and 2020 and to characterize temporal and regional variations in ECT utilization. METHODS The 2019 and 2020 National Inpatient Sample, an administrative database of inpatient hospitalizations in the United States, was queried for hospitalizations involving the delivery of ECT based on procedural codes. Overall number of ECT procedures was calculated based on the overall number of ECT procedural claims. RESULTS In the 2019 NIS, 14,230 inpatient hospitalizations (95% confidence interval, 12,936-15,524) involved the use of ECT, with a cumulative 52,450 inpatient ECT procedures administered. In 2020, the number of inpatient hospitalizations with ECT decreased to 12,055 (95% confidence interval, 10,878-13,232), with a 10.0% reduction in overall procedures to 47,180. Whereas January and February ECT hospitalizations were comparable in both years, ECT hospitalizations decreased by more than 25% in March through May 2020 relative to 2019 volume. There was regional variability in the change in ECT utilization between 2019 and 2020. CONCLUSIONS Electroconvulsive therapy use among general hospital inpatients declined between 2019 and 2020, with regional variability in the magnitude of change. Further study is warranted into the root causes and optimal responses to these changes.
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Affiliation(s)
- James Luccarelli
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Michael E. Henry
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Felicia Smith
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Scott R. Beach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Thomas H. McCoy
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Yamazaki R, Matsuda Y, Oba M, Oi H, Kito S. Maintenance repetitive transcranial magnetic stimulation (rTMS) therapy for treatment-resistant depression: a study protocol of a multisite, prospective, non-randomized longitudinal study. BMC Psychiatry 2023; 23:437. [PMID: 37322460 PMCID: PMC10273734 DOI: 10.1186/s12888-023-04944-0] [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: 07/09/2022] [Accepted: 06/08/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is a widely used treatment for major depressive disorder (MDD), and its effectiveness in preventing relapse/recurrence of MDD has been explored. Although few small sample controlled studies exist, the protocols of maintenance rTMS therapy were heterogeneous and evidence of its effectiveness is not sufficient. Thus, this study aims to evaluate whether maintenance rTMS is effective in maintaining the treatment response in patients with MDD with a large sample size and feasible study design. METHODS In this multicenter open-labelled parallel-group trial we plan to recruit 300 patients with MDD who have responded or remitted to acute rTMS therapy. Participants would be classified into two groups according to their preference; the maintenance rTMS and pharmacotherapy group, and the pharmacotherapy only group. The protocol of maintenance rTMS therapy is once a week for the first six months and once biweekly for the second six months. The primary outcome is the relapse/recurrence rates during 12 months following enrollment. Other measures of depressive symptoms and recurrence/relapse rates at different time points are the secondary outcomes. The primary analysis is the between-group comparison adjusted for background factors using a logistic regression model. We will perform the group comparison with inverse probability of treatment weighting as the sensitivity analysis to ensure the comparability of the two groups. DISCUSSION We hypothesize that maintenance rTMS therapy could be an effective and safe treatment for preventing depressive relapse/recurrence. Considering the limitation of potential bias owing to the study design, we plan to use statistical approaches and external data to avoid overestimation of the efficacy. TRIAL REGISTRATION Japan Registry of Clinical Trials, ID: jRCT1032220048 . Registered 1 May 2022.
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Affiliation(s)
- Ryuichi Yamazaki
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuki Matsuda
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Mari Oba
- Department of Clinical Data Science, Clinical Research and Education Premotion Division, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hideki Oi
- Department of Clinical Data Science, Clinical Research and Education Premotion Division, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Shinsuke Kito
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan.
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-Machi, Kodaira-Shi, Tokyo, 1878551, Japan.
- Neuromodulation Therapy and Research Center, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.
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Grover S, Kathiravan S, Chakrabarti S. The clinical profile and outcome of patients receiving continuation electroconvulsive therapy (C-ECT): A retrospective study. Indian J Psychiatry 2023; 65:647-654. [PMID: 37485402 PMCID: PMC10358809 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_169_23] [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: 03/14/2023] [Revised: 04/23/2023] [Accepted: 05/23/2023] [Indexed: 07/25/2023] Open
Abstract
Background There is a lack of data on the use of continuation electroconvulsive therapy (C-ECT) from India. Objectives This study aimed to evaluate the clinical profile and outcome of patients receiving C-ECT. Materials and Methods The ECT register was used to identify patients receiving C-ECT (ECT after completion of an acute course, to maintain remission or prevent relapse) from 2011 to July 2022. Socio-demographic, clinical, and treatment outcome details were extracted from their treatment records. Results A total of 72 C-ECT courses were identified that were used in 60 patients. Out of all the patients receiving ECT, only 3.25% of patients receive C-ECT. The majority of the patients were male (60%). The mean age of the patients at the time of starting ECT was around 39 years. The most common diagnosis was schizophrenia (73.3%), followed by recurrent depressive disorder (21.6%). The most common indication was persistent psychotic symptoms poorly responding to multiple antipsychotic trials of 3.09 (SD: 1.39), including clozapine. These patients received a mean of 22.58 (SD: 8.05; range: 10 to 46) ECTs, with 10.0 (SD: 4.83) ECTs for the management of the acute phase of illness and 12.57 (SD: 6.20) ECTs as part of continuation treatment. The majority (61.1%) of the patients received four (once weekly) C-ECTs in the first month, followed by three more in the next month. However, 16 patients received weekly ECTs during the second month too, as symptoms worsened with the lowering of frequencies. Twelve patients received more than one C-ECT course. The majority of the patients maintained the improvement gained during the acute phase or showed further improvement with C-ECT along with ongoing pharmacotherapy as rated on appropriate scales. The Clinical Global Impressions-Severity (CGI-S) difference before and after C-ECTs was 2.94 (SD: 0.88). Conclusions C-ECT is considered in only in a small proportion of patients. However, when used, it is effective in maintaining the benefits gained during the acute course of ECT and preventing relapse.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjana Kathiravan
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Subho Chakrabarti
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Zilles-Wegner D, Sartorius A. [Electroconvulsive Therapy in the New National Guideline Depression: Effectiveness, Evidence, and Grade of Recommendation]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2023; 91:209-212. [PMID: 37192610 DOI: 10.1055/a-2046-5279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
In comparison to the previous version, the new national guideline 'Unipolar Depression' comprises more differentiated statements and recommendations regarding the use of electroconvulsive therapy (ECT). In principle, this is most welcome, as it clarifies the particular significance of ECT in different clinical situations. In parallel, this differentiation of recommendations depending on the presence of specific features of depressive disorders (e. g., psychotic symptoms, suicidality) led to different grades of recommendations for ECT. This may be correct and rational under the strict methodology of a guideline process, but nevertheless may appear confusing and contradictory in clinical practice. This article describes the relationships and putative discrepancies between the effectiveness of ECT, scientific evidence, and grading of guideline recommendations with comments on these for clinical practice from experts' point of view.
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Affiliation(s)
- David Zilles-Wegner
- Klinik für Psychiatrie and Psychotherapie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Alexander Sartorius
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Mannheim, Germany
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Ahmad Hariza AM, Mohd Yunus MH, Murthy JK, Wahab S. Clinical Improvement in Depression and Cognitive Deficit Following Electroconvulsive Therapy. Diagnostics (Basel) 2023; 13:diagnostics13091585. [PMID: 37174977 PMCID: PMC10178332 DOI: 10.3390/diagnostics13091585] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/17/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
Electroconvulsive therapy (ECT) is a long-standing treatment choice for disorders such as depression when pharmacological treatments have failed. However, a major drawback of ECT is its cognitive side effects. While numerous studies have investigated the therapeutic effects of ECT and its mechanism, much less research has been conducted regarding the mechanism behind the cognitive side effects of ECT. As both clinical remission and cognitive deficits occur after ECT, it is possible that both may share a common mechanism. This review highlights studies related to ECT as well as those investigating the mechanism of its outcomes. The process underlying these effects may lie within BDNF and NMDA signaling. Edema in the astrocytes may also be responsible for the adverse cognitive effects and is mediated by metabotropic glutamate receptor 5 and the protein Homer1a.
