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Al-Wandi A, Landén M, Nordenskjöld A. Electroconvulsive therapy in the maintenance phase of psychotic unipolar depression. Acta Psychiatr Scand 2024; 150:148-159. [PMID: 38804530 DOI: 10.1111/acps.13711] [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: 02/16/2024] [Revised: 04/12/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE To determine whether the rates of readmissions and suicide vary in psychotic unipolar depression based on whether patients receive maintenance electroconvulsive therapy (M-ECT) following the initial series of ECT, and to examine if there is an age-dependent association. METHODS We used Swedish national registries to identify hospitalized patients with psychotic unipolar depression, treated 2008-2019 who received ECT during their hospital stay. The patients who received subsequent M-ECT within 14 days after discharge were compared with those who did not. The primary composite outcome was time to readmission due to a psychiatric disorder, suicide attempt, or suicide within 2 years from discharge. Data were analyzed using Cox regression adjusted for previous psychiatric admissions, age, sex, comorbidity, and pharmacological treatment. We also conducted a within-individual analysis using the sign-test, with patients having ≥1 hospital episode followed by M-ECT and ≥1 hospital episode without M-ECT. RESULTS A total of 1873 patients were included, of which 130 received M-ECT. There was no statistically significant group difference regarding the primary outcome in the whole sample. However, when stratified by age, there was a significant difference in favor of M-ECT for patients >65 years (adjusted hazard ratio 0.55, 95% confidence interval 0.35-0.87). The within-individual analysis, including 46 patients, significantly favored M-ECT. CONCLUSION M-ECT was not associated with a differential risk of the composite of readmission and suicide in psychotic depression. Among patients >65 years, M-ECT was significantly associated with a decreased risk of the outcome. The possibility of residual confounding cannot be excluded.
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Affiliation(s)
- Ahmed Al-Wandi
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mikael Landén
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Axel Nordenskjöld
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Tonkul M, Baune BT, Kavakbasi E. Response to Intermittent Theta Burst Stimulation in Treatment-Resistant Depression: Comparison of Patients With and Without History of Electroconvulsive Therapy in the Current Depressive Episode. J ECT 2024:00124509-990000000-00183. [PMID: 38981032 DOI: 10.1097/yct.0000000000001044] [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: 07/11/2024]
Abstract
INTRODUCTION Intermittent theta burst stimulation (iTBS) is a novel form of repetitive transcranial magnetic stimulation (rTMS) conducted in patients with treatment-resistant depression (TRD). In this retrospective naturalistic study, we investigated the outcome of iTBS in treatment-resistant depression patients with (ECT+) and without (ECT-) history of electroconvulsive therapy (ECT) in their current depressive episode, as well as among previous ECT responders and nonresponders. METHODS We included 66 inpatients (57.6% women; mean age, 52.7 years) at a German University Department of Psychiatry. A binary logistic regression model was utilized to investigate the impact of ECT treatment history on response to iTBS. RESULTS Overall response rate was 51.5%. History of ECT in the current episode was present in 47% of patients. In the regression model, history of ECT in the current episode was associated with significantly worse response to iTBS (odds ratio, 0.252; 95% confidence interval, 0.085-0.743; P = 0.013), whereas other disease- and treatment-related covariates had no significant impact on treatment outcome. In the ECT+ group, ECT nonresponders showed a significantly worse outcome of iTBS than ECT responders. Overall rate of treatment discontinuations was 3%. CONCLUSIONS In this study, iTBS was most effective in patients without history of ECT in the current episode. Previous ECT responders had better outcome following iTBS than ECT nonresponders. Hence, patients with ECT response, who had to discontinue ECT due to side effects or complications, may be considered suitable candidates to be switched to iTBS.
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Affiliation(s)
- Mustafa Tonkul
- From the Department of Psychiatry, University Hospital Münster, University of Münster, Münster, Germany
| | | | - Erhan Kavakbasi
- From the Department of Psychiatry, University Hospital Münster, University of Münster, Münster, Germany
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3
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Yrondi A, Blanc O, Anguill L, Arbus C, Boudieu L, Patoz MC, Arnould A, Charpeaud T, Genty JB, Abidine R, Redon M, Rey R, Aouizerate B, Bennabi D, El-Hage W, Etain B, Holtzmann J, Leboyer M, Molière F, Richieri RM, Stéphan F, Vaiva G, Sauvaget A, Poulet E, Haffen E, Courtet P, Fossati P, Llorca PM, Samalin L. Adherence to clinical practice guidelines for using electroconvulsive therapy in elderly depressive patients. BMC Psychiatry 2024; 24:487. [PMID: 38961386 PMCID: PMC11223384 DOI: 10.1186/s12888-024-05933-7] [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: 01/05/2024] [Accepted: 06/25/2024] [Indexed: 07/05/2024] Open
Abstract
OBJECTIVES Electroconvulsive therapy (ECT) is one of the most effective treatments in mood disorders, mainly in major depressive episode (MDE) in the context of either unipolar (MDD) or bipolar disorder (BD). However, ECT remains a neglected and underused treatment. Older people are at high risk patients for the development of adverse drug reactions. In this context, we sought to determine the duration of MDEs and the number of lines of treatment before the initiation of ECT in patients aged 65 years or over according to the presence or absence of first-line indications for using ECT from international guidelines. METHODS In this multicenter, retrospective study including patients aged 65 years or over with MDEs in MDD or BD who have been treated with ECT for MDEs, data on the duration of MDEs and the number of lines of treatment received before ECT were collected. The reasons for using ECT, specifically first-line indications (suicidality, urgency, presence of catatonic and psychotic features, previous ECT response, patient preference) were recorded. Statistical comparisons between groups used standard statistical tests. RESULTS We identified 335 patients. The mean duration of MDEs before ECT was about 9 months. It was significantly shorter in BD than in MDD- about 7 and 10 months, respectively. The co-occurrence of chronic medical disease increased the duration before ECT in the MDD group. The presence of first-line indications for using ECT from guidelines did not reduce the duration of MDEs before ECT, except where there was a previous response to ECT. The first-line indications reduced the number of lines of treatment before starting ECT. CONCLUSION Even if ECT seems to be a key treatment in the elderly population due to its efficacity and safety for MDEs, the delay before this treatment is still too long.
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Affiliation(s)
- Antoine Yrondi
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France.
- Service de Psychiatrie Et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse, INSERM, UPS, 330 Avenue de Grande Bretagne, 31059, Toulouse, France.
| | - Olivier Blanc
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - Loic Anguill
- Service de Psychiatrie Et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse, INSERM, UPS, 330 Avenue de Grande Bretagne, 31059, Toulouse, France
| | - Christophe Arbus
- Service de Psychiatrie Et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse, INSERM, UPS, 330 Avenue de Grande Bretagne, 31059, Toulouse, France
| | - Ludivine Boudieu
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - Marie-Camille Patoz
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - Adeline Arnould
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | | | - Jean-Baptiste Genty
- Université Paris-Est, UMR_S955, UPEC, Créteil, France Inserm, U955, Equipe 15 Psychiatrie Génétique, Créteil, France AP-HP, Hôpital H. Mondor-A. Chenevier, Pôle de Psychiatrie, Créteil, France Fondation FondaMental, Fondation de Cooperation Scientifique, Créteil, France
| | - Racan Abidine
- Service de Psychiatrie Et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse, INSERM, UPS, 330 Avenue de Grande Bretagne, 31059, Toulouse, France
| | - Maximilien Redon
- Service de Psychiatrie Et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse, INSERM, UPS, 330 Avenue de Grande Bretagne, 31059, Toulouse, France
| | - Romain Rey
- INSERM U1028, CNRS UMR5292, University Lyon 1, Lyon Neuroscience Research Centre, Psychiatric Disorders: From Resistance to Response ΨR2 Team, Centre Hospitalier Le Vinatier, Bron, France
| | - Bruno Aouizerate
- Pôle de Psychiatrie Générale Et Universitaire, Centre de Référence Régional Des Pathologies Anxieuses Et de La Dépression, Centre Expert Dépression Résistante FondaMental, CH Charles Perrens, Bordeaux, Laboratoire Nutrition Et Neurobiologie Intégrée (UMR INRAE 1286), Université de Bordeaux, Bordeaux, France
| | - Djamila Bennabi
- Université de Franche-Comté, UMR INSERM 1322 LINC, Service de Psychiatrie de L'adulte, CIC-1431 INSERM, CHU de Besançon, F-25030, Besançon, France
| | - Wissam El-Hage
- Clinique Psychiatrique Universitaire, Centre Expert Dépression Résistante FondaMental, CHRU de Tours, Tours, France
| | - Bruno Etain
- Département de Psychiatrie Et de Médecine Addictologique, Lariboisière-Fernand Widal GHU APHP Nord Université Paris Cité Paris, Paris, France
| | - Jérôme Holtzmann
- Service de Psychiatrie de L'adulte, CS 10217, Centre Expert Dépression Résistante FondaMental, CHU de Grenoble, Hôpital Nord, Grenoble, France
| | - Marion Leboyer
- Université Paris-Est, UMR_S955, UPEC, Créteil, France Inserm, U955, Equipe 15 Psychiatrie Génétique, Créteil, France AP-HP, Hôpital H. Mondor-A. Chenevier, Pôle de Psychiatrie, Créteil, France Fondation FondaMental, Fondation de Cooperation Scientifique, Créteil, France
| | - Fanny Molière
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, INSERM U1061, Montpellier University, Montpellier, France
| | - Raphaelle Marie Richieri
- Pôle Psychiatrie, Centre Expert Dépression Résistante FondaMental, CHU La Conception, Marseille, France
| | - Florian Stéphan
- Service Hospitalo-Universitaire de Psychiatrie Générale Et de Réhabilitation Psycho Sociale 29G01 Et 29G02, Centre Expert Depression Résistante FondaMental, EA 7479, CHRU de Brest, Hôpital de Bohars, Brest, France
| | - Guillaume Vaiva
- University Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition & Centre National de Ressources Et Résilience Pour Les Psychotraumatismes (Cn2r Lille Paris), F-59000, Lille, France
| | - Anne Sauvaget
- Nantes Université, CHU Nantes, Movement, Interactions, Performance, MIP, UR 4334, 44000, Nantes, France
- French Society for Biological Psychiatry and Neuropsychopharmacology, STEP Section (Stimulation Transcrânienne en Psychiatrie), Saint-Germain-en-Laye, France
| | - Emmanuel Poulet
- Psychiatric Emergency Service, Hospices Civils de Lyon, F-69005, Lyon, France
- France Centre Hospitalier Le Vinatier, Bron; INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, PSYR2 Team, F-69000, Lyon, France
- University Lyon 1, Villeurbanne, F-69000, Villeurbanne, France
| | - Emmanuel Haffen
- Université de Franche-Comté, UMR INSERM 1322 LINC, Service de Psychiatrie de L'adulte, CIC-1431 INSERM, CHU de Besançon, F-25030, Besançon, France
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, INSERM U1061, Montpellier University, Montpellier, France
| | - Philippe Fossati
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France
- Control-Interoception Attention Team, Paris Brain Institute (ICM), Sorbonne University, INSERM, CNRS, APHP, Hôpital de La Pitié-Salpêtrière, DMU Neuroscience, Paris, France
| | - Pierre-Michel Llorca
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - Ludovic Samalin
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
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McCall WV, George MS, Sackeim HA. Magnetic Seizure Therapy vs Electroconvulsive Therapy for Major Depressive Episode. JAMA Psychiatry 2024; 81:736-737. [PMID: 38656342 DOI: 10.1001/jamapsychiatry.2024.0692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
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Kronsell A, Nordenskjöld A, Mittendorfer-Rutz E, Tiger M. Long-term follow-up on patient attitudes towards renewed ECT: A register-based cohort study. J Psychiatr Res 2024; 177:24-30. [PMID: 38971053 DOI: 10.1016/j.jpsychires.2024.06.040] [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: 03/15/2024] [Revised: 05/24/2024] [Accepted: 06/24/2024] [Indexed: 07/08/2024]
Abstract
Electroconvulsive therapy (ECT) is a safe and effective treatment for major depressive disorder (MDD). After receiving ECT for MDD there is a large risk of relapse within the first year. Patient attitudes towards renewed treatment could impact their decisions regarding future therapy. We conducted a nationwide cohort study, using data from Swedish registers. Patients with MDD who received ECT were followed up to six months after the initial ECT-series. We investigated if certain patient and treatment characteristics during the initial treatment were correlated to their attitude towards renewed ECT at the six-month follow-up. Logistic regression models were used to calculate adjusted odds ratios for predictors. The Bonferroni method was used to adjust significance levels for multiple testing. The study included 1917 patients. 51.1% of patients were positive, 27.6% were undecided and 21.3% were negative towards renewed treatment. Patients with response to treatment were less likely to have a negative attitude towards renewed ECT (odds ratio 0.32, 95% CI 0.25-0.41, P < 0.001). Moreover, patients with experience of ECT prior to the index series were less likely to have a negative attitude towards renewed ECT (odds ratio 0.44, 95% CI 0.34-0.58, P < 0.001). In order to minimize the risk of negative attitudes towards renewed ECT for MDD, treatment should primarily be reserved for patients that are likely to respond to ECT.
