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Chen T, Loo C, Salvador-Carulla L, Jorm LR, Srasuebkul P, Sara G, Quiroz JC, Gallego B. Factors associated with electroconvulsive therapy treatment for adults with serious psychiatric conditions in Australia. Aust N Z J Psychiatry 2024; 58:809-820. [PMID: 39066683 DOI: 10.1177/00048674241266067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
OBJECTIVE To identify factors associated with receiving electroconvulsive therapy (ECT) for serious psychiatric conditions. METHODS Retrospective observational study using hospital administrative data linked with death registrations and outpatient mental health data in New South Wales (NSW), Australia. The cohort included patients admitted with a primary psychiatric diagnosis between 2013 and 2022. The outcome measure was receipt of ECT. RESULTS Of 94,950 patients, 3465 (3.6%) received ECT. The likelihood of receiving ECT was higher in older (hazard ratio [HR] = 1.03), female (HR = 1.24) patients. Compared to depression, patients with schizophrenia/schizoaffective disorder (HR = 0.79), schizophrenia-related disorders (HR = 0.37), mania (HR = 0.64) and other mood disorders (HR = 0.45) had lower odds of receiving ECT. Patients with depression and one other serious psychiatric condition had higher odds of receiving ECT than depression alone. Bipolar disorder likelihood of ECT did not differ from depression. A higher number of mental health outpatient visits in the prior year and an involuntary index admission with depression were also associated with receiving ECT. Likelihood of receiving ECT increased with year of admission (HR = 1.32), private patient status (HR = 2.06), higher socioeconomic status (HR = 1.09) and being married (HR = 1.25). CONCLUSIONS ECT use for depression and bipolar disorder in NSW aligns with clinical national guidelines. Patients with schizophrenia/schizoaffective, schizophrenia-related disorders, mania and other mood disorders had lower likelihood of ECT than depression, despite ECT being recommended by clinical guidelines for these diagnoses. Variations in ECT were strongly associated with healthcare access, with private patients twice as likely to receive ECT than their public counterparts, suggesting a need to explore ECT accessibility.
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Affiliation(s)
- Timothy Chen
- University of New South Wales, Sydney, NSW, Australia
| | - Colleen Loo
- Discipline of Psychiatry, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- Black Dog Institute, Randwick, NSW, Australia
| | | | - Louisa R Jorm
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Preeyaporn Srasuebkul
- Department of Developmental Disability Neuropsychiatry, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
| | - Grant Sara
- Discipline of Psychiatry, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- NSW Ministry of Health, St Leonards, NSW, Australia
| | - Juan C Quiroz
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Blanca Gallego
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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Garel N, Drury J, Thibault Lévesque J, Goyette N, Lehmann A, Looper K, Erritzoe D, Dames S, Turecki G, Rej S, Richard-Devantoy S, Greenway KT. The Montreal model: an integrative biomedical-psychedelic approach to ketamine for severe treatment-resistant depression. Front Psychiatry 2023; 14:1268832. [PMID: 37795512 PMCID: PMC10546328 DOI: 10.3389/fpsyt.2023.1268832] [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: 07/28/2023] [Accepted: 08/30/2023] [Indexed: 10/06/2023] Open
Abstract
Background Subanesthetic ketamine has accumulated meta-analytic evidence for rapid antidepressant effects in treatment-resistant depression (TRD), resulting in both excitement and debate. Many unanswered questions surround ketamine's mechanisms of action and its integration into real-world psychiatric care, resulting in diverse utilizations that variously resemble electroconvulsive therapy, conventional antidepressants, or serotonergic psychedelics. There is thus an unmet need for clinical approaches to ketamine that are tailored to its unique therapeutic properties. Methods This article presents the Montreal model, a comprehensive biopsychosocial approach to ketamine for severe TRD refined over 6 years in public healthcare settings. To contextualize its development, we review the evidence for ketamine as a biomedical and as a psychedelic treatment of depression, emphasizing each perspectives' strengths, weaknesses, and distinct methods of utilization. We then describe the key clinical experiences and research findings that shaped the model's various components, which are presented in detail. Results The Montreal model, as implemented in a recent randomized clinical trial, aims to synergistically pair ketamine infusions with conventional and psychedelic biopsychosocial care. Ketamine is broadly conceptualized as a brief intervention that can produce windows of opportunity for enhanced psychiatric care, as well as powerful occasions for psychological growth. The model combines structured psychiatric care and concomitant psychotherapy with six ketamine infusions, administered with psychedelic-inspired nonpharmacological adjuncts including rolling preparative and integrative psychological support. Discussion Our integrative model aims to bridge the biomedical-psychedelic divide to offer a feasible, flexible, and standardized approach to ketamine for TRD. Our learnings from developing and implementing this psychedelic-inspired model for severe, real-world patients in two academic hospitals may offer valuable insights for the ongoing roll-out of a range of psychedelic therapies. Further research is needed to assess the Montreal model's effectiveness and hypothesized psychological mechanisms.