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Affiliation(s)
- Ahmad Mus'ab Ahmad Hariza
- Department of Physiology, Faculty of Medicine, UKM Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
| | - Mohd Heikal Mohd Yunus
- Department of Physiology, Faculty of Medicine, UKM Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
| | - Jaya Kumar Murthy
- Department of Physiology, Faculty of Medicine, UKM Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
| | - Suzaily Wahab
- Department of Psychiatry, Faculty of Medicine, UKM Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
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Kudo S, Uchida T, Nishida H, Takamiya A, Kikuchi T, Yamagata B, Mimura M, Hirano J. Clinical characteristics and potential association to Parkinson's disease and dementia with Lewy bodies in patients with major depressive disorder who received maintenance electroconvulsive therapy: a retrospective chart review study. BMC Psychiatry 2023; 23:243. [PMID: 37041471 PMCID: PMC10091570 DOI: 10.1186/s12888-023-04743-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 04/03/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Maintaining remission after electroconvulsive therapy (ECT) is clinically relevant in patients with depression, and maintenance ECT has been introduced in patients who fail to maintain remission after ECT. However, the clinical characteristics and biological background of patients who receive maintenance ECT are poorly understood. Thus, this study aimed to examine the clinical background of patients who underwent maintenance ECT. METHODS Patients with major depressive disorder who underwent ECT followed by maintenance ECT (mECT group) and those who did not (acute ECT [aECT] group) were included. Clinical characteristics, including the results of neuroimaging examinations for Parkinson's disease (PD) and dementia with Levy body (DLB) such as myocardial 123I-metaiodobenzylguanidine (MIBG) scintigraphy and dopamine transporter imaging single-photon emission computerized tomography (DaT-SPECT), were compared between the groups. RESULTS In total, 13 and 146 patients were included in the mECT and aECT groups, respectively. Compared to the aECT group, the mECT group showed a significantly higher prevalence of melancholic features (92.3% vs. 27.4%, p < 0.001) and catatonic features (46.2% vs. 9.6%, p = 0.002). Overall, 8 of the 13 patients in the mECT group and 22 of the 146 patients in the aECT group underwent neuroimaging examinations for PD/DLB. The rate of patients examined is significantly higher in the mECT group than in the aECT group (61.5% vs. 11.2%, p < 0.001). Among the groups examined, 7/8 patients in the mECT group and 16/22 patients in the aECT group showed relevant neuroimaging findings for PD/DLB; the positive rate was not significantly different between the two groups (87.5% vs. 72.7%, p = 0.638). CONCLUSIONS Patients who receive acute and maintenance ECT may have underlying neurodegenerative diseases, including PD/DLB. Investigating the neurobiology of patients who receive maintenance ECT is important for developing appropriate treatments for depression.
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Affiliation(s)
- Shun Kudo
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
- Department of Psychiatry, Saitama City Hospital, Saitama, Japan
| | - Takahito Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan.
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne, Victoria, Australia.
| | - Hana Nishida
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Akihiro Takamiya
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Toshiaki Kikuchi
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Bun Yamagata
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Jinichi Hirano
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
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Dar H, Vuthaluru K, Folajimi A, Maheshwari L, Shah J, Senaratne M, Pizzorno G, Ali N. Effectiveness of Electroconvulsive Therapy for Preventing Relapse and Recurrence of Depression in Adults With Major Depressive Disorder: An Updated Meta-Analysis of Randomized Clinical Trials. Cureus 2023; 15:e35683. [PMID: 37012942 PMCID: PMC10066659 DOI: 10.7759/cureus.35683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
The present meta-analysis aimed to assess the impact of electroconvulsive therapy (ECT) in preventing the relapse and recurrence of depression in adults with major depressive disorders. The study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two authors conducted a systematic search of online databases, such as PubMed, PsycINFO, and EMBASE, using keywords, such as "electroconvulsive therapy," "depressive disorders," and "recurrence." The primary outcome measure was the incidence of relapse and recurrence in adults with major depressive disorder who received ECT alone or in combination with an antidepressant medication compared to those who received antidepressant medication alone. The secondary outcome measure was the change in the Mini-Mental State Examination score from baseline to the end of the trial in both groups. A total of six articles were included in the meta-analysis. The pooled rate of recurrence in the ECT group was 28.4% compared to 30.6% in the antidepressant group, with no significant difference between the two groups (risk ratio (RR) = 0.84, 95% confidence interval (CI) = 0.65-1.10, p = 0.21). However, subgroup analysis showed that the risk of recurrence was significantly lower in patients receiving ECT with antidepressant therapy compared to the antidepressant group alone (RR = 0.65, 95% CI = 0.45-0.93, p = 0.02). On the other hand, when ECT was given alone, the risk was higher in the ECT group compared to the antidepressant group; however, the difference was not statistically significant (RR = 1.17, 95% CI = 0.79-1.75). In conclusion, the results of this meta-analysis suggest that ECT alone or in combination with an antidepressant medication does not significantly impact the incidence of recurrence in adults with major depressive disorder when compared to antidepressant medication alone.
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Affiliation(s)
- Hassaan Dar
- Research, Jinnah Medical and Dental College, Islamabad, PAK
| | | | | | | | - Jeet Shah
- Medicine and Surgery, Sir Sayajirao General Hospital, Ahmedabad, IND
| | | | | | - Neelum Ali
- Internal Medicine, University of Health Sciences, Lahore, PAK
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Xu SX, Xie XH, Yao L, Chen LC, Wan Q, Chen ZH, Liu Z. Trajectories of Efficacy and Cognitive Function During Electroconvulsive Therapy Course in Young Adults with Treatment-Resistant Depression. Neuropsychiatr Dis Treat 2023; 19:267-281. [PMID: 36744206 PMCID: PMC9893845 DOI: 10.2147/ndt.s394155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/13/2023] [Indexed: 01/30/2023] Open
Abstract
Objective Little is known about the effectiveness and cognitive side-effects of electroconvulsive therapy (ECT) in young adults with treatment-resistant depression (TRD). The primary aim of this prospective longitudinal observational trial was to examine the clinical features and cognitive outcomes of young adults with TRD undergoing ECT. Methods Changes in depressive symptoms and objective and subjective cognitive function were assessed using repeated evaluation at baseline, after each ECT session, and at one-month follow-up using the Montgomery-Äsberg Depression Rating Scale (MADRS) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Forward Digital Span Test (FDST), and part of the Columbia Subjective Side Effects Schedule. Results Of 41 inpatients, 35 (85.4%) and 12 (29.3%) met the criteria for response and remission after ECT, respectively. The greatest clinical improvements occurred during the first 3-4 ECT sessions. While 34 patients reported subjective cognitive impairment increased with ECT, immediate and delayed memory (RBANS) significantly increased after ECT, consistent with FDST results. Objective cognition significantly improved during follow-up, but subjective cognition remained impaired. Conclusion ECT is effective in young adults with TRD. Although subjective cognitive impairment increased during treatment, objective cognitive impairments were not observed.
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Affiliation(s)
- Shu-xian Xu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Xin-hui Xie
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Lihua Yao
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Li-chang Chen
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Qirong Wan
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Zhen-hua Chen
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Zhongchun Liu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
- Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan, People's Republic of China
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Methfessel I, Belz M, Bühler F, Zilles-Wegner D. [Health service aspects of electroconvulsive therapy: analysis of external referrals to a university medical center]. DER NERVENARZT 2023; 94:8-17. [PMID: 35951050 PMCID: PMC9859897 DOI: 10.1007/s00115-022-01360-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The application of ECT in Germany varies widely depending on regional availability. This shortfall in ECT supply is partly compensated via referrals to hospitals with ECT services, yet restricted by limited resources in these clinics. OBJECTIVE External referrals for ECT were investigated at the University Medical Center Göttingen. We analyzed the referring institutions, patient characteristics, pharmacotherapy according to current guidelines before indications for ECT, and clinical outcome in cases of treatment with ECT. MATERIAL AND METHODS All external referrals were systematically recorded and retrospectively evaluated for the time span of 1 year. Besides descriptive presentation of the data, pharmacological pretreatment was compared with the current guideline recommendations. We used overall clinical impression (CGI-I) to determine the treatment response post-ECT. RESULTS External referrals were made for N = 52 patients, 82.7% of whom were from the inpatient setting and from a distance of up to 300 km. The most common diagnoses were unipolar depression (57.7%), followed by schizophrenia spectrum (36.5%). Prior to referral, at least one guideline-based pretreatment was given in the majority of cases. ECT was performed in 18 patients in our hospital, of whom 72.7% showed a good to very good response. CONCLUSION Both numbers and radius of external referrals indicate a high unmet need for ECT and thus limited access to this evidence-based and guideline-recommended therapy. As treatment close to home should be the goal, more hospitals are needed to establish (or expand) ECT services; however, even with considerable delays which are often associated with external referrals, the response rate is good across all diagnoses.