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Affiliation(s)
- Alexander Kronsell
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | | | | | - Mikael Tiger
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden
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Schuster H, Walters RW, Mathy J, Ramaswamy S, Alsakaf I. Correlation Between ECT Quality Measures and Likelihood to Transition From Acute to Continuation and Maintenance ECT. J ECT 2024:00124509-990000000-00171. [PMID: 38924479 DOI: 10.1097/yct.0000000000001028] [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: 06/28/2024]
Abstract
OBJECTIVES To evaluate the association between 3 ECT quality measures (seizure duration, Postictal Suppression Index [PSI], and heart rate response) and therapeutic compliance as indicated by transitioning from acute to continuation to maintenance phases of ECT. METHODS This was a retrospective chart review of patients who received ECT between July 2016 and July 2019. ECT quality measures were lagged by 1 ECT session to examine the effect of the prior session's quality measure on progressing to a higher ECT phase at the subsequent ECT session. Associations with therapeutic compliance were analyzed using mixed-effects ordinal regression and mixed-effects partial proportional odds models. RESULTS Seizure duration was associated with 8% higher adjusted odds of progressing to out of the acute phase (95% confidence interval [CI]: 2% to 15%, P = 0.007) and 18% higher adjusted odds of progressing to the maintenance phase (95% CI: 10% to 28%, P < 0.001); PSI was associated with 9% higher adjusted odds of progressing out of the acute phase (95% CI: 3% to 16%, P = 0.005), whereas heart rate response was not statistically associated with therapeutic compliance. Greater therapeutic compliance was also associated with bilateral electrode placement and older age. CONCLUSIONS Longer seizure duration was associated with greater therapeutic compliance across all ECT phases, PSI was associated with progressing out of the acute phase, and heart rate response was not associated with therapeutic compliance. Our findings assist ECT psychiatrists in optimizing ECT quality measures to promote better compliance with ECT.
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Affiliation(s)
| | - Ryan W Walters
- Clinical Research and Public Health, School of Medicine, Creighton University, Omaha, NE; and
| | - Jacob Mathy
- University of South Dakota School of Medicine, Sioux Falls, SD
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Nakamura S, Sugawara H, Asada R, Hatanaka A, Hori H. Bipolar disorder and Lewy body dementia: case report and literature review. Front Psychiatry 2024; 15:1409027. [PMID: 38895028 PMCID: PMC11184140 DOI: 10.3389/fpsyt.2024.1409027] [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: 03/29/2024] [Accepted: 05/07/2024] [Indexed: 06/21/2024] Open
Abstract
Depressive episodes with psychotic symptoms are prevalent among the older adults, emphasizing the need to differentiate them from dementia with Lewy bodies (DLB), in which depressive and psychotic symptoms commonly coexist. In contrast, psychotic symptoms occur more frequently in depressive episodes of bipolar disorder (BD) than in major depressive disorder (MDD). Although MDD is a significant risk factor for dementia, studies exploring the relationship between BD and dementia are lacking. This report details the case of a 74-year-old female who experienced severe psychotic depression that led to suicide attempts during a long-term course of young-onset BD. Ultimately, she was diagnosed with DLB based on her neurocognitive symptoms and results of the neuroimaging examination. She had experienced multiple relapses in the past, predominantly characterized by depressive episodes in her old age. Notably, she had never undergone lithium treatment, which is known for its potential efficacy in preventing relapse and dementia. Recent systematic reviews and meta-analyses have suggested that patients with BD have a higher risk of dementia than the general population, and that lithium usage is associated with a reduced risk. Moreover, patients with BD have been suggested to have an elevated risk of developing Parkinson's disease (PD), and the pathophysiological relationship between BD and PD may be attributed to dopamine dysregulation resulting from multiple relapses. Future research is imperative to identify strategies for preventing dementia in patients with BD and to develop interventions for the comorbidities of BD and DLB.
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Affiliation(s)
| | - Hiroko Sugawara
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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8
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Strandberg P, Nordenskjöld A, Bodén R, Ekman CJ, Lundberg J, Popiolek K. Electroconvulsive Therapy Versus Repetitive Transcranial Magnetic Stimulation in Patients With a Depressive Episode: A Register-Based Study. J ECT 2024; 40:88-95. [PMID: 38048154 DOI: 10.1097/yct.0000000000000971] [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: 12/05/2023]
Abstract
OBJECTIVES Electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) are both effective in treating depression. Although rTMS induces fewer adverse effects, its effectiveness relative to ECT is not well established. The aim of this study was to investigate the treatment outcomes of ECT and rTMS in patients who have received both interventions. METHODS This was a register-based observational crossover study in patients with depression who had undergone ECT and rTMS in Sweden between 2012 and 2021. Primary outcome was reduction in the Montgomery-Åsberg Depression Rating Scale-Self-report (MADRS-S) score. Secondary outcome was response defined as a 50% or greater decrease in the MADRS-S score. Subgroup analyses were performed to identify factors that predicted differential responses between rTMS and ECT. Continuous and categorical variables were analyzed using paired-samples t tests and McNemar tests, respectively. RESULTS In total, 138 patients across 19 hospitals were included. The MADRS-S score after ECT and rTMS was reduced by 15.0 and 5.6 ( P = 0.0001) points, respectively. Response rates to ECT and rTMS were 38% and 15% ( P = 0.0001), respectively. Electroconvulsive therapy was superior across all subgroups classified according to age and severity of depression. CONCLUSIONS Our results suggest that ECT is more effective than rTMS in treating depression among patients who have received both interventions. Age and baseline depression severity did not predict who would similarly benefit from rTMS and ECT.
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Affiliation(s)
| | - Axel Nordenskjöld
- Department of Psychiatry, University Health Care Research Centre, Faculty of Medicine and Health, Örebro University Hospital, Örebro University, Örebro
| | - Robert Bodén
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala
| | - Carl Johan Ekman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Sweden
| | - Johan Lundberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Sweden
| | - Katarzyna Popiolek
- Department of Psychiatry, University Health Care Research Centre, Faculty of Medicine and Health, Örebro University Hospital, Örebro University, Örebro
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Miller EA, Afshar HT, Mishra J, McIntyre RS, Ramanathan D. Predicting non-response to ketamine for depression: An exploratory symptom-level analysis of real-world data among military veterans. Psychiatry Res 2024; 335:115858. [PMID: 38547599 DOI: 10.1016/j.psychres.2024.115858] [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: 11/03/2023] [Revised: 03/04/2024] [Accepted: 03/09/2024] [Indexed: 04/14/2024]
Abstract
Ketamine helps some patients with treatment resistant depression (TRD), but reliable methods for predicting which patients will, or will not, respond to treatment are lacking. Herein, we aim to inform prediction models of non-response to ketamine/esketamine in adults with TRD. This is a retrospective analysis of PHQ-9 item response data from 120 patients with TRD who received repeated doses of intravenous racemic ketamine or intranasal eskatamine in a real-world clinic. Regression models were fit to patients' symptom trajectories, showing that all symptoms improved on average, but depressed mood improved relatively faster than low energy. Principal component analysis revealed a first principal component (PC) representing overall treatment response, and a second PC that reflects variance across affective versus somatic symptom subdomains. We then trained logistic regression classifiers to predict overall response (improvement on PC1) better than chance using patients' baseline symptoms alone. Finally, by parametrically adjusting the classifier decision thresholds, we identified optimal models for predicting non-response with a negative predictive value of over 96 %, while retaining a specificity of 22 %. Thus, we could identify 22 % of patients who would not respond based purely on their baseline symptoms. This approach could inform rational treatment recommendations to avoid additional treatment failures.
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Affiliation(s)
- Eric A Miller
- Department of Mental Health, VA San Diego Medical Center, San Diego, CA 92161, USA; Department of Psychiatry, UC San Diego, La Jolla, CA 92093, USA
| | - Houtan Totonchi Afshar
- Department of Mental Health, VA San Diego Medical Center, San Diego, CA 92161, USA; Department of Psychiatry, UC San Diego, La Jolla, CA 92093, USA
| | - Jyoti Mishra
- Department of Psychiatry, UC San Diego, La Jolla, CA 92093, USA; Center of Excellence for Stress and Mental Health, VA San Diego Medical Center, USA
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, Canada; Department of Pharmacology, University of Toronto, Toronto, Canada; Brain and Cognition Discovery Foundation, Toronto, Canada
| | - Dhakshin Ramanathan
- Department of Mental Health, VA San Diego Medical Center, San Diego, CA 92161, USA; Department of Psychiatry, UC San Diego, La Jolla, CA 92093, USA; Center of Excellence for Stress and Mental Health, VA San Diego Medical Center, USA.