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Affiliation(s)
- Nicolas Garel
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Jessica Drury
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | | | - Nathalie Goyette
- McGill Group for Suicide Studies, Douglas Mental Health Research Institute, Montreal, QC, Canada
| | - Alexandre Lehmann
- International Laboratory for Brain, Music and Sound Research, Montreal, QC, Canada
- Department of Otolaryngology, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Karl Looper
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
- Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, QC, Canada
| | - David Erritzoe
- Division of Psychiatry, Department of Brain Sciences, Centres for Neuropsychopharmacology and Psychedelic Research, Imperial College London, London, United Kingdom
| | - Shannon Dames
- Health Sciences and Human Services, Vancouver Island University, Nanaimo, BC, Canada
| | - Gustavo Turecki
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
- McGill Group for Suicide Studies, Douglas Mental Health Research Institute, Montreal, QC, Canada
| | - Soham Rej
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
- Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, QC, Canada
- Geri-PARTy Research Group, Jewish General Hospital, Montreal, QC, Canada
| | - Stephane Richard-Devantoy
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
- McGill Group for Suicide Studies, Douglas Mental Health Research Institute, Montreal, QC, Canada
| | - Kyle T. Greenway
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
- Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, QC, Canada
- Division of Psychiatry, Department of Brain Sciences, Centres for Neuropsychopharmacology and Psychedelic Research, Imperial College London, London, United Kingdom
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Salagre E, Rohde C, Vieta E, Østergaard SD. Electroconvulsive therapy following incident bipolar disorder: When, how, and for whom? Bipolar Disord 2022; 24:817-825. [PMID: 36064283 PMCID: PMC10087321 DOI: 10.1111/bdi.13254] [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: 12/30/2022]
Abstract
OBJECTIVE The use of electroconvulsive therapy (ECT) in the treatment of bipolar disorder (BD) remains poorly described. Based on data from Danish registries with complete nationwide coverage, this study of patients with incident BD aimed to describe when, how, and for whom ECT is used in the context of BD. METHODS We identified patients receiving their first diagnosis of BD in the period from 2008 to 2018, who subsequently received ECT. Descriptive statistics were used to clarify when, how, and for whom ECT is used. RESULTS We identified 1338 patients with incident BD who subsequently received ECT. The median age at the first ECT session was 50.6 years (interquartile range [IQR]: 26.4), and 62% of those treated with ECT were female. The median time from the diagnosis of BD to the first ECT treatment was 0.6 years (IQR: 2.6), and 58% of the patients receiving ECT had the first treatment within the first year after being diagnosed with BD. The most common indication for the first ECT treatment was depression (mainly non-psychotic depression), followed by mania (mainly psychotic mania). The first ECT session was typically provided to inpatients (97%), upon patient consent (98%) and with bilateral electrode placement (60%). CONCLUSIONS A substantial proportion of the patients with incident BD who receive ECT require this treatment within the first year after the diagnosis. The most common indication for ECT is depression followed by (psychotic) mania. Inpatient voluntary ECT using bilateral electrode placement is the most common form of administration.
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Affiliation(s)
- Estela Salagre
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain.,Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christopher Rohde
- Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Søren D Østergaard
- Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Lafrenière S, Gholi-Zadeh-Kharrat F, Sirois C, Massamba V, Rochette L, Brousseau-Paradis C, Patry S, Gagné C, Lemasson M, Gariépy G, Mérette C, Rahme E, Lesage A. The 5-year longitudinal diagnostic profile and health services utilization of patients treated with electroconvulsive therapy in Quebec: a population-based study. Soc Psychiatry Psychiatr Epidemiol 2022; 58:629-639. [PMID: 36163429 DOI: 10.1007/s00127-022-02369-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/15/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Electroconvulsive therapy (ECT) is effective for treating several psychiatric disorders. However, only a minority of patients are treated with ECT. It is of primary importance to characterize their profile for epidemiological purposes and to inform clinical practice. We aimed to characterize the longitudinal profile of psychopathology and services utilization of patients first treated with ECT. METHODS We conducted a population-based comparative study using data from a national administrative database in Quebec. Patients who received a first ECT between 2002 and 2016 were compared to controls who were hospitalized in psychiatry but did not receive ECT. We performed descriptive analyses to compare psychiatric diagnoses, domains of psychopathology (internalizing, externalizing and thought/psychotic disorders), medical services and medication use in the 5 years prior to the ECT or hospitalization. RESULTS 5 080 ECT patients were compared with 179 594 controls. Depressive, anxiety, bipolar and psychotic disorders were more frequent in the ECT group. 96.2% of ECT patients had been diagnosed with depression and 53.8% with a primary psychotic disorder. In the ECT group, 1.0% had been diagnosed exclusively with depression and 47.0% had disorders from that belong to all three domains of psychopathology. Having both internalizing and thought/psychotic disorders was associated with an increased likelihood of receiving ECT vs having internalizing disorders alone (unadjusted OR = 2.93; 95% CI = 2.63, 3.26). All indicators of mental health services utilization showed higher use among ECT patients. CONCLUSION Our results provide robust evidence of complex longitudinal psychopathology and extensive services utilization among ECT patients.