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Affiliation(s)
- Isabel Methfessel
- grid.411984.10000 0001 0482 5331Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Von-Siebold-Str. 5, 37075 Göttingen, Deutschland
| | - Michael Belz
- grid.411984.10000 0001 0482 5331Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Von-Siebold-Str. 5, 37075 Göttingen, Deutschland
| | - Fabienne Bühler
- grid.411984.10000 0001 0482 5331Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Von-Siebold-Str. 5, 37075 Göttingen, Deutschland
| | - David Zilles-Wegner
- grid.411984.10000 0001 0482 5331Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Von-Siebold-Str. 5, 37075 Göttingen, Deutschland
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Lambrichts S, Vansteelandt K, Hebbrecht K, Wagenmakers MJ, Oudega ML, Obbels J, van Exel E, Dols A, Bouckaert F, Schrijvers D, Verwijk E, Sienaert P. Which residual symptoms predict relapse after successful electroconvulsive therapy for late-life depression? J Psychiatr Res 2022; 154:111-116. [PMID: 35933854 DOI: 10.1016/j.jpsychires.2022.07.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/23/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022]
Abstract
The risk of relapse following successful acute-phase treatment of late-life depression (LLD), including electroconvulsive therapy (ECT), is substantial. In order to improve reliable prediction of individuals' risk of relapse, we assessed the association between individual residual symptoms following a successful acute course of ECT for LLD and relapse at six-month follow-up. This prospective cohort study was part of the MODECT study, which included 110 patients aged 55 years and older with major depressive disorder. Participants who showed response to the index ECT course were monitored for relapse for six months. We used multivariable stepwise logistic regression models to assess the association between the scores on the 10 individual Montgomery-Åsberg Depression Rating Scale (MADRS) items at the end of the acute ECT course and relapse at six-month follow-up. Of the 80 responders with available six-month follow-up data (58.75% of which had psychotic features at baseline), 36.25% had relapsed. Higher scores on the MADRS items 'reduced sleep' (odds ratio (OR) = 2.03, 95% confidence interval (CI) = 1.11-3.69, p = 0.0214) and 'lassitude' (OR = 1.62, 95% CI = 1.00-2.62, p = 0.0497) at the end of the acute ECT course were significantly associated with increased risk of relapse at six-month follow-up. In conclusion, some residual depressive symptoms, including sleep disturbance and lassitude, may help better identify patients vulnerable to relapse following a successful acute course of ECT for LLD. If these findings can be replicated, studies assessing interventions that target specific residual symptoms may further reduce post-ECT depressive relapse rates.
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Affiliation(s)
- Simon Lambrichts
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Leuvensesteenweg 517, 3070, Kortenberg, Belgium.
| | - Kristof Vansteelandt
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Leuvensesteenweg 517, 3070, Kortenberg, Belgium
| | - Kaat Hebbrecht
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Leuvensesteenweg 517, 3070, Kortenberg, Belgium
| | - Margot J Wagenmakers
- GGZ in Geest Specialized Mental Health Care, Old Age Psychiatry, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Psychiatry, De Boelelaan, 1117, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands
| | - Mardien L Oudega
- GGZ in Geest Specialized Mental Health Care, Old Age Psychiatry, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Psychiatry, De Boelelaan, 1117, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands
| | - Jasmien Obbels
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Leuvensesteenweg 517, 3070, Kortenberg, Belgium
| | - Eric van Exel
- GGZ in Geest Specialized Mental Health Care, Old Age Psychiatry, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Psychiatry, De Boelelaan, 1117, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands
| | - Annemiek Dols
- GGZ in Geest Specialized Mental Health Care, Old Age Psychiatry, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Psychiatry, De Boelelaan, 1117, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, the Netherlands
| | - Filip Bouckaert
- KU Leuven, University Psychiatric Center KU Leuven (UPC KU Leuven), Leuvensesteenweg 517, 3070, Kortenberg, Belgium
| | - Didier Schrijvers
- UAntwerp, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University Psychiatric Hospital Duffel, Stationsstraat 22c, 2570 Duffel, Belgium
| | - Esmée Verwijk
- Amsterdam UMC Location University of Amsterdam, Medical Psychology, Amsterdam, the Netherlands; Department of Psychology, Brain & Cognition, University of Amsterdam, Amsterdam, the Netherlands
| | - Pascal Sienaert
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Leuvensesteenweg 517, 3070, Kortenberg, Belgium
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Neuromodulation and Hippocampal Neurogenesis in Depression: A Scoping Review. Brain Res Bull 2022; 188:92-107. [PMID: 35853529 DOI: 10.1016/j.brainresbull.2022.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/29/2022] [Accepted: 07/14/2022] [Indexed: 11/22/2022]
Abstract
The 'neurogenesis hypothesis of depression' emphasizes the importance of upregulated hippocampal neurogenesis for the efficacy of antidepressant treatment. Neuromodulation is a promising therapeutic method that stimulates neural circuitries to treat neuropsychiatric illnesses. We conducted a scoping review on the neurogenic and antidepressant outcomes of neuromodulation in animal models of depression. PubMed, Web of Science, and PsycInfo were comprehensively searched for full-text English articles from inception to October 5, 2021. Data screening and extraction were conducted independently by two researchers. Seventeen eligible studies were included in this review. The majority of studies used non-invasive neuromodulation (n = 14) and assessed neurogenesis using neural proliferation (n = 16) and differentiation markers (n = 9). Limited reports (n = 2) used neurogenic inhibitors to evaluate the role of neurogenesis on the depressive-like behavioral outcomes. Overall, neuromodulation substantially effectuated both hippocampal cell proliferation and antidepressant-like behavior in animal models of depression, with some providing evidence for enhanced neuronal differentiation and maturation. The proposed neurogenic-related mechanisms mediating the neuromodulation efficacies included neurotrophic processes, anti-apoptotic pathways, and normalization of HPA axis functions. Further research is warranted to explore the role of neuromodulation-induced neurogenic effects on treatment efficacies and to elucidate the underlying molecular mechanisms.
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Rojas M, Ariza D, Ortega Á, Riaño-Garzón ME, Chávez-Castillo M, Pérez JL, Cudris-Torres L, Bautista MJ, Medina-Ortiz O, Rojas-Quintero J, Bermúdez V. Electroconvulsive Therapy in Psychiatric Disorders: A Narrative Review Exploring Neuroendocrine-Immune Therapeutic Mechanisms and Clinical Implications. Int J Mol Sci 2022; 23:6918. [PMID: 35805923 PMCID: PMC9266340 DOI: 10.3390/ijms23136918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/10/2022] [Accepted: 05/23/2022] [Indexed: 01/12/2023] Open
Abstract
Electroconvulsive therapy (ECT) is based on conducting an electrical current through the brain to stimulate it and trigger generalized convulsion activity with therapeutic ends. Due to the efficient use of ECT during the last years, interest in the molecular bases involved in its mechanism of action has increased. Therefore, different hypotheses have emerged. In this context, the goal of this review is to describe the neurobiological, endocrine, and immune mechanisms involved in ECT and to detail its clinical efficacy in different psychiatric pathologies. This is a narrative review in which an extensive literature search was performed on the Scopus, Embase, PubMed, ISI Web of Science, and Google Scholar databases from inception to February 2022. The terms "electroconvulsive therapy", "neurobiological effects of electroconvulsive therapy", "molecular mechanisms in electroconvulsive therapy", and "psychiatric disorders" were among the keywords used in the search. The mechanisms of action of ECT include neurobiological function modifications and endocrine and immune changes that take place after ECT. Among these, the decrease in neural network hyperconnectivity, neuroinflammation reduction, neurogenesis promotion, modulation of different monoaminergic systems, and hypothalamus-hypophysis-adrenal and hypothalamus-hypophysis-thyroid axes normalization have been described. The majority of these elements are physiopathological components and therapeutic targets in different mental illnesses. Likewise, the use of ECT has recently expanded, with evidence of its use for other pathologies, such as Parkinson's disease psychosis, malignant neuroleptic syndrome, post-traumatic stress disorder, and obsessive-compulsive disorder. In conclusion, there is sufficient evidence to support the efficacy of ECT in the treatment of different psychiatric disorders, potentially through immune, endocrine, and neurobiological systems.
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Affiliation(s)
- Milagros Rojas
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo 4004, Venezuela; (D.A.); (Á.O.); (M.C.-C.); (J.L.P.)
| | - Daniela Ariza
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo 4004, Venezuela; (D.A.); (Á.O.); (M.C.-C.); (J.L.P.)
| | - Ángel Ortega
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo 4004, Venezuela; (D.A.); (Á.O.); (M.C.-C.); (J.L.P.)
| | - Manuel E. Riaño-Garzón
- Facultad de Ciencias Jurídicas y Sociales, Universidad Simón Bolívar, Cúcuta 540006, Colombia; (M.E.R.-G.); (M.J.B.)
| | - Mervin Chávez-Castillo
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo 4004, Venezuela; (D.A.); (Á.O.); (M.C.-C.); (J.L.P.)