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10
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Brancati GE, Torrigiani S, Acierno D, Fustini C, Puglisi F, Elefante C, Lattanzi L, Medda P, Perugi G. Response to electroconvulsive therapy in elderly patients with late-onset bipolar disorder: The impact of cerebral small vessel disease. Int J Geriatr Psychiatry 2024; 39:e6098. [PMID: 38777619 DOI: 10.1002/gps.6098] [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: 12/27/2023] [Accepted: 05/03/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES Cerebral Small Vessel Disease (CSVD) is a chronic, progressive vascular disorder that confers increased vulnerability to psychiatric syndromes, including late-life mood disorders. In this study, we investigated the impact of CSVD on electroconvulsive therapy (ECT) outcomes in patients with late-onset bipolar disorder (BD). METHODS A sample of 54 non-demented elderly patients (≥60 years) with late-onset BD and treatment-resistant major depression, mixed state, or catatonia who underwent bilateral ECT were included in this naturalistic observational study. A diagnosis of CSVD was established based on brain neuroimaging performed before ECT. All patients were evaluated before and after ECT using the Brief Psychiatric Rating Scale (BPRS), the Hamilton Rating Scale for Depression (HAM-D), and the Clinical Global Impression scale (CGI). RESULTS Of the total sample, 19 patients were diagnosed with CSVD (35.2%). No significant differences were observed at baseline between patients with and without CSVD. Overall, a response was obtained in 66%-68.5% of patients, with remission in 56.2%. No significant differences in ECT outcomes were found between those with and without CSVD, and both groups exhibited substantial improvements in symptom severity following ECT. CONCLUSIONS The outcome of ECT in late-onset BD was not influenced by the presence of CSVD. This finding aligns with previous research on unipolar depression. Accordingly, ECT should be considered for elderly patients with late-onset BD, regardless of the presence of CSVD.
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Affiliation(s)
- Giulio Emilio Brancati
- Department of Clinical and Experimental Medicine, Psychiatry Unit 2, University Hospital of Pisa, Pisa, Italy
| | - Samuele Torrigiani
- Department of Clinical and Experimental Medicine, Psychiatry Unit 2, University Hospital of Pisa, Pisa, Italy
| | - Donatella Acierno
- Department of Clinical and Experimental Medicine, Psychiatry Unit 2, University Hospital of Pisa, Pisa, Italy
| | - Chiara Fustini
- Department of Clinical and Experimental Medicine, Psychiatry Unit 2, University Hospital of Pisa, Pisa, Italy
| | - Flavia Puglisi
- Department of Clinical and Experimental Medicine, Psychiatry Unit 2, University Hospital of Pisa, Pisa, Italy
| | - Camilla Elefante
- Department of Clinical and Experimental Medicine, Psychiatry Unit 2, University Hospital of Pisa, Pisa, Italy
| | - Lorenzo Lattanzi
- Department of Clinical and Experimental Medicine, Psychiatry Unit 2, University Hospital of Pisa, Pisa, Italy
| | - Pierpaolo Medda
- Department of Clinical and Experimental Medicine, Psychiatry Unit 2, University Hospital of Pisa, Pisa, Italy
| | - Giulio Perugi
- Department of Clinical and Experimental Medicine, Psychiatry Unit 2, University Hospital of Pisa, Pisa, Italy
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11
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Hedna K, Jonson M, Sigström R, Levinsson A, Nordenskjöld A, Waern M. Suicidal behavior and all-cause mortality in depressed older adults aged 75+ treated with electroconvulsive therapy: A Swedish register-based comparison study. Int J Geriatr Psychiatry 2024; 39:e6102. [PMID: 38767969 DOI: 10.1002/gps.6102] [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: 01/10/2024] [Accepted: 05/03/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVES Electroconvulsive therapy (ECT) is effective in treating late-life depression. There is limited research on suicidal behavior and all-cause mortality in the oldest old after ECT. METHODS Older adults aged 75 years and above who had been inpatients for moderate to severe depression between January 1, 2011, and December 31, 2017, were included in the study. We used exact and propensity score matching to balance groups. We compared suicidal behavior (fatal and non-fatal) and all-cause mortality in those who had received ECT and those with other depression treatments. RESULTS Of the study population, 1802 persons who received ECT were matched to 4457 persons with other treatments. There were no significant differences in the risk of suicidal behavior between groups, (within 3 months: odds ratio 0.73; 95% confidence intervals (CI), 0.44-1.23, within 4 months to 1 year: aOR 1.34; 95% CI, 0.84-2.13). All-cause mortality was lower among ECT recipients compared to those who had received other treatments, both within 3 months (aOR, 0.35; 95% CI, 0.23-0.52), and within 4 months to 1 year (aOR 0.65; 95% CI, 0.50-0.83). CONCLUSIONS Compared to other depression treatments, ECT is not associated with a higher risk of suicidal behavior in patients aged 75 and above. ECT is associated with lower all-cause mortality in this age group, but we advise caution regarding causal inferences.
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Affiliation(s)
- Khedidja Hedna
- Department of Psychiatry and Neurochemistry, AgeCap Center, Gothenburg University, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Statistikkonsulterna Väst AB, Gothenburg, Sweden
| | - Mattias Jonson
- Department of Psychiatry and Neurochemistry, AgeCap Center, Gothenburg University, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Addiction and Dependency, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Robert Sigström
- Department of Psychiatry and Neurochemistry, AgeCap Center, Gothenburg University, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cognition and Old Age Psychiatry, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Levinsson
- Department of Social Medicine and Public Health, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal-CRCHUM, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Axel Nordenskjöld
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Margda Waern
- Department of Psychiatry and Neurochemistry, AgeCap Center, Gothenburg University, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychosis Clinic, Gothenburg, Sweden
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12
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Wang X, Ren H, Zhang Z, Zhong X, Luo Q, Huang Y, Qiu H. The efficacy of electroconvulsive therapy in adolescent major depressive disorder with suicidal ideation: A propensity score-matched, retrospective cohort study. Asian J Psychiatr 2024; 95:103998. [PMID: 38493750 DOI: 10.1016/j.ajp.2024.103998] [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: 11/01/2023] [Revised: 03/03/2024] [Accepted: 03/06/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND More evidence is needed to validate the use of ECT in adolescent depression. This study aims to compare the effectiveness of electroconvulsive therapy (ECT) to conventional medication therapy for adolescents with major depression with suicidal ideation. METHODS In this retrospective cohort study, we reviewed inpatient records from the First Affiliated Hospital of Chongqing Medical University spanning December 2016 to June 2021. We focused on adolescents diagnosed with severe depression presenting with suicidal tendencies. To equalize baseline differences between patients, we used the one-to-one propensity score matching to match patients who received ECT treatment with those who did not. Multivariate regression analysis was utilized to adjust for potential confounders, and subgroup analyses and sensitivity analyses were conducted to verify the robustness of our findings. RESULTS Of the 626 patients in this study, 474 underwent ECT treatment while 152 received medication treatment, all aged between 10 and 18 years. Once matched, each group contained 143 patients. The ECT group demonstrated a significantly higher response rate and greater reductions in both Hamilton Depression Rating Scale and Hamilton Anxiety Scale scores (all P < 0.001). Additionally, the ECT group was more effective in reducing suicidal ideation, with fewer individuals retaining such ideation at discharge. In the multivariable regression analysis, both ECT treatment and shorter disease duration were independently linked to enhanced antidepressant efficacy. Subgroup analyses and sensitivity analyses verified the robustness of the main study effect. CONCLUSIONS For adolescents with major depressive disorder and suicidal ideation, combining ECT with pharmacotherapy is more effective than pharmacotherapy alone before medications reach full effect.
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Affiliation(s)
- Xinglian Wang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hao Ren
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Chongqing Changshou District Third People's Hospital, Chongqing, China
| | - Zheng Zhang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiufen Zhong
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Chongqing Mental Health Center, Chongqing, China
| | - Qinghua Luo
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yan Huang
- Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China.
| | - Haitang Qiu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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13
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Baldinger-Melich P, Spies M, Bozic I, Kasper S, Rujescu D, Frey R. Perspectives in treatment-resistant depression: esketamine and electroconvulsive therapy. Wien Klin Wochenschr 2024:10.1007/s00508-024-02358-w. [PMID: 38662240 DOI: 10.1007/s00508-024-02358-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/23/2024] [Indexed: 04/26/2024]
Abstract
Modern electroconvulsive therapy (ECT) and the approval of nasal esketamine for clinical use have significantly improved the approach to treatment-resistant depression (TRD), which is defined as non-response to at least two different courses of antidepressants with verified adherence to treatment, adequate dosage, and duration of treatment. The goal of this literature review is to present the newest evidence regarding efficacy and safety. Furthermore, we aim to provide an overview of future perspectives in this field of research, for example, regarding structural and molecular effects. Both treatment methods will be critically evaluated for their individual advantages, disadvantages, and response rates. Firstly, we will discuss the well-established method of ECT and its different treatment modalities. Secondly, we will discuss the properties of ketamine, the discovery of its antidepressive effects and the route to clinical approval of the esketamine nasal spray. We will comment on research settings which have evaluated intravenous ketamine against ECT. The decision-making process between esketamine nasal spray or ECT should include the assessment of contraindications, age, severity of disease, presence of psychotic symptoms, patient preference and treatment accessibility. We conclude that both treatment options are highly effective in TRD. If both are indicated, pragmatically esketamine will be chosen before ECT; however, ECT studies in ketamine non-responders are missing.
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Affiliation(s)
- Pia Baldinger-Melich
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Vienna, Austria
| | - Marie Spies
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Vienna, Austria
| | - Ina Bozic
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Vienna, Austria
| | - Siegfried Kasper
- Department of Molecular Neurosciences, Center for Brain Research, Vienna, Austria
| | - Dan Rujescu
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Vienna, Austria
| | - Richard Frey
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University Vienna, Vienna, Austria.
- Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Vienna, Austria.
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14
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Guo Y, Xia M, Ye R, Bai T, Wu Y, Ji Y, Yu Y, Ji GJ, Wang K, He Y, Tian Y. Electroconvulsive Therapy Regulates Brain Connectome Dynamics in Patients With Major Depressive Disorder. Biol Psychiatry 2024:S0006-3223(24)01171-5. [PMID: 38521158 DOI: 10.1016/j.biopsych.2024.03.012] [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: 10/18/2023] [Revised: 02/22/2024] [Accepted: 03/06/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is an effective treatment for patients with major depressive disorder (MDD), but its underlying neural mechanisms remain largely unknown. The aim of this study was to identify changes in brain connectome dynamics after ECT in MDD and to explore their associations with treatment outcome. METHODS We collected longitudinal resting-state functional magnetic resonance imaging data from 80 patients with MDD (50 with suicidal ideation [MDD-SI] and 30 without [MDD-NSI]) before and after ECT and 37 age- and sex-matched healthy control participants. A multilayer network model was used to assess modular switching over time in functional connectomes. Support vector regression was used to assess whether pre-ECT network dynamics could predict treatment response in terms of symptom severity. RESULTS At baseline, patients with MDD had lower global modularity and higher modular variability in functional connectomes than control participants. Network modularity increased and network variability decreased after ECT in patients with MDD, predominantly in the default mode and somatomotor networks. Moreover, ECT was associated with decreased modular variability in the left dorsal anterior cingulate cortex of MDD-SI but not MDD-NSI patients, and pre-ECT modular variability significantly predicted symptom improvement in the MDD-SI group but not in the MDD-NSI group. CONCLUSIONS We highlight ECT-induced changes in MDD brain network dynamics and their predictive value for treatment outcome, particularly in patients with SI. This study advances our understanding of the neural mechanisms of ECT from a dynamic brain network perspective and suggests potential prognostic biomarkers for predicting ECT efficacy in patients with MDD.