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Affiliation(s)
- Simon Lafrenière
- Department of Psychiatry and Neurosciences, Université Laval, Quebec City, Qc, Canada. .,Institut Universitaire en Santé Mentale de Québec, 2601, Chemin de La Canardière, Quebec, QC, G1J 2G3, Canada.
| | - Fatemeh Gholi-Zadeh-Kharrat
- Department of Electrical Engineering and Computer Engineering, Université Laval, Quebec, Qc, Canada.,Institut National de Santé Publique du Québec, Quebec City, Qc, Canada
| | - Caroline Sirois
- Institut National de Santé Publique du Québec, Quebec City, Qc, Canada.,Faculty of Pharmacy, Université Laval, Quebec, Qc, Canada.,Centre of Excellence on Aging of Quebec, VITAM Research Centre on Sustainable Health, Quebec City, Qc, Canada
| | - Victoria Massamba
- Institut National de Santé Publique du Québec, Quebec City, Qc, Canada
| | - Louis Rochette
- Institut National de Santé Publique du Québec, Quebec City, Qc, Canada
| | | | - Simon Patry
- Department of Psychiatry and Neurosciences, Université Laval, Quebec City, Qc, Canada.,Institut Universitaire en Santé Mentale de Québec, 2601, Chemin de La Canardière, Quebec, QC, G1J 2G3, Canada
| | - Christian Gagné
- Computer Vision and Systems Laboratory, Université Laval, Quebec, Qc, Canada
| | - Morgane Lemasson
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, Qc, Canada
| | - Geneviève Gariépy
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada.,Institut Universitaire en Santé Mentale de Montréal Research Centre, Montreal, Qc, Canada
| | - Chantal Mérette
- Department of Psychiatry and Neurosciences, Université Laval, Quebec City, Qc, Canada.,CERVO Research Centre, Quebec City, Canada
| | - Elham Rahme
- Department of Medicine, Division of Clinical Epidemiology, McGill University, Montreal, Qc, Canada
| | - Alain Lesage
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, Qc, Canada.,Institut Universitaire en Santé Mentale de Montréal Research Centre, Montreal, Qc, Canada
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ECT on a world map - a narrative review of the use of electroconvulsive therapy and its frequency in the world. CURRENT PROBLEMS OF PSYCHIATRY 2022. [DOI: 10.2478/cpp-2022-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction: Since implementation, electroconvulsive therapy has remained very effective treatment in psychiatry. The aim of this study is to present the differences in its use in medical practice around the world. The range of diseases in which ECT is most commonly used and the frequency of its use in different countries were compared with special attention to the differences between highly and poorly developed countries.
Material and method: Review of literature by searching PubMed and Google Scholar databases using the keywords: indications of ECT, frequency of ECT use for papers published from 1991 to 2021.
Results: Among the diseases for which electroconvulsive therapy is used worldwide, major depression dominates, while in Asia and Africa this therapy is used in schizophrenia. In Latin America it is used primarily for schizophrenia and bipolar disorder. In Poland, it is used for depression, bipolar disorder, and fewer for schizophrenia. The highest rate of people treated with therapy per 100,000 population is found in countries such as the USA (51), Canada (23.2-25.6), Australia (37.85), Sweden (41), Finland (23), Slovakia (29.2), Estonia (27.8) and Belgium (47).
Conclusions: There is a relationship between the range of diseases most frequently treated with ECT, the frequency of use and the level of country development. In the high developed countries, ECT is used mainly in major depression, in less developed countries more frequent treatment of schizophrenia may be determined by the high cost of medications and limited availability of hospital beds. The highest rates of use of this therapy are found in more developed countries.