- Psychiatric Hospital of Maracaibo, Maracaibo 4004, Venezuela
| | - José Luis Pérez
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo 4004, Venezuela; (D.A.); (Á.O.); (M.C.-C.); (J.L.P.)
| | - Lorena Cudris-Torres
- Programa de Psicología, Fundación Universitaria del Área Andina, Valledupar 200001, Colombia;
| | - María Judith Bautista
- Facultad de Ciencias Jurídicas y Sociales, Universidad Simón Bolívar, Cúcuta 540006, Colombia; (M.E.R.-G.); (M.J.B.)
| | - Oscar Medina-Ortiz
- Facultad de Medicina, Universidad de Santander, Cúcuta 540003, Colombia;
- Facultad de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla 080002, Colombia
| | - Joselyn Rojas-Quintero
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 77054, USA;
| | - Valmore Bermúdez
- Facultad de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla 080002, Colombia
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Affiliation(s)
- Randall T Espinoza
- From the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (R.T.E.); and the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (C.H.K.)
| | - Charles H Kellner
- From the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (R.T.E.); and the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (C.H.K.)
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21
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Munkholm K, Jørgensen KJ, Paludan-Müller AS. Electroconvulsive therapy for preventing relapse and recurrence in people with depression. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2022. [DOI: 10.1002/14651858.cd015164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Klaus Munkholm
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Karsten Juhl Jørgensen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Asger Sand Paludan-Müller
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
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Wilson S, Croarkin PE, Aaronson ST, Carpenter LL, Cochran M, Stultz DJ, Kozel FA. Systematic review of preservation TMS that includes continuation, maintenance, relapse-prevention, and rescue TMS. J Affect Disord 2022; 296:79-88. [PMID: 34592659 DOI: 10.1016/j.jad.2021.09.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/07/2021] [Accepted: 09/11/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND A dearth of evidence-based information exists to guide the delivery of transcranial magnetic stimulation (TMS) after a successful acute course of treatment for Major Depressive Disorder. METHODS To provide guidance for clinicians, existing literature focused on "preservation TMS" was systematically reviewed and synthesized. Preservation TMS was defined as TMS used to sustain a clinical response after a successful acute course of treatment and included reports using the terms maintenance, continuation, relapse prevention, or rescue TMS. The review protocol was registered on Open Science Framework and reported following PRISMA guidelines. Data were abstracted by two authors and discrepancies were resolved by a third author. Primary outcome measures focused on clinical efficacy. The evaluated studies were graded using the Levels of Evidence criteria published by the Oxford Centre for Evidence-Based Medicine. RESULTS The search included 536 abstracts and 16 additional papers, from which 63 full articles were screened. Data were abstracted from 30 qualifying sources (N=1,494) including 4 randomized controlled trials (one sham controlled), 14 open trials, and 12 case series. Overall, the quality of existing literature was low regarding efficacy but provided clear support for effectiveness and safety across a range of preservation TMS protocols based on mostly uncontrolled studies. CONCLUSIONS Existing literature suggests that preservation TMS protocols significantly vary and are mostly supported by open trials and case series. Due to a lack of effective alternatives, preservation TMS will likely be required for certain patients who respond to acute TMS therapy. More studies of preservation TMS are critically needed.
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Affiliation(s)
- Saydra Wilson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Scott T Aaronson
- Sheppard Pratt Health System, Department of Psychiatry, University of Maryland, Baltimore, MD, USA
| | - Linda L Carpenter
- Brown University Department of Psychiatry and Human Behavior, Butler Hospital, Providence, RI, USA
| | - Michelle Cochran
- Department of Psychiatry, Neuroscience and TMS Treatment Centers, Vanderbilt University Medical Center, Brentwood, TN, USA
| | - Debra J Stultz
- Stultz Sleep and Behavioral Health, Barboursville, WV, USA
| | - F Andrew Kozel
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Florida State University, 1115 W. Call Street, Tallahassee, FL 32306, USA.
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Teng M, Khoo AL, Zhao YJ, Abdin E, Mok YM, Lim BP, Tor PC. Neurostimulation therapies in major depressive disorder: A decision-analytic model. Early Interv Psychiatry 2021; 15:1531-1541. [PMID: 33254283 DOI: 10.1111/eip.13091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 12/28/2022]
Abstract
AIM Neurostimulation techniques are effective treatments for major depressive disorders (MDD). However, the optimal sequence of electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) as part of antidepressant treatment algorithm is unclear. We examined the cost-effectiveness of ECT and TMS in MDD. METHODS A decision-analytic model was developed to determine total costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) for 10 strategies. Each strategy comprised four treatment lines with ECT and TMS incorporated as second, third, or fourth line. A scenario analysis that explored the cost-effectiveness of maintenance approach by continuing ECT and TMS after acute treatment was performed. RESULTS In the base case, fourth-line TMS after three preceding trials of antidepressants was least costly at US$ 5523 yielding 1.424 QALYs. Compared with this strategy, fourth-line ECT and third-line TMS followed by ECT were cost-effective with ICERs of US$ 7601 per QALY gained and US$ 11 388 per QALY gained, respectively. In the scenario analysis where continuation treatments of ECT and TMS were provided, third-line TMS followed by ECT was cost-effective, with an ICER of US$ 17 198 per QALY gained. Effectiveness of ECT and cost of managing severe depression were influential parameters affecting the cost-effectiveness results. CONCLUSIONS In acute treatment of MDD, fourth-line ECT was the most cost-effective strategy. In maintenance treatment, the strategy that incorporated third-line TMS and fourth-line ECT was cost-effective. The overall findings confirmed the value of neurostimulation therapies which should be offered early in the process of managing depression.
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Affiliation(s)
- Monica Teng
- Group Health Informatics, National Healthcare Group, Singapore, Singapore
| | - Ai Leng Khoo
- Group Health Informatics, National Healthcare Group, Singapore, Singapore
| | - Ying Jiao Zhao
- Group Health Informatics, National Healthcare Group, Singapore, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Yee Ming Mok
- Department of Mood and Anxiety, Institute of Mental Health, Singapore, Singapore
| | - Boon Peng Lim
- Group Health Informatics, National Healthcare Group, Singapore, Singapore
| | - Phern Chern Tor
- Research Division, Institute of Mental Health, Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore, Singapore.,National University of Singapore, Singapore, Singapore
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24
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Munkholm K, Jørgensen KJ, Paludan-Müller AS. Electroconvulsive therapy for preventing relapse and recurrence in bipolar disorder. Hippokratia 2021. [DOI: 10.1002/14651858.cd015172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Klaus Munkholm
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Karsten Juhl Jørgensen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Asger Sand Paludan-Müller
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
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25
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Kirov G, Jauhar S, Sienaert P, Kellner CH, McLoughlin DM. Electroconvulsive therapy for depression: 80 years of progress. Br J Psychiatry 2021; 219:594-597. [PMID: 35048827 DOI: 10.1192/bjp.2021.37] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Electroconvulsive therapy is the most effective treatment for severe, psychotic or treatment-resistant depression. However, its effectiveness continues to be questioned, both in mainstream media and narratives within the scientific literature. In this analysis, we use an evidence-based approach to demonstrate the efficacy and safety of modern electroconvulsive therapy.
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Affiliation(s)
- George Kirov
- MRC Centre for Neuropsychiatric Genetics & Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, UK
| | - Sameer Jauhar
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Pascal Sienaert
- Academic Center for ECT and Neuromodulation, University Psychiatric Center, KU Leuven, Belgium
| | - Charles H Kellner
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, South Carolina, USA
| | - Declan M McLoughlin
- Department of Psychiatry and Trinity College Institute of Neuroscience, Trinity College Dublin, St Patrick's University Hospital, Ireland
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26
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Kurimoto N, Inagaki T, Aoki T, Kadotani H, Kurimoto F, Kuriyama K, Yamada N, Ozeki Y. Factors causing a relapse of major depressive disorders following successful electroconvulsive therapy: A retrospective cohort study. World J Psychiatry 2021; 11:841-853. [PMID: 34733646 PMCID: PMC8546764 DOI: 10.5498/wjp.v11.i10.841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/26/2021] [Accepted: 08/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is used to treat major depressive disorder (MDD). Relapse is often observed even after successful ECT, followed by adequate pharmaceutical treatment for MDD.
AIM To investigate the diagnostic factors and treatment strategies associated with depression relapse.
METHODS We analyzed the relationships between relapse, the diagnostic change from MDD to bipolar disorder (BP), and treatment after the initial ECT. We performed a 3-year retrospective study of the prognoses of 85 patients of the Shiga University of Medical Science Hospital. The relative risk of relapse of depressive symptoms was calculated based on the diagnostic change from MDD to BP. A receiver operating characteristic (ROC) curve was generated to evaluate the predictive accuracy of diagnostic changes from MDD to BP based on the duration between the first course of ECT and the relapse of depressive symptoms.