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Affiliation(s)
- Yuanyuan Guo
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Mingrui Xia
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China; Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China; IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Rong Ye
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China; Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Tongjian Bai
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, China; Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China
| | - Yue Wu
- Department of Psychology and Sleep Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yang Ji
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yue Yu
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Gong-Jun Ji
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China; Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China
| | - Kai Wang
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, China; School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China; Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China; Anhui Institute of Translational Medicine, Hefei, China
| | - Yong He
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China; Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China; IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China; Chinese Institute for Brain Research, Beijing, China.
| | - Yanghua Tian
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, China; School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China; Department of Psychology and Sleep Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology, the Second Affiliated Hospital of Anhui Medical University, Hefei, China.
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15
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Ter Hark SE, Coenen MJH, Vos CF, Aarnoutse RE, Nolen WA, Birkenhager TK, van den Broek WW, Schellekens AFA, Verkes RJ, Janzing JGE. A genetic risk score to predict treatment nonresponse in psychotic depression. Transl Psychiatry 2024; 14:132. [PMID: 38431658 PMCID: PMC10908776 DOI: 10.1038/s41398-024-02842-x] [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: 07/14/2023] [Revised: 02/09/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024] Open
Abstract
Psychotic depression is a severe and difficult-to-treat subtype of major depressive disorder for which higher rates of treatment-resistant depression were found. Studies have been performed aiming to predict treatment-resistant depression or treatment nonresponse. However, most of these studies excluded patients with psychotic depression. We created a genetic risk score (GRS) based on a large treatment-resistant depression genome-wide association study. We tested whether this GRS was associated with nonresponse, nonremission and the number of prior adequate antidepressant trials in patients with a psychotic depression. Using data from a randomized clinical trial with patients with a psychotic depression (n = 122), we created GRS deciles and calculated positive prediction values (PPV), negative predictive values (NPV) and odds ratios (OR). Nonresponse and nonremission were assessed after 7 weeks of treatment with venlafaxine, imipramine or venlafaxine plus quetiapine. The GRS was negatively correlated with treatment response (r = -0.32, p = 0.0023, n = 88) and remission (r = -0.31, p = 0.0037, n = 88), but was not correlated with the number of prior adequate antidepressant trials. For patients with a GRS in the top 10%, we observed a PPV of 100%, a NPV of 73.7% and an OR of 52.4 (p = 0.00072, n = 88) for nonresponse. For nonremission, a PPV of 100%, a NPV of 51.9% and an OR of 21.3 (p = 0.036, n = 88) was observed for patients with a GRS in the top 10%. Overall, an increased risk for nonresponse and nonremission was seen in patients with GRSs in the top 40%. Our results suggest that a treatment-resistant depression GRS is predictive of treatment nonresponse and nonremission in psychotic depression.
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Affiliation(s)
- Sophie E Ter Hark
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands.
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands.
| | - Marieke J H Coenen
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Cornelis F Vos
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Rob E Aarnoutse
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Willem A Nolen
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tom K Birkenhager
- Department of Psychiatry, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - Arnt F A Schellekens
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
- Nijmegen Institute for Scientist Practitioners in Addiction (NISPA), Radboud University, Nijmegen, The Netherlands
| | - Robbert-Jan Verkes
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joost G E Janzing
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
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16
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Rhee TG, Shim SR, Popp JH, Trikalinos TA, Rosenheck RA, Kellner CH, Seiner SJ, Espinoza RT, Forester BP, McIntyre RS. Efficacy and safety of ketamine-assisted electroconvulsive therapy in major depressive episode: a systematic review and network meta-analysis. Mol Psychiatry 2024; 29:750-759. [PMID: 38123725 DOI: 10.1038/s41380-023-02366-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/27/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To meta-analyze clinical efficacy and safety of ketamine compared with other anesthetic agents in the course of electroconvulsive therapy (ECT) in major depressive episode (MDE). METHODS PubMed/MEDLINE, Cochrane Library, Embase, GoogleScholar, and US and European trial registries were searched from inception through May 23, 2023, with no language limits. We included RCTs with (1) a diagnosis of MDE; (2) ECT intervention with ketamine and/or other anesthetic agents; and (3) measures included: depressive symptoms, cognitive performance, remission or response rates, and serious adverse events. Network meta-analysis (NMA) was performed to compare ketamine and 7 other anesthetic agents. Hedges' g standardized mean differences (SMDs) were used for continuous measures, and relative risks (RRs) were used for other binary outcomes using random-effects models. RESULTS Twenty-two studies were included in the systematic review. A total of 2322 patients from 17 RCTs were included in the NMA. The overall pooled SMD of ketamine, as compared with propofol as a reference group, was -2.21 (95% confidence interval [CI], -3.79 to -0.64) in depressive symptoms, indicating that ketamine had better antidepressant efficacy than propofol. In a sensitivity analysis, however, ketamine-treated patients had a worse outcome in cognitive performance than propofol-treated patients (SMD, -0.18; 95% CI, -0.28 to -0.09). No other statistically significant differences were found. CONCLUSIONS Ketamine-assisted ECT is tolerable and may be efficacious in improving depressive symptoms, but a relative adverse impact on cognition may be an important clinical consideration. Anesthetic agents should be considered based on patient profiles and/or preferences to improve effectiveness and safety of ECT use.
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Affiliation(s)
- Taeho Greg Rhee
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA.
- VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, West Haven, CT, USA.
- Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, CT, USA.
| | - Sung Ryul Shim
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Chungcheongnam-do, Republic of Korea
| | - Jonah H Popp
- Center for Evidence Synthesis in Health, Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Thomas A Trikalinos
- Center for Evidence Synthesis in Health, Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Robert A Rosenheck
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, West Haven, CT, USA
| | - Charles H Kellner
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Stephen J Seiner
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Division of Neurotherapeutics, McLean Hospital, Belmont, MA, USA
| | - Randall T Espinoza
- Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, CA, USA
| | - Brent P Forester
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Division of Neurotherapeutics, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Tufts University School of Medicine, Boston, MA, USA
| | - Roger S McIntyre
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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17
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Stuiver S, Pottkämper JCM, Verdijk JPAJ, Ten Doesschate F, van Putten MJAM, Hofmeijer J, van Waarde JA. Restoration of postictal cortical activity after electroconvulsive therapy relates to recovery of orientation in person, place, and time. Eur Psychiatry 2024; 67:e16. [PMID: 38351599 DOI: 10.1192/j.eurpsy.2024.10] [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: 03/08/2024] Open
Abstract
BACKGROUND Most patients show temporary impairments in clinical orientation after electroconvulsive therapy (ECT)-induced seizures. It is unclear how postictal reorientation relates to electroencephalography (EEG) restoration. This relationship may provide additional measures to quantify postictal recovery and shed light on neurophysiological aspects of reorientation after ECT. METHODS We analyzed prospectively collected clinical and continuous ictal and postictal EEG data from ECT patients. Postictal EEG restoration up to 1 h was estimated by the evolution of the normalized alpha-delta ratio (ADR). Times to reorientation in the cognitive domains of person, place, and time were assessed postictally. In each cognitive domain, a linear mixed model was fitted to investigate the relationships between time to reorientation and postictal EEG restoration. RESULTS In total, 272 pairs of ictal-postictal EEG and reorientation times of 32 patients were included. In all domains, longer time to reorientation was associated with slower postictal EEG recovery. Longer seizure duration and postictal administration of midazolam were related to longer time to reorientation in all domains. At 1-hour post-seizure, most patients were clinically reoriented, while their EEG had only partly restored. CONCLUSIONS We show a relationship between postictal EEG restoration and clinical reorientation after ECT-induced seizures. EEG was more sensitive than reorientation time in all domains to detect postictal recovery beyond 1-hour post-seizure. Our findings indicate that clinical reorientation probably depends on gradual cortical synaptic recovery, with longer seizure duration leading to longer postsynaptic suppression after ECT seizures.
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Affiliation(s)
- Sven Stuiver
- Technical Medical Centre, Faculty of Science and Technology, Clinical Neurophysiology, University of Twente, Enschede, The Netherlands
- Department of Psychiatry, Rijnstate Hospital, Arnhem, The Netherlands
| | - Julia C M Pottkämper
- Technical Medical Centre, Faculty of Science and Technology, Clinical Neurophysiology, University of Twente, Enschede, The Netherlands
- Department of Psychiatry, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Neurology and Clinical Neurophysiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Joey P A J Verdijk
- Technical Medical Centre, Faculty of Science and Technology, Clinical Neurophysiology, University of Twente, Enschede, The Netherlands
- Department of Psychiatry, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Michel J A M van Putten
- Technical Medical Centre, Faculty of Science and Technology, Clinical Neurophysiology, University of Twente, Enschede, The Netherlands
| | - Jeannette Hofmeijer
- Technical Medical Centre, Faculty of Science and Technology, Clinical Neurophysiology, University of Twente, Enschede, The Netherlands
- Department of Neurology and Clinical Neurophysiology, Rijnstate Hospital, Arnhem, The Netherlands
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18
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Bruin WB, Oltedal L, Bartsch H, Abbott C, Argyelan M, Barbour T, Camprodon J, Chowdhury S, Espinoza R, Mulders P, Narr K, Oudega M, Rhebergen D, Ten Doesschate F, Tendolkar I, van Eijndhoven P, van Exel E, van Verseveld M, Wade B, van Waarde J, Zhutovsky P, Dols A, van Wingen G. Development and validation of a multimodal neuroimaging biomarker for electroconvulsive therapy outcome in depression: a multicenter machine learning analysis. Psychol Med 2024; 54:495-506. [PMID: 37485692 DOI: 10.1017/s0033291723002040] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is the most effective intervention for patients with treatment resistant depression. A clinical decision support tool could guide patient selection to improve the overall response rate and avoid ineffective treatments with adverse effects. Initial small-scale, monocenter studies indicate that both structural magnetic resonance imaging (sMRI) and functional MRI (fMRI) biomarkers may predict ECT outcome, but it is not known whether those results can generalize to data from other centers. The objective of this study was to develop and validate neuroimaging biomarkers for ECT outcome in a multicenter setting. METHODS Multimodal data (i.e. clinical, sMRI and resting-state fMRI) were collected from seven centers of the Global ECT-MRI Research Collaboration (GEMRIC). We used data from 189 depressed patients to evaluate which data modalities or combinations thereof could provide the best predictions for treatment remission (HAM-D score ⩽7) using a support vector machine classifier. RESULTS Remission classification using a combination of gray matter volume and functional connectivity led to good performing models with average 0.82-0.83 area under the curve (AUC) when trained and tested on samples coming from the three largest centers (N = 109), and remained acceptable when validated using leave-one-site-out cross-validation (0.70-0.73 AUC). CONCLUSIONS These results show that multimodal neuroimaging data can be used to predict remission with ECT for individual patients across different treatment centers, despite significant variability in clinical characteristics across centers. Future development of a clinical decision support tool applying these biomarkers may be feasible.