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Kaster TS, Blumberger DM, Gomes T, Sutradhar R, Dasklakis ZJ, Wijeysundera DN, Vigod SN. Patient-level Characteristics and Inequitable Access to Inpatient Electroconvulsive Therapy for Depression: A Population-based Cross-sectional Study: Caractéristiques au niveau du patient et accès inéquitable à la thérapie électroconvulsive pour patients hospitalisés. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:147-158. [PMID: 32613857 PMCID: PMC7918876 DOI: 10.1177/0706743720935647] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE A variety of patient characteristics drive the use of electroconvulsive therapy (ECT) in depression. However, the extent to which each characteristic influences the receipt of ECT, and whether they are appropriate, is unknown. The aim of this study is to identify patient-level characteristics associated with receiving inpatient ECT for depression. METHOD We identified all psychiatric inpatients with a major depressive episode admitted to hospital ≥3 days in Ontario, Canada (2009 to 2017). The association between patient-level characteristics at admission and receipt of inpatient ECT was determined using logistic regression, where a generalized estimating equations approach accounted for repeat admissions. RESULTS The cohort included 53,174 inpatients experiencing 75,429 admissions, with 6,899 admissions involving ECT (9.2%). Among demographic factors, age was most associated with ECT-younger adults had reduced (OR = 0.30, 95%CI, 0.24 to 0.37; 18 to 25 years) while older adults had increased (OR = 3.08, 95%CI, 2.41 to 3.93; 85+ years) odds compared to middle-aged adults (46 to 55 years). The likelihood of ECT was greater for individuals who were married/partnered, had postsecondary education, and resided in the highest neighborhood income quintile. Among clinical factors, illness polarity was most associated with receiving ECT-bipolar depression had reduced odds of receiving ECT (OR = 0.62, 95%CI, 0.57 to 0.69) The likelihood of receiving ECT was greater in psychotic depression, more depressive symptoms, and incapable to consent to treatment and was reduced with comorbid substance use disorders and several medical comorbidities. CONCLUSIONS Nearly 1 in 10 admissions for depression in Ontario, Canada, involve ECT. Many clinical factors associated with receiving inpatient ECT were concordant with clinical guidelines; however, nonclinical factors associated with its use warrant investigation of their impact on equitable access to ECT.
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Affiliation(s)
- Tyler S Kaster
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, 7938 University of Toronto, Ontario, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, 7938 University of Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Tara Gomes
- 518773Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,50010ICES, Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, 7938University of Toronto, Ontario, Canada
| | - Rinku Sutradhar
- 50010ICES, Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, 7938University of Toronto, Ontario, Canada
| | - Zafiris J Dasklakis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, 7938 University of Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Duminda N Wijeysundera
- 518773Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, 7938University of Toronto, Ontario, Canada.,Department of Anesthesia, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, 7938University of Toronto, Ontario, Canada
| | - Simone N Vigod
- Department of Psychiatry, 7938 University of Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, 7938University of Toronto, Ontario, Canada.,Women's College Hospital, Toronto, Ontario, Canada
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A Descriptive Study of Data Collection Systems Used in Electroconvulsive Therapy Units in the Province of Quebec, Canada. J ECT 2020; 36:36-41. [PMID: 31232911 DOI: 10.1097/yct.0000000000000614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to describe the data collection systems routinely used by electroconvulsive therapy (ECT) units across the province of Quebec, Canada. METHODS We conducted a descriptive, cross-sectional study. Using an online survey, 31 ECT units delivering inpatient or outpatient ECT treatments in the province of Quebec provided information on the data collection systems used, data recorded, data collection strategies, indicators of satisfaction, limitations of the current data collection systems, and expectations toward the improvement of ECT data collection. RESULTS Most units routinely collected information on individuals receiving ECT treatments, mainly on the medical chart (80%) and in paper format (71%). Most units (88.9%) collected ECT data manually. Electroconvulsive therapy parameters are collected by 66% to 80% of units, but only 16% of them have computerized records. The main limitations of the current systems are as follows: (a) the low frequency of computerization, (b) the underutilization of data, and (c) difficulties in the integration of information from different ECT units. Although 83.3% were satisfied with the current data collection strategies, 80% had a very positive opinion about the development and implementation of an innovative ECT provincial data collection registry. CONCLUSIONS An integrated ECT provincial data collection system could overcome the variability documented in existing strategies and respond to the current provincial needs and expectations. Also, an integrated ECT provincial data collection system could support both clinical research and quality assurance necessary to inform standards of ECT practice in Quebec.
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Goldbloom DS, Gratzer D. Barriers to Brain Stimulation Therapies for Treatment-Resistant Depression: Beyond Cost Effectiveness. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:193-195. [PMID: 31818129 PMCID: PMC7019463 DOI: 10.1177/0706743719893584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - David Gratzer
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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