RESULTS Eighty-five patients initially diagnosed with MDD and successfully treated with ECT were enrolled in the study. Compared with the MDD participants, more BP patients experienced relapses and required continuation and/or maintenance ECT to maintain remission (65.6% vs 15.1%, P < 0.001; relative risk = 4.35, 95%CI: 2.19-8.63, P < 0.001). Twenty-nine patients experienced relapses during the three-year follow-up. In 21 (72.4%, 21/29) patients with relapse, the diagnosis was changed from MDD to BP. The duration from the first course of ECT to relapse was shorter for the BP patients than for the MDD patients (9.63 ± 10.4 mo vs 3.38 ± 3.77 mo, P = 0.022); for most patients, the interval was less than one month. The relative risk of depressive symptoms based on diagnostic changes was 4.35 (95% confidence interval: 2.19–8.63, P < 0.001), and the area under the ROC curve for detecting diagnostic changes based on relapse duration was 0.756 (95%CI: 0.562-0.895, P = 0.007).
CONCLUSION It may be beneficial to suspect BP and change the treatment strategy from MDD to BP for patients experiencing an early relapse.
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Affiliation(s)
- Naoki Kurimoto
- Department of Psychiatry, Shiga University of Medical Science, Otsu 520-2192, Shiga, Japan
- Department of Psychiatry, Shigasato Hospital, Otsu 520-0006, Shiga, Japan
| | - Takahiko Inagaki
- Department of Psychiatry, Shiga University of Medical Science, Otsu 520-2192, Shiga, Japan
- Department of Psychiatry, Biwako Hospital, Otsu 520-0113, Shiga, Japan
| | - Takashi Aoki
- Department of Psychiatry, Shiga University of Medical Science, Otsu 520-2192, Shiga, Japan
- Department of Psychiatry, Shiga Hachiman Hospital, Omihachiman 523-8503, Shiga, Japan
| | - Hiroshi Kadotani
- Department of Psychiatry, Shiga University of Medical Science, Otsu 520-2192, Shiga, Japan
- Department of Sleep and Behavioral Sciences, Shiga University of Medical Science, Otsu 520-2192, Shiga, Japan
| | - Fujiki Kurimoto
- Department of Psychiatry, Shigasato Hospital, Otsu 520-0006, Shiga, Japan
| | - Kenichi Kuriyama
- Department of Psychiatry, Shiga University of Medical Science, Otsu 520-2192, Shiga, Japan
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira 187-8502, Tokyo, Japan
| | - Naoto Yamada
- Department of Psychiatry, Shiga University of Medical Science, Otsu 520-2192, Shiga, Japan
| | - Yuji Ozeki
- Department of Psychiatry, Shiga University of Medical Science, Otsu 520-2192, Shiga, Japan
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27
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Martínez-Amorós E, Cardoner N, Gálvez V, de Arriba-Arnau A, Soria V, Palao DJ, Menchón JM, Urretavizcaya M. Can the Addition of Maintenance Electroconvulsive Therapy to Pharmacotherapy Improve Relapse Prevention in Severe Major Depressive Disorder? A Randomized Controlled Trial. Brain Sci 2021; 11:brainsci11101340. [PMID: 34679404 PMCID: PMC8534103 DOI: 10.3390/brainsci11101340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/03/2021] [Indexed: 12/22/2022] Open
Abstract
Few systematic evaluations have been performed of the efficacy of electroconvulsive therapy (ECT) as a relapse prevention strategy in major depressive disorder (MDD). This is a single-blind, multicenter, randomized controlled trial to compare the efficacy and tolerability of pharmacotherapy plus maintenance ECT (M-Pharm/ECT) versus pharmacotherapy alone (M-Pharm) in the prevention of MDD relapse. Subjects with MDD who had remitted with bilateral acute ECT (n = 37) were randomly assigned to receive M-Pharm/ECT (n = 19, 14 treatments) or M-Pharm (n = 18) for nine months. The subjects were followed up for 15 months. The main outcome was relapse of depression, defined as a score of 18 or more on the Hamilton Depression Rating Scale. At nine months, 35% of the subjects treated with M-Pharm/ECT relapsed as compared with 61% of the patients treated with M-Pharm. No statistically significant differences between groups were indicated by either Kaplan–Meier or Cox proportional hazards regression analyses. The subjects without psychotic features were at higher risk of relapse. There were no statistically significant differences in the MMSE scores of the two groups at the end of the study. Further studies are needed to better define the indications for M-ECT in order to improve its efficacy as a relapse prevention strategy.
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Affiliation(s)
- Erika Martínez-Amorós
- Department of Mental Health, Parc Taulí University Hospital, Institut d’Investigació i Innovació Sanitària Parc Taulí (I3PT), 08208 Sabadell, Spain; (E.M.-A.); (V.G.); (D.J.P.)
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, 28029 Madrid, Spain; (V.S.); (J.M.M.)
| | - Narcís Cardoner
- Department of Mental Health, Parc Taulí University Hospital, Institut d’Investigació i Innovació Sanitària Parc Taulí (I3PT), 08208 Sabadell, Spain; (E.M.-A.); (V.G.); (D.J.P.)
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, 28029 Madrid, Spain; (V.S.); (J.M.M.)
- Correspondence: (N.C.); (M.U.)
| | - Verònica Gálvez
- Department of Mental Health, Parc Taulí University Hospital, Institut d’Investigació i Innovació Sanitària Parc Taulí (I3PT), 08208 Sabadell, Spain; (E.M.-A.); (V.G.); (D.J.P.)
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Aida de Arriba-Arnau
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group—Psychiatry and Mental Health, 08907 L’Hospitalet de Llobregat, Spain;
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, 08007 Barcelona, Spain
| | - Virginia Soria
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, 28029 Madrid, Spain; (V.S.); (J.M.M.)
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group—Psychiatry and Mental Health, 08907 L’Hospitalet de Llobregat, Spain;
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, 08007 Barcelona, Spain
| | - Diego J. Palao
- Department of Mental Health, Parc Taulí University Hospital, Institut d’Investigació i Innovació Sanitària Parc Taulí (I3PT), 08208 Sabadell, Spain; (E.M.-A.); (V.G.); (D.J.P.)
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, 28029 Madrid, Spain; (V.S.); (J.M.M.)
| | - José M. Menchón
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, 28029 Madrid, Spain; (V.S.); (J.M.M.)
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group—Psychiatry and Mental Health, 08907 L’Hospitalet de Llobregat, Spain;
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, 08007 Barcelona, Spain
| | - Mikel Urretavizcaya
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, 28029 Madrid, Spain; (V.S.); (J.M.M.)
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group—Psychiatry and Mental Health, 08907 L’Hospitalet de Llobregat, Spain;
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, 08007 Barcelona, Spain
- Correspondence: (N.C.); (M.U.)
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28
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Stippl A, Kirkgöze FN, Bajbouj M, Grimm S. Differential Effects of Electroconvulsive Therapy in the Treatment of Major Depressive Disorder. Neuropsychobiology 2021; 79:408-416. [PMID: 32344410 DOI: 10.1159/000505553] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 12/11/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIMS/METHODS Electroconvulsive therapy (ECT) is still one of the most potent treatments in the acute phase of major depressive disorder (MDD) and particularly applied in patients considered treatment resistant. However, despite the frequent and widespread use of ECT for >70 years, the exact neurobiological mechanisms underlying its efficacy remain unclear. The present review aims to describe differential antidepressant and cognitive effects of ECT as well as effects on markers of neural activity and connectivity, neurochemistry, and inflammation that might underlie the treatment response and remission. RESULTS Region- specific changes in brain function and volume along with changes in concentrations of neurotransmitters and neuroinflammatory cytokines might serve as potential biomarkers for ECT outcomes. CONCLUSIONS However, as current data is not consistent, future longitudinal investigations should combine modalities such as MRI, MR spectroscopy, and peripheral physiological measures to gain a deeper insight into interconnected time- and modality-specific changes in response to ECT.