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Affiliation(s)
- Willem Benjamin Bruin
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Leif Oltedal
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Hauke Bartsch
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Christopher Abbott
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Miklos Argyelan
- The Feinstein Institutes for Medical Research, Manhasset, NY, USA
- The Zucker Hillside Hospital, Glen Oaks, NY, USA
| | - Tracy Barbour
- Division of Neuropsychiatry and Neuromodulation, Massachusetts General Hospital, Harvard Medical School. Boston, MA, USA
| | - Joan Camprodon
- Division of Neuropsychiatry and Neuromodulation, Massachusetts General Hospital, Harvard Medical School. Boston, MA, USA
| | - Samadrita Chowdhury
- Division of Neuropsychiatry and Neuromodulation, Massachusetts General Hospital, Harvard Medical School. Boston, MA, USA
| | - Randall Espinoza
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, USA
| | - Peter Mulders
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, The Netherlands
| | - Katherine Narr
- Ahmanson-Lovelace Brain Mapping Center, Departments of Neurology, and Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, USA
| | - Mardien Oudega
- Department of Old Age Psychiatry, GGZinGeest, Department of Psychiatry, Amsterdam UMC, location VUmc, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Didi Rhebergen
- Mental Health Institute GGZ Centraal, Amersfoort; Department of Psychiatry, Amsterdam UMC, location VUmc, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Freek Ten Doesschate
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Rijnstate, Department of Psychiatry, Arnhem, The Netherlands
| | - Indira Tendolkar
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, The Netherlands
| | - Philip van Eijndhoven
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, The Netherlands
| | - Eric van Exel
- Department of Old Age Psychiatry, GGZinGeest, Department of Psychiatry, Amsterdam UMC, location VUmc, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | | | - Benjamin Wade
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, UCLA, Los Angeles, USA
| | | | - Paul Zhutovsky
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Annemiek Dols
- Department of Old Age Psychiatry, GGZinGeest, Department of Psychiatry, Amsterdam UMC, location VUmc, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Guido van Wingen
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, The Netherlands
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19
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Argyelan M, Deng ZD, Ousdal OT, Oltedal L, Angulo B, Baradits M, Spitzberg AJ, Kessler U, Sartorius A, Dols A, Narr KL, Espinoza R, van Waarde JA, Tendolkar I, van Eijndhoven P, van Wingen GA, Takamiya A, Kishimoto T, Jorgensen MB, Jorgensen A, Paulson OB, Yrondi A, Péran P, Soriano-Mas C, Cardoner N, Cano M, van Diermen L, Schrijvers D, Belge JB, Emsell L, Bouckaert F, Vandenbulcke M, Kiebs M, Hurlemann R, Mulders PC, Redlich R, Dannlowski U, Kavakbasi E, Kritzer MD, Ellard KK, Camprodon JA, Petrides G, Malhotra AK, Abbott CC. Electroconvulsive therapy-induced volumetric brain changes converge on a common causal circuit in depression. Mol Psychiatry 2024; 29:229-237. [PMID: 37985787 PMCID: PMC11116108 DOI: 10.1038/s41380-023-02318-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/23/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023]
Abstract
Neurostimulation is a mainstream treatment option for major depression. Neuromodulation techniques apply repetitive magnetic or electrical stimulation to some neural target but significantly differ in their invasiveness, spatial selectivity, mechanism of action, and efficacy. Despite these differences, recent analyses of transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS)-treated individuals converged on a common neural network that might have a causal role in treatment response. We set out to investigate if the neuronal underpinnings of electroconvulsive therapy (ECT) are similarly associated with this causal depression network (CDN). Our aim here is to provide a comprehensive analysis in three cohorts of patients segregated by electrode placement (N = 246 with right unilateral, 79 with bitemporal, and 61 with mixed) who underwent ECT. We conducted a data-driven, unsupervised multivariate neuroimaging analysis Principal Component Analysis (PCA) of the cortical and subcortical volume changes and electric field (EF) distribution to explore changes within the CDN associated with antidepressant outcomes. Despite the different treatment modalities (ECT vs TMS and DBS) and methodological approaches (structural vs functional networks), we found a highly similar pattern of change within the CDN in the three cohorts of patients (spatial similarity across 85 regions: r = 0.65, 0.58, 0.40, df = 83). Most importantly, the expression of this pattern correlated with clinical outcomes (t = -2.35, p = 0.019). This evidence further supports that treatment interventions converge on a CDN in depression. Optimizing modulation of this network could serve to improve the outcome of neurostimulation in depression.
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Affiliation(s)
- Miklos Argyelan
- Feinstein Institutes for Medical Research, Institute of Behavioral Science, Manhasset, NY, USA.
- The Zucker Hillside Hospital, Glen Oaks, NY, USA.
| | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Olga Therese Ousdal
- Department of Biomedicine, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Leif Oltedal
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Brian Angulo
- Feinstein Institutes for Medical Research, Institute of Behavioral Science, Manhasset, NY, USA
| | - Mate Baradits
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | | | - Ute Kessler
- Department of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Hungary
| | - Alexander Sartorius
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Annemiek Dols
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Neuroscience, Amsterdam, The Netherlands
| | - Katherine L Narr
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Randall Espinoza
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Indira Tendolkar
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, the Netherlands
| | - Philip van Eijndhoven
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, the Netherlands
| | - Guido A van Wingen
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Akihiro Takamiya
- Department of Neuropsychiatry Keio University School of Medicine, Tokyo, Japan
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Belgium
| | - Taishiro Kishimoto
- Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan
| | - Martin B Jorgensen
- Psychiatric Center Copenhagen and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anders Jorgensen
- Psychiatric Center Copenhagen and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Olaf B Paulson
- Neurobiological Research Unit Rigshospitalet and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Antoine Yrondi
- Service de Psychiatrie et Psychologie Médicale, Centre Expert Dépression Résistante, Fondation Fondamental, CHU Toulouse, ToNIC, Toulouse NeuroImaging Center, Univerité de Toulouse, Inserm, UPS, Toulouse, France
| | - Patrice Péran
- ToNIC, Toulouse NeuroImaging Center, Univeristé de Toulouse, Inserm, UPS, Toulouse, France
| | - Carles Soriano-Mas
- Department of Social Psychology and Quantitative Psychology, Universitat de Barcelona-UB, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, Barcelona, Spain
- CIBERSAM, Carlos III Health Institute, Madrid, Spain
| | - Narcis Cardoner
- CIBERSAM, Carlos III Health Institute, Madrid, Spain
- Sant Pau Mental Health Research Group, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, School of Medicine Bellaterra, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Cano
- CIBERSAM, Carlos III Health Institute, Madrid, Spain
- Sant Pau Mental Health Research Group, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Linda van Diermen
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Psychiatric Center Bethanie, Andreas Vesaliuslaan 39, 2980, Zoersel, Belgium
| | - Didier Schrijvers
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- University Psychiatric Center Duffel, Stationstraat 22, Duffel, 2570, Belgium
| | - Jean-Baptiste Belge
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Psychiatry, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Louise Emsell
- Geriatric Psychiatry, University Psychiatric Center-KU Leuven, Leuven, Belgium
| | - Filip Bouckaert
- Geriatric Psychiatry, University Psychiatric Center-KU Leuven, Leuven, Belgium
| | | | - Maximilian Kiebs
- School of Medicine & Health Sciences University Hospital Oldenburg, Oldenburg, Germany
- Department of Psychiatry and Psychotherapy University Hospital Bonn, Bonn, Germany
| | - René Hurlemann
- School of Medicine & Health Sciences University Hospital Oldenburg, Oldenburg, Germany
| | - Peter Cr Mulders
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, the Netherlands
| | - Ronny Redlich
- Department of Psychology, University of Halle, Halle, Germany
- German Center for Mental Health (DZPG), Site Jena-Magdeburg-Halle, Halle, Germany
| | - Udo Dannlowski
- Department of Translational Psychiatry, University of Muenster, Muenster, Germany
| | - Erhan Kavakbasi
- Department of Mental Health, University of Muenster, Muenster, Germany
| | - Michael D Kritzer
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristen K Ellard
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joan A Camprodon
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Anil K Malhotra
- Feinstein Institutes for Medical Research, Institute of Behavioral Science, Manhasset, NY, USA
- The Zucker Hillside Hospital, Glen Oaks, NY, USA
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20
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Ernstsson O, Heintz E, Nordenskjöld A, Johnson JA, Korkmaz S, Zethraeus N. Association between pulse width and health-related quality of life after electroconvulsive therapy in patients with unipolar or bipolar depression: an observational register-based study. Nord J Psychiatry 2024; 78:137-145. [PMID: 38079191 DOI: 10.1080/08039488.2023.2289915] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/12/2023] [Indexed: 02/02/2024]
Abstract
AIMS To examine the association between pulse width and HRQoL measured within one week after electroconvulsive therapy (ECT) and at six-month follow-up in patients with unipolar or bipolar depression. METHODS This was an observational register study using data from the Swedish National Quality Registry for ECT (2011-2019). Inclusion criteria were: age ≥18 years; index treatment for unipolar/bipolar depression; unilateral electrode placement; information on pulse width; EQ-5D measurements before and after ECT. Multiple linear regressions were performed to investigate the association between pulse width (<0.5 ms; 0.5 ms; >0.5 ms) and HRQoL (EQ-5D-3L index; EQ VAS) one week after ECT (primary outcome) and six months after ECT (secondary outcome). RESULTS The sample included 5,046 patients with unipolar (82%) or bipolar (18%) depression. At first ECT session, 741 patients (14.7%) had pulse width <0.5 ms, 3,639 (72.1%) had 0.5 ms, and 666 (13.2%) had >0.5 ms. There were no statistically significant associations between pulse width and HRQoL one week after ECT. In the subsample of patients with an EQ-5D index recorded six months after ECT (n = 730), patients receiving 0.5 ms had significantly lower HRQoL (-0.089) compared to <0.5 ms, after adjusting for demographic and clinical characteristics (p = .011). The corresponding analysis for EQ VAS did not show any statistically significant associations. CONCLUSION No robust associations were observed between pulse width and HRQoL after ECT. On average, significant improvements in HRQoL were observed one week and six months after ECT for patients with unipolar or bipolar disease, independent of the pulse width received.