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Affiliation(s)
- Anna Stippl
- Department of Psychiatry and Psychotherapy, Charité, University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Fatma Nur Kirkgöze
- Department of Psychiatry and Psychotherapy, Charité, University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Charité, University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Simone Grimm
- Department of Psychiatry and Psychotherapy, Charité, University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany, .,MSB Medical School Berlin, Berlin, Germany, .,Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Psychiatric Hospital, Zurich, Switzerland,
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29
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Jelovac A, Kolshus E, McLoughlin DM. Relapse following bitemporal and high-dose right unilateral electroconvulsive therapy for major depression. Acta Psychiatr Scand 2021; 144:218-229. [PMID: 34033117 DOI: 10.1111/acps.13331] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/20/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is an effective acute treatment for severe and/or medication-resistant depression but maintaining remission following completion of a course remains a clinical challenge. METHODS EFFECT-Dep Trial (ISRCTN23577151) participants with a DSM-IV major depressive episode who met remission criteria after a randomly assigned course of twice-weekly brief-pulse bitemporal (1.5 × seizure threshold) or high-dose (6 × seizure threshold) right unilateral ECT were monitored for relapse for 12 months. In line with the pragmatic trial design, all patients received treatment-as-usual individualised pharmacotherapy during and after ECT; no remitter received continuation ECT. RESULTS Of 61 remitters, 24 (39.3%) relapsed, one (1.6%) withdrew from the study while in remission and the remaining 36 (59.0%) stayed well for a year. Most relapses occurred within the first six months, resulting in a cumulative six-month relapse rate of 31.1%. In a multivariable Cox proportional hazards regression model, older age (p = 0.039) and psychotic features at pre-ECT baseline (p = 0.037) were associated with a more favourable long-term prognosis while a greater number of previous depressive episodes (p = 0.028) and bipolar II (but not bipolar I) diagnosis (p = 0.030) were associated with a worse long-term outcome. Electrode placement and medication resistance prior to ECT had no effect on relapse. Adjusting for covariates, fewer patients treated with lithium relapsed in the overall group (p = 0.008) and in the unipolar depression subgroup (p = 0.027). CONCLUSION Long-term outcome following high-dose right unilateral ECT does not differ from bitemporal ECT. Prognosis is particularly favourable in older adults, psychotic depression and patients maintained on lithium.
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Affiliation(s)
- Ana Jelovac
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, Dublin 8, Ireland
| | - Erik Kolshus
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, Dublin 8, Ireland.,Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland
| | - Declan M McLoughlin
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, Dublin 8, Ireland.,Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland
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30
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Methfessel I, Besse M, Belz M, Zilles‐Wegner D. Effectiveness of maintenance electroconvulsive therapy-Evidence from modifications due to the COVID-19 pandemic. Acta Psychiatr Scand 2021; 144:238-245. [PMID: 33960406 PMCID: PMC8212113 DOI: 10.1111/acps.13314] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/20/2021] [Accepted: 05/03/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Continuation and maintenance ECT (c-/m-ECT) are effective in the prevention of relapse and recurrence of both affective and psychotic disorders. However, data are scarce concerning the trajectories of severe mental disorders after the end of c-/m-ECT. This prospective study investigates the clinical outcome of patients with versus without modifications of their c-/m-ECT schedules. METHODS In the context of the COVID-19 pandemic, ECT capacities were restricted at many clinics in early 2020. All patients receiving c-/m-ECT in March and April 2020 at our department (n = 53, unipolar depression, bipolar disorder, schizophrenia) were followed up for six months to investigate the impact of treatment modifications imposed by the pandemic. Based on individual decisions, c-/m-ECT was either (a) continued without modification, (b) continued with reduced frequency, or (c) discontinued. RESULTS Both reduced frequency and discontinuation of c-/m-ECT were associated with significant clinical deterioration as measured by CGI-I (Clinical Global Impression Scale - Global Improvement) during the six-month follow-up when compared to the subgroup of patients without any treatment modification (p = 0.005, p = 0.011). Furthermore, patients with discontinued or reduced c-/m-ECT showed significantly higher rates of rehospitalizations (p = 0.028) and new acute courses of ECT (p = 0.018). CONCLUSION Despite the limitations of a heterogeneous and relatively small sample, our study strongly corroborates the effectiveness of c-/m-ECT in a real-world population. Especially, patients with shorter time since index ECT seem to be at high risk for severe clinical deterioration in the case of treatment discontinuation or reduction.
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Affiliation(s)
- Isabel Methfessel
- Department of Psychiatry and PsychotherapyUniversity Medical Center GöttingenGöttingenGermany
| | - Matthias Besse
- Department of Psychiatry and PsychotherapyUniversity Medical Center GöttingenGöttingenGermany
| | - Michael Belz
- Department of Psychiatry and PsychotherapyUniversity Medical Center GöttingenGöttingenGermany
| | - David Zilles‐Wegner
- Department of Psychiatry and PsychotherapyUniversity Medical Center GöttingenGöttingenGermany
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Lambrichts S, Detraux J, Vansteelandt K, Nordenskjöld A, Obbels J, Schrijvers D, Sienaert P. Does lithium prevent relapse following successful electroconvulsive therapy for major depression? A systematic review and meta-analysis. Acta Psychiatr Scand 2021; 143:294-306. [PMID: 33506961 DOI: 10.1111/acps.13277] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The risk of relapse following successful antidepressant treatment, including electroconvulsive therapy (ECT), is substantial. Lithium has been suggested to effectively prevent relapse, yet data remain limited and inconclusive. We performed a systematic review and meta-analysis to examine the efficacy of continuation treatment with lithium in preventing relapse following a successful acute course of ECT in patients with major depression, in comparison to continuation treatment without lithium. We also assessed the role of several study characteristics, possibly impacting the treatment effect. METHODS A systematic literature search, using the PubMed, Embase, Web of Science, and Cochrane Library databases (up to June 2020), was conducted for prospective and retrospective studies, including patients with unipolar or bipolar depression, that assessed the efficacy of lithium for post-ECT depressive relapse prevention. RESULTS Of 2556 records screened, 14 articles reporting on 9748 participants who received continuation treatment either with (N = 1571) or without lithium (N = 8177) were included in the meta-analysis. Patients receiving lithium were less likely to experience depressive relapse after a successful acute course of ECT, compared to patients receiving post-ECT prophylaxis without lithium (weighted odds ratio (OR) = 0.53, 95% confidence interval (CI) = 0.34, 0.82), with a number needed to treat (NNT) of 7 (95% CI = 4, 21). We found some limited evidence that older patients may benefit more from continuation treatment with lithium, compared to younger patients. Using the GRADE criteria, the quality of evidence for our outcome measure (i.e., relapse rate) was rated as very low. CONCLUSION Continuation treatment with lithium may have superior efficacy in reducing the risk of relapse after a successful acute ECT course for major depression, in comparison to continuation treatment without lithium. High-quality studies are needed to confirm this finding.
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Affiliation(s)
- Simon Lambrichts
- Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Kortenberg, Belgium
| | - Johan Detraux
- Department of Neurosciences, Research Group Psychiatry, University Psychiatric Center KU Leuven (UPC KU Leuven), Kortenberg, Belgium
| | - Kristof Vansteelandt
- Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Kortenberg, Belgium
| | - Axel Nordenskjöld
- Faculty of Health and Medical Sciences, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Jasmien Obbels
- Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Kortenberg, Belgium
| | - Didier Schrijvers
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Pascal Sienaert
- Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Kortenberg, Belgium
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32
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Watson NF, McCall C, Doherty M. Faradization for insomnia: a sleep neurology history. J Clin Sleep Med 2021; 17:249-254. [PMID: 33124978 DOI: 10.5664/jcsm.8958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
NONE Insomnia is highly prevalent and challenging to treat. We typically regard insomnia as a disorder of the modern world, but physicians and patients have been struggling with this malady for millennia. Here we present the curious historical practice of using electrization or faradization to treat insomnia. We present methods of application, hypotheses regarding mechanism of action, and historical case reports and case series to better understand this phenomenon. We put faradization for insomnia in the context of the modern use of electrical therapies to support and facilitate human health in multiple different health care arenas. Last, we examine current efforts to use these antiquated concepts to address insomnia through transcranial direct current stimulation and cranial electrical stimulation.
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Affiliation(s)
- Nathaniel F Watson
- Department of Neurology, University of Washington School of Medicine, Seattle, Washington.,University of Washington Medicine Sleep Center, Seattle, Washington
| | - Catherine McCall
- University of Washington Medicine Sleep Center, Seattle, Washington.,Seattle VA Puget Sound Healthcare System, Seattle, Washington
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Malhi GS, Bell E, Bassett D, Boyce P, Bryant R, Hazell P, Hopwood M, Lyndon B, Mulder R, Porter R, Singh AB, Murray G. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2021; 55:7-117. [PMID: 33353391 DOI: 10.1177/0004867420979353] [Citation(s) in RCA: 246] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To provide advice and guidance regarding the management of mood disorders, derived from scientific evidence and supplemented by expert clinical consensus to formulate s that maximise clinical utility. METHODS Articles and information sourced from search engines including PubMed, EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (e.g. books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Relevant information was appraised and discussed in detail by members of the mood disorders committee, with a view to formulating and developing consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous consultation and external review involving: expert and clinical advisors, key stakeholders, professional bodies and specialist groups with interest in mood disorders. RESULTS The Royal Australian and New Zealand College of Psychiatrists mood disorders clinical practice guidelines 2020 (MDcpg2020) provide up-to-date guidance regarding the management of mood disorders that is informed by evidence and clinical experience. The guideline is intended for clinical use by psychiatrists, psychologists, primary care physicians and others with an interest in mental health care. CONCLUSION The MDcpg2020 builds on the previous 2015 guidelines and maintains its joint focus on both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. MOOD DISORDERS COMMITTEE Gin S Malhi (Chair), Erica Bell, Darryl Bassett, Philip Boyce, Richard Bryant, Philip Hazell, Malcolm Hopwood, Bill Lyndon, Roger Mulder, Richard Porter, Ajeet B Singh and Greg Murray.
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Affiliation(s)
- Gin S Malhi
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Erica Bell
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | | | - Philip Boyce
- Department of Psychiatry, Westmead Hospital and the Westmead Clinical School, Wentworthville, NSW, Australia.,Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Philip Hazell
- Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, VIC, Australia
| | - Bill Lyndon
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ajeet B Singh
- The Geelong Clinic Healthscope, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
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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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Abstract
OBJECTIVE Resolution of suicidal ideation for patients with major depressive disorder is an important public health challenge. We aimed to determine whether electroconvulsive therapy (ECT) or fluoxetine was more efficacious in resolving suicidal ideation and achieving long-term protective effect against suicidality. METHODS The data used in this study were drawn from 2 open-label trials for major depressive disorder patients receiving ECT or fluoxetine for acute treatment, together with continuation medication in the 12-week follow-up. We compared the effects of ECT and fluoxetine on suicidal ideation as scored by the suicide item on the 17-item Hamilton Rating Scale for Depression. RESULTS The differences between these 2 groups in time to resolution of suicidal ideation (suicide item = 0) in the acute treatment period, and time to relapse of suicidal ideation (suicide item score ≥1 or rehospitalization for suicidality) in the follow-up period were analyzed. Electroconvulsive therapy-treated patients (n = 111) had significantly shorter time to resolution of suicidal ideation than fluoxetine-treated patients (n = 114) during acute treatment. However, there was no statistically significant difference in time to relapse of suicidal ideation between 2 groups in the 12-week follow-up period. CONCLUSIONS Electroconvulsive therapy was superior to fluoxetine in resolving suicidal ideation during acute treatment. Therefore, ECT should be an early consideration for suicidal patients. Electroconvulsive therapy and fluoxetine were equally effective in preventing recurrence of suicidal ideation in the 12-week follow-up period. Routine suicide risk assessments from hospital care to outpatient care are required to identify any signs of suicidal relapse.
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Giacobbe J, Pariante CM, Borsini A. The innate immune system and neurogenesis as modulating mechanisms of electroconvulsive therapy in pre-clinical studies. J Psychopharmacol 2020; 34:1086-1097. [PMID: 32648795 PMCID: PMC7672674 DOI: 10.1177/0269881120936538] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is a powerful and fast-acting anti-depressant strategy, often used in treatment-resistant patients. In turn, patients with treatment-resistant depression often present an increased inflammatory response. The impact of ECT on several pathophysiological mechanisms of depression has been investigated, with a focus which has largely been on cellular and synaptic plasticity. Although changes in the immune system are known to influence neurogenesis, these processes have principally been explored independently from each other in the context of ECT. OBJECTIVE The aim of this review was to compare the time-dependent consequences of acute and chronic ECT on concomitant innate immune system and neurogenesis-related outcomes measured in the central nervous system in pre-clinical studies. RESULTS During the few hours following acute electroconvulsive shock (ECS), the expression of the astrocytic reactivity marker glial fibrillary acidic protein (GFAP) and inflammatory genes, such as cyclooxygenase-2 (COX2), were significantly increased together with the neurogenic brain-derived neurotrophic factor (BDNF) and cell proliferation. Similarly, chronic ECS caused an initial upregulation of the same astrocytic marker, immune genes, and neurogenic factors. Interestingly, over time, inflammation appeared to be dampened, while glial activation and neurogenesis were maintained, after either acute or chronic ECS. CONCLUSION Regardless of treatment duration ECS would seemingly trigger a rapid increase in inflammatory molecules, dampened over time, as well as a long-lasting activation of astrocytes and production of growth and neurotrophic factors, leading to cell proliferation. This suggests that both innate immune system response and neurogenesis might contribute to the efficacy of ECT.
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Affiliation(s)
| | | | - Alessandra Borsini
- Alessandra Borsini, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, Division of Psychological Medicine, Stress, Psychiatry and Immunology Lab & Perinatal Psychiatry, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London SE5 9RT, UK.
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Rajji TK, Bowie CR, Herrmann N, Pollock BG, Bikson M, Blumberger DM, Butters MA, Daskalakis ZJ, Fischer CE, Flint AJ, Golas AC, Graff-Guerrero A, Kumar S, Lourenco L, Mah L, Ovaysikia S, Thorpe KE, Voineskos AN, Mulsant BH. Design and Rationale of the PACt-MD Randomized Clinical Trial: Prevention of Alzheimer’s dementia with Cognitive remediation plus transcranial direct current stimulation in Mild cognitive impairment and Depression. J Alzheimers Dis 2020; 76:733-751. [DOI: 10.3233/jad-200141] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Tarek K. Rajji
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Christopher R. Bowie
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychology, Queen’s University, Kingston, Ontario, Canada
| | - Nathan Herrmann
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Bruce G. Pollock
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York, NY, USA
| | - Daniel M. Blumberger
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Meryl A. Butters
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Zafiris J. Daskalakis
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Corinne E. Fischer
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Keenan Research Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Alastair J. Flint
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Angela C. Golas
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Ariel Graff-Guerrero
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sanjeev Kumar
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Lillian Lourenco
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Linda Mah
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Baycrest, Toronto, Ontario, Canada
| | - Shima Ovaysikia
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kevin E. Thorpe
- Dalla Lana School of Public Health, University of Toronto
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Aristotle N. Voineskos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Benoit H. Mulsant
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Luccarelli J, McCoy TH, Seiner SJ, Henry ME. Maintenance ECT is associated with sustained improvement in depression symptoms without adverse cognitive effects in a retrospective cohort of 100 patients each receiving 50 or more ECT treatments. J Affect Disord 2020; 271:109-114. [PMID: 32479305 PMCID: PMC7289157 DOI: 10.1016/j.jad.2020.03.152] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/19/2020] [Accepted: 03/29/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is the most effective acute treatment for depression, but relapse is common following discontinuation. One strategy for prolonging remission is the use of maintenance ECT, but the clinical evidence supporting its efficacy and safety are limited. We examined the effects of maintenance ECT on depression and cognition. METHODS Participants were from a retrospective cohort of 100 patients receiving ECT at a freestanding psychiatric hospital and who received at least 50 treatments during a single treatment series. QIDS, BASIS-24, and MoCA were assessed at baseline and every 10 treatments thereafter during the clinical course. RESULTS ECT was associated with a rapid decrease in depression symptoms and overall self-reported mental health status within the first 10 treatments, which was sustained throughout a median of 22.1 months of follow-up. There was no change in cognitive functioning as measured by the MoCA. Bilateral and brief pulse treatment parameters were more common by treatment 50 than at the first treatment. Most participants either continued in ECT at the end of the study period or discontinued due to sustained remission. LIMITATIONS retrospective observational study without control group who did not receive ECT. CONCLUSIONS In this ECT cohort with at least 50 treatments, improvement in depression was sustained on QIDS and BASIS-24 and adverse cognitive effects were not detected by serial MoCAs, supporting the utility of maintenance ECT in this cohort.