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Affiliation(s)
- Olivia Ernstsson
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Emelie Heintz
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
- Centre for Health Economics, Informatics and Health Services Research, Stockholm Health Care Services, Stockholm, Sweden
| | - Axel Nordenskjöld
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | | | - Seher Korkmaz
- Department of Digitalization and IT, Health and Care Administration, Stockholm, Sweden
| | - Niklas Zethraeus
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
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21
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Miskowiak KW, Petersen JZ, Macoveanu J, Ysbæk-Nielsen AT, Lindegaard IA, Cramer K, Mogensen MB, Hammershøj LG, Stougaard ME, Jørgensen JL, Schmidt LS, Vinberg M, Ehrenreich H, Hageman I, Videbech P, Gbyl K, Kellner CH, Kessing LV, Jørgensen MB. Effect of erythropoietin on cognitive side-effects of electroconvulsive therapy in depression: A randomized, double-blind, placebo-controlled trial. Eur Neuropsychopharmacol 2024; 79:38-48. [PMID: 38128460 DOI: 10.1016/j.euroneuro.2023.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
Electroconvulsive therapy (ECT) is one of the most effective and rapid-acting treatment for severe depression but is associated with cognitive side-effects. Identification of add-on treatments that counteract these side-effects would be very helpful. This randomized, double-blinded, placebo-controlled, parallel-group study investigated the effects of four add-on erythropoietin (EPO; 40,000 IU/ml) or saline (placebo) infusions over 2.5 weeks of ECT (eight ECT sessions) in severely depressed patients with unipolar or bipolar depression. Neuropsychological assessments were conducted pre-ECT, three days after the eighth ECT (week 4), and at a 3-month follow-up. Further, functional magnetic resonance imaging (fMRI) was conducted after the eighth ECT. The primary outcome was change from pre- to post-ECT in a 'speed of complex cognitive processing' composite. Secondary outcomes were verbal and autobiographical memory. Of sixty randomized patients, one dropped out before baseline. Data were thus analysed for 59 patients (EPO, n = 33; saline, n = 26), of whom 28 had fMRI data. No ECT-related decline occurred in the primary global cognition measure (ps≥0.1), and no effect of EPO versus saline was observed on this outcome (ps≥0.3). However post-ECT, EPO-treated patients exhibited faster autobiographical memory recall than saline-treated patients (p = 0.02), which was accompanied by lower memory-related parietal cortex activity. The absence of global cognition changes with ECT and EPO, coupled with the specific impact of EPO on autobiographical memory recall speed and memory-related parietal cortex activity, suggests that assessing autobiographical memory may provide increased sensitivity in evaluating and potentially preventing cognitive side-effects of ECT. TRIAL REGISTRATIONS: ClinicalTrials.gov: NCT03339596, EudraCT no.: 2016-002326-36.
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Affiliation(s)
- Kamilla W Miskowiak
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark; Neurocognition and Emotion in Affective Disorders Centre (NEAD), Department of Psychology, University of Copenhagen, and Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark.
| | - Jeff Z Petersen
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Julian Macoveanu
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Alexander T Ysbæk-Nielsen
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark; Neurocognition and Emotion in Affective Disorders Centre (NEAD), Department of Psychology, University of Copenhagen, and Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Ida A Lindegaard
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark; Neurocognition and Emotion in Affective Disorders Centre (NEAD), Department of Psychology, University of Copenhagen, and Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Katrine Cramer
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Madel B Mogensen
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Lisa G Hammershøj
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Marie E Stougaard
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Josefine L Jørgensen
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Lejla Sjanic Schmidt
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Maj Vinberg
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; The Early Multimodular Prevention and Intervention Research Institution (EMPIRI), Mental Health Centre, Northern Zealand, Copenhagen University Hospital, Mental Health Services, Capital Region of Denmark, Denmark
| | - Hannelore Ehrenreich
- Clincial Neuroscience, Max-Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
| | - Ida Hageman
- Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Poul Videbech
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Psychiatric Centre Glostrup, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Krzysztof Gbyl
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Psychiatric Centre Glostrup, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Charles H Kellner
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Lars V Kessing
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Martin B Jørgensen
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Ren H, Wang X, Zhang Z, Zhong X, Luo Q, Qiu H, Huang Y. Electroconvulsive therapy for adolescents with severe depressive episode and suicidality: retrospective comparison between responders and non-responders. Child Adolesc Psychiatry Ment Health 2024; 18:13. [PMID: 38245725 PMCID: PMC10800036 DOI: 10.1186/s13034-023-00701-z] [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: 08/24/2023] [Accepted: 12/29/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND For adolescents with major depression who exhibit suicidal tendencies, Electroconvulsive Therapy (ECT) is increasingly adopted in clinical practice. Yet, the precise mechanisms behind its effectiveness remain elusive, and studies on factors that influence treatment outcomes are scarce. METHODS In this retrospective comparative study, we included all adolescent severe depressive episode patients with suicidal tendencies admitted to the Psychiatry Department of the First Affiliated Hospital of Chongqing Medical University between 2017 and 2021 and received ECT treatment. By collecting data on personal history, medical history, and standard treatment features, we established demographic, disease, medication, and ECT treatment factors variables. Patients were divided into effective and ineffective groups based on the Clinical Global Impressions-Improvement (CGI-I) scale scores, and differences between outcomes were compared. Logistic regression analyses were used to identify factors independently associated with ineffectiveness. RESULTS A total of 494 adolescent severe depressive episode patients with suicidal behavior who received ECT were included in this study. According to CGI-I scores, the treatment was effective in 361 patients (73.1%) and ineffective in 133 patients (26.9%). Logistic regression analyses showed that 8 to 12 and 12 to 16 ECT sessions reduced the risk of ineffectiveness compared to fewer than 4 sessions. The risk of ineffectiveness decreased with age and increased with comorbidity with obsessive-compulsive disorder (OCD). Compared to sertraline, escitalopram was associated with a heightened risk of futility, whereas olanzapine and aripiprazole demonstrated a reduced risk when contrasted with quetiapine. CONCLUSIONS ECT's ineffectiveness in treating adolescent severe depressive episode with suicidal behavior decreases with age, and comorbidity with OCD significantly increases the risk of treatment failure. Fewer than 8 ECT sessions may hinder achieving satisfactory results.
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Affiliation(s)
- Hao Ren
- The First Affiliated Hospital of Chongqing Medical University, ChongQing, China
- Chongqing Changshou District, Mental Health Center, ChongQing, China
| | - Xinglian Wang
- The First Affiliated Hospital of Chongqing Medical University, ChongQing, China
| | - Zheng Zhang
- The First Affiliated Hospital of Chongqing Medical University, ChongQing, China
| | - Xiufen Zhong
- The First Affiliated Hospital of Chongqing Medical University, ChongQing, China
- Chongqing Mental Health Center, ChongQing, China
| | - Qinghua Luo
- The First Affiliated Hospital of Chongqing Medical University, ChongQing, China
| | - Haitang Qiu
- The First Affiliated Hospital of Chongqing Medical University, ChongQing, China.
| | - Yan Huang
- Chongqing Tradit Chinese Medicine Hospital, ChongQing, China.
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23
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Sellevåg K, Bartz-Johannessen CA, Oedegaard KJ, Nordenskjöld A, Mohn C, Bjørke JS, Kessler U. Unmasking patient diversity: Exploring cognitive and antidepressive effects of electroconvulsive therapy. Eur Psychiatry 2024; 67:e12. [PMID: 38214065 DOI: 10.1192/j.eurpsy.2024.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is an established treatment for depression, but more data on effectiveness and safety in clinical practice is needed. The aim of this register-based study was to investigate short-term effectiveness and cognitive safety after ECT, evaluated by clinicians and patients. Secondary, we investigated predictors for remission and cognitive decline. METHODS The study included 392 patients from the Regional Register for Neurostimulation Treatment in Western Norway. Depressive symptoms and cognitive function were assessed with Montgomery-Åsberg Depression Rating Scale and Mini-Mental State Examination (clinician-rated) and Beck Depression Inventory and Everyday Memory Questionnaire (patient-rated). Assessments were done prior to ECT-series and a mean of 1.7 days after (range 6 days before and 12 days after) end of ECT-series. Paired samples t-tests were extended by detailed, clinically relevant subgroups. Predictors were examined using logistic regression. RESULTS Clinician- and patient-rated remission rates were 49.5 and 41.0%, respectively. There was a large reduction in depressive symptoms and a small improvement in cognition after ECT, but we also identified subgroups with non-response of ECT in combination with cognitive decline (4.6% clinician-rated, 15.7% patient-rated). Positive predictors for patient- and clinician-rated remission were increasing age, shorter duration of depressive episode, and psychotic features. Antipsychotic medication at the commencement of treatment and previous ECT-treatment gave higher odds of clinician-rated remission, whereas higher pretreatment subjective depression level was associated with lower odds for patient-rated remission. Clinician-rated cognitive decline was predicted by higher pretreatment MMSE scores, whereas psychotic features, increasing age, and greater pretreatment subjective memory concerns were associated with lower odds for patient-rated cognitive decline. CONCLUSIONS Our study supports ECT as an effective and safe treatment, although subgroups have a less favorable outcome. ECT should be considered at an early stage for older patients suffering from depression with psychotic features. Providing comprehensive and balanced information from clinicians and patients perspectives on effects and side effects, may assist in a joint consent process.
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Affiliation(s)
- Kjersti Sellevåg
- NKS Olaviken Gerontopsychiatric Hospital, Askøy, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christoffer A Bartz-Johannessen
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ketil J Oedegaard
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Axel Nordenskjöld
- The University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Christine Mohn
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- National Centre for Suicide Research and Prevention (NSSF), Department of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jeanette S Bjørke
- Psychiatric Division, Stavanger University Hospital, Stavanger, Norway
| | - Ute Kessler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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24
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Belge JB, Mulders P, Van Diermen L, Sienaert P, Sabbe B, Abbott CC, Tendolkar I, Schrijvers D, van Eijndhoven P. Reviewing the neurobiology of electroconvulsive therapy on a micro- meso- and macro-level. Prog Neuropsychopharmacol Biol Psychiatry 2023; 127:110809. [PMID: 37331685 DOI: 10.1016/j.pnpbp.2023.110809] [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: 01/22/2023] [Revised: 05/27/2023] [Accepted: 06/07/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) remains the one of the most effective of biological antidepressant interventions. However, the exact neurobiological mechanisms underlying the efficacy of ECT remain unclear. A gap in the literature is the lack of multimodal research that attempts to integrate findings at different biological levels of analysis METHODS: We searched the PubMed database for relevant studies. We review biological studies of ECT in depression on a micro- (molecular), meso- (structural) and macro- (network) level. RESULTS ECT impacts both peripheral and central inflammatory processes, triggers neuroplastic mechanisms and modulates large scale neural network connectivity. CONCLUSIONS Integrating this vast body of existing evidence, we are tempted to speculate that ECT may have neuroplastic effects resulting in the modulation of connectivity between and among specific large-scale networks that are altered in depression. These effects could be mediated by the immunomodulatory properties of the treatment. A better understanding of the complex interactions between the micro-, meso- and macro- level might further specify the mechanisms of action of ECT.
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Affiliation(s)
- Jean-Baptiste Belge
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Psychiatry, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - Peter Mulders
- Department of Psychiatry, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, P.O. Box 9010, 6500 GL Nijmegen, The Netherlands
| | - Linda Van Diermen
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Psychiatric Center Bethanië, Andreas Vesaliuslaan 39, Zoersel 2980, Belgium
| | - Pascal Sienaert
- KU Leuven - University of Leuven, University Psychiatric Center KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), Leuvensesteenweg 517, Kortenberg 3010, Belgium
| | - Bernard Sabbe
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Indira Tendolkar
- Department of Psychiatry, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, P.O. Box 9010, 6500 GL Nijmegen, The Netherlands
| | - Didier Schrijvers
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Psychiatry, University Psychiatric Center Duffel, Stationstraat 22, Duffel 2570, Belgium
| | - Philip van Eijndhoven
- Department of Psychiatry, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, P.O. Box 9010, 6500 GL Nijmegen, The Netherlands
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Wade B, Pindale R, Camprodon J, Luccarelli J, Li S, Meisner R, Seiner S, Henry M. Individual Prediction of Optimal Treatment Allocation Between Electroconvulsive Therapy or Ketamine using the Personalized Advantage Index. RESEARCH SQUARE 2023:rs.3.rs-3682009. [PMID: 38077094 PMCID: PMC10705694 DOI: 10.21203/rs.3.rs-3682009/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Introduction Electroconvulsive therapy (ECT) and ketamine are two effective treatments for depression with similar efficacy; however, individual patient outcomes may be improved by models that predict optimal treatment assignment. Here, we adapt the Personalized Advantage Index (PAI) algorithm using machine learning to predict optimal treatment assignment between ECT and ketamine using medical record data from a large, naturalistic patient cohort. We hypothesized that patients who received a treatment predicted to be optimal would have significantly better outcomes following treatment compared to those who received a non-optimal treatment. Methods Data on 2526 ECT and 235 mixed IV ketamine and esketamine patients from McLean Hospital was aggregated. Depressive symptoms were measured using the Quick Inventory of Depressive Symptomatology (QIDS) before and during acute treatment. Patients were matched between treatments on pretreatment QIDS, age, inpatient status, and psychotic symptoms using a 1:1 ratio yielding a sample of 470 patients (n=235 per treatment). Random forest models were trained and predicted differential patientwise minimum QIDS scores achieved during acute treatment (min-QIDS) scores for ECT and ketamine using pretreatment patient measures. Analysis of Shapley Additive exPlanations (SHAP) values identified predictors of differential outcomes between treatments. Results Twenty-seven percent of patients with the largest PAI scores who received a treatment predicted optimal had significantly lower min-QIDS scores compared to those who received a non-optimal treatment (mean difference=1.6, t=2.38, q<0.05, Cohen's D=0.36). Analysis of SHAP values identified prescriptive pretreatment measures. Conclusions Patients assigned to a treatment predicted to be optimal had significantly better treatment outcomes. Our model identified pretreatment patient factors captured in medical records that can provide interpretable and actionable guidelines treatment selection.
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Affiliation(s)
- Benjamin Wade
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ryan Pindale
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Joan Camprodon
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - James Luccarelli
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Shuang Li
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Robert Meisner
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Stephen Seiner
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Michael Henry
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Schukking N, Scheepstra KWF, Bergfeld IO, van Waarde JA, Tendolkar I, Spaans HP, Hegeman AJM, Scheepens DS, Lok A. A Multicenter Retrospective Chart Review on the Effectiveness and Tolerability of Electroconvulsive Therapy in Adolescents and Young Adults With Major Depressive Disorder or Bipolar Depression. J ECT 2023:00124509-990000000-00119. [PMID: 37984354 DOI: 10.1097/yct.0000000000000978] [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: 11/22/2023]
Abstract
BACKGROUND Major depressive disorder and bipolar depression in adolescents and young adults are prevalent and major contributors to the global burden of disease, whereas effective interventions are limited. Available evidence is insufficient to assess effectiveness and tolerability of electroconvulsive therapy in depressed adolescents and young adults. METHODS A retrospective chart review was conducted in patients with major depressive disorder or bipolar depression who underwent electroconvulsive therapy from 2001 to 2021 in 12 centers in the Netherlands. Patients were classified as young (15-25 years) and older adults (26-80 years). Primary outcome was effectiveness, expressed as response (≥50% reduction in rating scale score compared with baseline) and remission. Rating scale scores were cross-sectionally assessed at baseline and at the end of the index course. Outcomes of remitters were included in responders. Secondary outcome was occurrence of subjective cognitive impairment and adverse events. Long-term outcomes were not available. RESULTS In the young (n = 57) and older adult (n = 41) group, 40.4% and 56.1% (P = 0.153) of patients achieved response and 28.1% and 39.0% (P = 0.281) remission, respectively. Subjective cognitive impairment (80.5% vs 56.3%; P = 0.001) and transient cardiac arrhythmia (14.6% vs 2.8%; P = 0.020) were reported significantly more frequently in the older adult group. CONCLUSIONS Despite significantly more comorbidity of personality disorders, autism spectrum disorders, and anxiety disorders, effectiveness in the young was similar to the older adults. Tolerability was even superior in the young, despite significantly more bilateral treatment. Electroconvulsive therapy could be considered a viable treatment option in depressed adolescents and young adults.
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Affiliation(s)
- Nout Schukking
- From the Department of Adult Psychiatry, Amsterdam UMC, University of Amsterdam
| | | | | | | | - Indira Tendolkar
- Department of Psychiatry, Donders Institute for Brain, Cognition, and Behavior, Nijmegen
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Takamiya A, Kishimoto T, Mimura M. What Can We Tell About the Effect of Electroconvulsive Therapy on the Human Hippocampus? Clin EEG Neurosci 2023; 54:584-593. [PMID: 34547937 DOI: 10.1177/15500594211044066] [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: 11/16/2022]
Abstract
Electroconvulsive therapy (ECT) is the most effective antidepressant treatment, although its mechanisms of action remain unclear. Since 2010, several structural magnetic resonance imaging studies based on a neuroplastic hypothesis have consistently reported increases in the hippocampal volume following ECT. Moreover, volume increases in the human dentate gyrus, where neurogenesis occurs, have also been reported. These results are in line with the preclinical findings of ECT-induced neuroplastic changes, including neurogenesis, gliogenesis, synaptogenesis, and angiogenesis, in rodents and nonhuman primates. Despite this robust evidence of an effect of ECT on hippocampal plasticity, the clinical relevance of these human hippocampal changes continues to be questioned. This narrative review summarizes recent findings regarding ECT-induced hippocampal volume changes. Furthermore, this review also discusses methodological considerations and future directions in this field.
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Affiliation(s)
- Akihiro Takamiya
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Taishiro Kishimoto
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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Feenstra TC, la Cruz EKJ, Obbels J, Laroy M, Bouckaert F, Sienaert P, Oudega M, Dols A, van Exel E, Beekman ATF, Rhebergen D. The Cortisol Awakening Response as a Biomarker for Cognitive Side-Effects of Electroconvulsive Therapy. Am J Geriatr Psychiatry 2023; 31:991-995. [PMID: 37479670 DOI: 10.1016/j.jagp.2023.07.004] [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: 06/06/2023] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE To test whether the cortisol awakening response (CAR) could be a biomarker for cognitive decline during electroconvulsive therapy (ECT). METHODS We studied 50 older patients with depression who were treated with ECT from the MODECT cohort. We used linear regression analyses to examine the association between CAR and cognitive change, assessed by the change in Mini Mental State Examination scores between baseline and 1 week after ECT course. CAR was assessed by the area under the curve of cortisol levels, according to Pruessner's-formula. Associations were adjusted for putative confounders, based on previous literature and availability. RESULTS We found no significant associations between the CAR and cognitive change during the ECT course in (un)adjusted models. CONCLUSION Our results indicate that the CAR is not usable as a biomarker for ECT-induced cognitive decline during ECT course. Further research in cohorts with larger samples is needed.
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Affiliation(s)
- Thomas C Feenstra
- GGZ Centraal Mental Health Care (TCF, EKJLC, DR), Amersfoort, The Netherlands; Amsterdam Public Health Research Institute, Mental Health Program (TCF, ATFB, DR), Amsterdam, The Netherlands.
| | - Eldon K J la Cruz
- GGZ Centraal Mental Health Care (TCF, EKJLC, DR), Amersfoort, The Netherlands
| | - Jasmien Obbels
- Department of Neurosciences (JO, ML, FB, PS), Academic Center for ECT and Neuromodulation (AcCENT), KU Leuven, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Maarten Laroy
- Department of Neurosciences (JO, ML, FB, PS), Academic Center for ECT and Neuromodulation (AcCENT), KU Leuven, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Filip Bouckaert
- Department of Neurosciences (JO, ML, FB, PS), Academic Center for ECT and Neuromodulation (AcCENT), KU Leuven, University Psychiatric Center KU Leuven, Leuven, Belgium; Department of Geriatric Psychiatry (FB), KU Leuven, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Pascal Sienaert
- Department of Neurosciences (JO, ML, FB, PS), Academic Center for ECT and Neuromodulation (AcCENT), KU Leuven, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Mardien Oudega
- Department of Psychiatry (MO, AD, ATFB, DR), Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; GGZ inGeest Mental Health Care (MO, EVE, ATFB), Amsterdam, The Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program (MO, AD, EVE), Amsterdam, The Netherlands
| | - Annemieke Dols
- Department of Psychiatry (AD), University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Psychiatry (MO, AD, ATFB, DR), Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program (MO, AD, EVE), Amsterdam, The Netherlands
| | - Eric van Exel
- GGZ inGeest Mental Health Care (MO, EVE, ATFB), Amsterdam, The Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program (MO, AD, EVE), Amsterdam, The Netherlands
| | - Aartjan T F Beekman
- Amsterdam Public Health Research Institute, Mental Health Program (TCF, ATFB, DR), Amsterdam, The Netherlands; Department of Psychiatry (MO, AD, ATFB, DR), Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; GGZ inGeest Mental Health Care (MO, EVE, ATFB), Amsterdam, The Netherlands
| | - Didi Rhebergen
- GGZ Centraal Mental Health Care (TCF, EKJLC, DR), Amersfoort, The Netherlands; Amsterdam Public Health Research Institute, Mental Health Program (TCF, ATFB, DR), Amsterdam, The Netherlands; Department of Psychiatry (MO, AD, ATFB, DR), Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Zhu Y, Wang F, Wang F, Liu H, Guo X, Wang Z, He R, Wu X, Cao L, Wu Z, Peng D, Fang Y. Program of algorithm for pharmacological treatment of major depressive disorder in China: Benefits or not? Heliyon 2023; 9:e20951. [PMID: 37920522 PMCID: PMC10618797 DOI: 10.1016/j.heliyon.2023.e20951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 11/04/2023] Open
Abstract
Background This research was designed to investigate Algorithm Guided Treatment (AGT) and clinical traits for the prediction of antidepressant treatment outcomes in Chinese patients with major depressive disorder (MDD). Methods This study included 581 patients who had reached treatment response and 406 patients remained non-responded observed after three months of treatment. Sociodemographic factors, clinical traits, and psychiatric rating scales for evaluating therapeutic responses between the two groups were compared. Logistic regression analysis was adopted to determine the risk factors of unresponsive to antidepressant (URA) in MDD. Kaplan-Meier survival analysis was utilized to compare the therapeutic response between AGT and treatment as usual (TAU). Results Compared to the MDD responsive to antidepressant (RA) group, the URA group had significantly lower rates of the following clinical traits: married status, anxious distress, moderate to severe depressive symptoms, and higher rates of comorbidity (p-value < 0.05). Logistic Regression Analysis showed that eight clinical traits from psychiatric rating scales, such as anxious characteristics, were correlated positively with URA, while the other eight symptoms, such as autonomic symptoms, were negatively correlated. Time to symptomatic remission was longer in TAU without statistically significant (p-value = 0.11) by log-rank testing. Conclusions The factors may affect the therapeutic responses and compliance of patients, increasing the non-response risk for antidepressants. Therapeutic responses might be improved by increasing the clarification and elucidation of different symptom clusters of patients. Benefits on treatment response to AGT were not found in our study, indicating a one-size-fits-all approach may not work.Trial Registration: We registered as a clinical trial at the International Clinical Trials Registry Platform (No. NCT01764867) and obtained ethical approval 2012-42 from SMHC.