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Affiliation(s)
- James Luccarelli
- Department of Psychiatry, Massachusetts General Hospital, Boston (Luccarelli, Henry, McCoy); Department of Psychiatry, McLean Hospital, Belmont (Seiner).
| | | | | | - Michael E. Henry
- Department of Psychiatry, Massachusetts General Hospital, Boston (Luccarelli, Henry, McCoy); Department of Psychiatry, McLean Hospital, Belmont (Seiner)
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Atashnama A, Aly H, Krishnan V, Howari R, Mayur P. Naturalistic outcomes of continuation right unilateral ultrabrief ECT in major depression: a retrospective chart review. Australas Psychiatry 2020; 28:286-290. [PMID: 32391725 DOI: 10.1177/1039856220917070] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Continuation treatment of major depression following an acute course of electroconvulsive treatment (ECT) may be often required to prevent relapse. Data on continuation phase of right unilateral ultrabrief ECT are sparse and there are doubts if it is inherently capable of relapse prevention. METHODS All consecutive adult patients with major depression who received the first 'run' of continuation phase of right unilateral ultrabrief ECT over a 10-year period were routinely followed up. ECT frequency varied from weekly to up to once every 4 weeks for a maximum period of 6 months. The data were extracted from a retrospective chart review. RESULTS 20 out of 22 patients persisted with ultrabrief pulses (0.3 ms) with two needing 0.5 ms pulse widths. The median duration of continuation treatment was 51 days (range: 14-460). At the end of 1 month (n = 17), treatment gap in days mean (SD): 10.18 (7.08), widening to mean (SD): 20.11 (16.85) at 4 months (n = 9). Stimulus dose increased throughout the continuation phase: p = 0.026. In 16 out of 22 patients, more than 70% of the visits were charted as being 'in remission'. CONCLUSION As most patients receiving ultrabrief ECT remained well, this study suggests that ultrabrief ECT can be used effectively in continuation therapy.
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Affiliation(s)
| | - Husayn Aly
- Western Sydney Local Health District, Australia
| | | | | | - Prashanth Mayur
- Cumberland Hospital, Australia.,University of Sydney, Australia
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40
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A Measure to Assess Perceptions and Knowledge About Electroconvulsive Therapy: Development and Psychometric Properties. J ECT 2020; 36:e1-e6. [PMID: 31192871 DOI: 10.1097/yct.0000000000000609] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Although electroconvulsive therapy (ECT) has been found to be one of the most robust and rapid treatments for severe depression, it is widely underused partly because of negative perceptions and inaccurate knowledge about the treatment. METHODS The 18-item ECT Perception and Knowledge (ECT-PK) measure was developed through a systematic review of the literature, subject matter expert ratings, and examination of content validity. The ECT-PK consists of Perception and Knowledge subscales, which were tested on a national sample of 1091 US adults who screened positive for depression in 2018 through Amazon's Mechanical Turk platform. RESULTS Evaluation of the ECT-PK subscales found that both subscales demonstrated good construct validity, criterion validity, and internal consistency reliability. Participants who had higher Perception and Knowledge subscale scores were significantly more likely to report that they were willing to try ECT. The ECT-PK revealed that many participants reported fears about pain, brain damage, and memory loss resulting from ECT, and had inaccurate knowledge about ECT being outdated or lacking scientific evidence. CONCLUSIONS Together, these results showed that the ECT-PK is an efficient and effective contemporary tool to measure the perception and knowledge of ECT, and highlights areas in need of psychoeducation.
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Fitzgibbon KP, Plett D, Chan BCF, Hancock-Howard R, Coyte PC, Blumberger DM. Cost-Utility Analysis of Electroconvulsive Therapy and Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression in Ontario. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:164-173. [PMID: 31801363 PMCID: PMC7019468 DOI: 10.1177/0706743719890167] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate the cost-effectiveness of repetitive transcranial magnetic stimulation (rTMS) and electroconvulsive therapy (ECT), and combining both treatments in a stepped care pathway for patients with treatment-resistant depression (TRD) in Ontario. METHODS A cost-utility analysis evaluated the lifetime costs and benefits to society of rTMS and ECT as first-line treatments for TRD using a Markov model, which simulates the costs and health benefits of patients over their lifetime. Health states included acute treatment, maintenance treatment, remission, and severe depression. Treatment efficacy and health utility data were extracted and synthesized from randomized controlled trials and meta-analyses evaluating these techniques. Direct costing data were obtained from national and provincial costing databases. Indirect costs were derived from government records. Scenario, threshold, and probabilistic sensitivity analyses were performed to test robustness of the results. RESULTS rTMS dominated ECT, as it was less costly and produced better health outcomes, measured in quality-adjusted life years (QALYs), in the base case scenario. rTMS patients gained an average of 0.96 additional QALYs (equivalent to approximately 1 year in perfect health) over their lifetime with costs that were $46,094 less than ECT. rTMS remained dominant in the majority of scenario and threshold analyses. However, results from scenarios in which the model's maximum lifetime allowance of rTMS treatment courses was substantially limited, the dominance of rTMS over ECT was attenuated. The scenario that showed the highest QALY gain (1.19) and the greatest cost-savings ($46,614) was when rTMS nonresponders switched to ECT. CONCLUSION From a societal perspective utilizing a lifetime horizon, rTMS is a cost-effective first-line treatment option for TRD relative to ECT, as it is less expensive and produces better health outcomes. The reduced side effect profile and greater patient acceptability of rTMS that allow it to be administered more times than ECT in a patient's lifetime may contribute to its cost-effectiveness.
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Affiliation(s)
- Kyle P Fitzgibbon
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Donna Plett
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Brian C F Chan
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Rebecca Hancock-Howard
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Reconsidering the seizure threshold? A retrospective study about seizure quality among patients with maintenance ECT. Acta Neuropsychiatr 2019; 31:52-55. [PMID: 30398129 DOI: 10.1017/neu.2018.29] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Electroconvulsive therapy (ECT) is a safe and validated technique used to treat various psychiatric conditions. It triggers an artificially-induced seizure. This seizure is defined using several parameters such as the amount of energy, duration, frequency, pulse width and intensity. Efficacy and adverse events depend on the amount of energy delivered. Due to technical control, the amount of energy delivered by our unit's ECT device was limited to 614 mC, 60% of the maximum possible output of the device. We wondered if lowering the dose would lead to better seizure quality among maintenance ECT patients. METHODS We assessed seizure quality based on the EEG, using a validated tool created by MacPherson. Two evaluators independently rated the seizures. Pre- and post-control scores were compared using Student's t-test for paired samples. RESULTS We analysed data from 15 patients. Mean age was 65 years old. Twelve had depressive disorder, two had schizophrenia and one had schizo-affective disorder. Mean duration of seizure before control was 41.1 s [95% confidence interval (95CI)=26.1, 51.1]. The mean MacPherson's score was 20.3 (95CI=16.2, 24.4). After control, the mean MacPherson's score was 28.2 (23.1, 33.3), showing a significant difference with the pre-control dataset (p=0.032; t=-2.4; df=14). Specifically, peak mid-ictal amplitude increased from 6.9 (95CI=5.1, 8.7) to 10.0 (95CI=7.2, 12.8). Other sub-scores remained unchanged. CONCLUSION Lowering the energy delivered led to an overall increase of seizure quality among our sample. This highlights the necessity and utility of retitration during ECT maintenance, possibly leading to better management of our patients.
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Affiliation(s)
- John Read
- University of East London, London, UK
| | | | - Sameer Jauhar
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Declan M McLoughlin
- Department of Psychiatry, Trinity College Dublin, St Patrick's University Hospital, Dublin, Ireland
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Hermida AP, Glass OM, Shafi H, McDonald WM. Electroconvulsive Therapy in Depression: Current Practice and Future Direction. Psychiatr Clin North Am 2018; 41:341-353. [PMID: 30098649 DOI: 10.1016/j.psc.2018.04.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The current practice of electroconvulsive therapy (ECT) has evolved over several decades with the implementation of safer equipment and advancement of techniques. In addition, modifications in the delivery of ECT, such as the utilization of brief and ultrabrief pulse widths and individualization of treatment parameters, have improved the safety of ECT without sacrificing efficacy. This article aims to provide psychiatrists with a balanced, in-depth look into the recent advances in ECT technique as well as the evidence of ECT for managing depression in special populations and patients with comorbid medical problems.
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Affiliation(s)
- Adriana P Hermida
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive Northeast, Atlanta, GA 30329, USA.
| | - Oliver M Glass
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive Northeast, Atlanta, GA 30329, USA
| | - Hadia Shafi
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive Northeast, Atlanta, GA 30329, USA
| | - William M McDonald
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive Northeast, Atlanta, GA 30329, USA
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Abstract
Trends in brain stimulation include becoming less invasive, more focal, and more durable with less toxicity. Several of the more interesting new potentially disruptive technologies that are just making their way through basic and sometimes clinical research studies include low-intensity focused ultrasound and temporally interfering electric fields. It is possible, and even likely, that noninvasive brain stimulation may become the dominant form of brain treatments over the next 20 years. The future of brain stimulation therapeutics is bright.
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Affiliation(s)
- Kevin A Caulfield
- Brain Stimulation Laboratory, Medical University of South Carolina, 67 President Street, 502 North, Charleston, SC 29425, USA; Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC 29401, USA.
| | - Mark S George
- Brain Stimulation Laboratory, Medical University of South Carolina, 67 President Street, 502 North, Charleston, SC 29425, USA; Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC 29401, USA
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