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Affiliation(s)
- Yuncheng Zhu
- Division of Mood Disorders, Shanghai Hongkou Mental Health Center, Shanghai, 200083, China
- Clinical Research Center, Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
- Clinical Research Center for Mental Health, School of Medicine, Shanghai University, Shanghai, 200083, China
| | - Fang Wang
- Shanghai Yangpu Mental Health Center, Shanghai, 200093, China
| | - Fan Wang
- Clinical Research Center, Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Hongmei Liu
- Clinical Research Center, Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Xiaoyun Guo
- Clinical Research Center, Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Zuowei Wang
- Division of Mood Disorders, Shanghai Hongkou Mental Health Center, Shanghai, 200083, China
- Clinical Research Center for Mental Health, School of Medicine, Shanghai University, Shanghai, 200083, China
| | - Ruoqiao He
- School of Social Work, New York University, New York, 10003, USA
| | - Xiaohui Wu
- Clinical Research Center, Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Lan Cao
- Clinical Research Center, Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Zhiguo Wu
- Shanghai Yangpu Mental Health Center, Shanghai, 200093, China
| | - Daihui Peng
- Clinical Research Center, Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Yiru Fang
- Clinical Research Center, Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
- Clinical Research Center for Mental Health, School of Medicine, Shanghai University, Shanghai, 200083, China
- Department of Psychiatry & Affective Disorders Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, 200030, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 201108, China
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30
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Botschek T, Hußlein V, Peters EMJ, Brosig B. Hair cortisol as outcome parameter for psychological and neuropsychiatric interventions-a literature review. Front Psychiatry 2023; 14:1227153. [PMID: 37881597 PMCID: PMC10595010 DOI: 10.3389/fpsyt.2023.1227153] [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: 05/22/2023] [Accepted: 09/22/2023] [Indexed: 10/27/2023] Open
Abstract
Background Studies measuring hair cortisol concentration (HCC) have been increasingly conducted to document stress-related, endocrine changes aggregated over time. Previous studies have shown that HCC reflects abnormalities in the hypothalamic-pituitary-adrenocortical axis (HPA axis) in the context of somatic diseases, such as Cushing's syndrome. HCC variations also reveal a corresponding alteration in HPA-axis-function in mental disorders, highlighting its potential role as a biomarker for interventions targeting mental health problems. Aims The aim of this study was to investigate the role of HCC in various psychological and neuropsychiatric interventions and to explore the extent to which HCC can serve as a predictive or outcome parameter in such interventions by conducting a PRISMA-compliant review of the literature. Methods From May to July 2022, the databases Web of Science, Google Scholar, PsychINFO, and ResearchGate were systematically searched using different combinations of relevant keywords. Studies of different types that examined HCC in the context of a wide range of psychological and neuropsychiatric interventions were included. Studies in languages other than English or German and animal studies were excluded. The MMAT tool was used, to assesses the Risk of bias. Results The initial search identified 334 studies. After applying the inclusion and exclusion criteria, 14 publications with a total number of 1,916 participants were identified. An association between HCC and PTSD, depressive disorders, and ongoing social and family stress can be documented. The effect of relaxation techniques, mental training, CBT, or PTSD therapy on HCC has been studied with equivocal results. Some studies found decreased HCC after treatment, while others did not show a clear effect. Baseline HCC appears to be of particular importance. In some studies, higher baseline HCC was associated with increased treatment response, providing a predictive value for HCC. Discussion HCC is increasingly being used as a biomarker for the mapping of psychological and neuropsychiatric interventions. However, due to the wide range of study populations and interventions, results are still heterogeneous. Nevertheless, HCC seems to be an encouraging biological parameter to describe the trajectory of different interventions aimed at improving mental health.
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Affiliation(s)
- Tim Botschek
- Family Psychosomatics, Department of Pediatrics and Neonatology, Justus-Liebig University Giessen, Gießen, Germany
| | - Vincent Hußlein
- Family Psychosomatics, Department of Pediatrics and Neonatology, Justus-Liebig University Giessen, Gießen, Germany
| | - Eva M. J. Peters
- Psychoneuroimmunology Laboratory, Department of Psychosomatic Medicine and Psychotherapy, Justus-Liebig University Giessen, Gießen, Germany
- Psychosomatics and Psychotherapy, Charité Center 12 Internal Medicine and Dermatology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Burkhard Brosig
- Family Psychosomatics, Department of Pediatrics and Neonatology, Justus-Liebig University Giessen, Gießen, Germany
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Dols A, Sekhon H, Rej S, Klaus F, Bodenstein K, Sajatovic M. Bipolar Disorder Among Older Adults: Newer Evidence to Guide Clinical Practice. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:370-379. [PMID: 38695001 PMCID: PMC11058954 DOI: 10.1176/appi.focus.20230010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
The term older-age bipolar disorder (OABD) refers to patients with bipolar disorder who are ages 50 and older. Research findings suggest important differences, including the attenuation of manic symptoms with age and the occurrence of multiple somatic comorbid conditions. Although the pharmacological treatment of OABD is fairly similar, adverse effects, somatic comorbidity, and drug-drug interactions are more common. Lithium is effective in treating OABD and may have the potential to be neuroprotective. Anticonvulsants and second-generation antipsychotics have a growing evidence supporting their use in treating OABD. Behavioral intervention can be a helpful adjunct to pharmacological treatment. Clinicians and health care systems need to be prepared to provide care and services to individuals with bipolar disorder throughout the life span. Although older adults have typically been excluded from bipolar disorder RCTs, emerging efforts organized by global advocates and harnessing teams of clinicians and scientists have the potential to advance care.
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Affiliation(s)
- Annemiek Dols
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht, the Netherlands (Dols); Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Quebec, Canada (Sekhon, Rej, Bodenstein); McLean Hospital (Harvard Medical School Affiliate), Belmont, Massachusetts (Sekhon); Department of Psychiatry, University of California, San Diego, La Jolla, California (Klaus); Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Sajatovic)
| | - Harmehr Sekhon
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht, the Netherlands (Dols); Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Quebec, Canada (Sekhon, Rej, Bodenstein); McLean Hospital (Harvard Medical School Affiliate), Belmont, Massachusetts (Sekhon); Department of Psychiatry, University of California, San Diego, La Jolla, California (Klaus); Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Sajatovic)
| | - Soham Rej
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht, the Netherlands (Dols); Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Quebec, Canada (Sekhon, Rej, Bodenstein); McLean Hospital (Harvard Medical School Affiliate), Belmont, Massachusetts (Sekhon); Department of Psychiatry, University of California, San Diego, La Jolla, California (Klaus); Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Sajatovic)
| | - Federica Klaus
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht, the Netherlands (Dols); Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Quebec, Canada (Sekhon, Rej, Bodenstein); McLean Hospital (Harvard Medical School Affiliate), Belmont, Massachusetts (Sekhon); Department of Psychiatry, University of California, San Diego, La Jolla, California (Klaus); Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Sajatovic)
| | - Katie Bodenstein
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht, the Netherlands (Dols); Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Quebec, Canada (Sekhon, Rej, Bodenstein); McLean Hospital (Harvard Medical School Affiliate), Belmont, Massachusetts (Sekhon); Department of Psychiatry, University of California, San Diego, La Jolla, California (Klaus); Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Sajatovic)
| | - Martha Sajatovic
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht, the Netherlands (Dols); Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Quebec, Canada (Sekhon, Rej, Bodenstein); McLean Hospital (Harvard Medical School Affiliate), Belmont, Massachusetts (Sekhon); Department of Psychiatry, University of California, San Diego, La Jolla, California (Klaus); Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Sajatovic)
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Domke AK, Hempel M, Hartling C, Stippl A, Carstens L, Gruzman R, Herrera Melendez AL, Bajbouj M, Gärtner M, Grimm S. Functional connectivity changes between amygdala and prefrontal cortex after ECT are associated with improvement in distinct depressive symptoms. Eur Arch Psychiatry Clin Neurosci 2023; 273:1489-1499. [PMID: 36715751 PMCID: PMC10465635 DOI: 10.1007/s00406-023-01552-7] [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: 08/19/2022] [Accepted: 01/09/2023] [Indexed: 01/31/2023]
Abstract
Electroconvulsive therapy (ECT) is one of the most effective treatments for treatment-resistant depression. However, the underlying mechanisms of action are not yet fully understood. The investigation of depression-specific networks using resting-state fMRI and the relation to differential symptom improvement might be an innovative approach providing new insights into the underlying processes. In this naturalistic study, we investigated the relationship between changes in resting-state functional connectivity (rsFC) and symptom improvement after ECT in 21 patients with treatment-resistant depression. We investigated rsFC before and after ECT and focused our analyses on FC changes directly related to symptom reduction and on FC at baseline to identify neural targets that might predict individual clinical responses to ECT. Additional analyses were performed to identify the direct relationship between rsFC change and symptom dimensions such as sadness, negative thoughts, detachment, and neurovegetative symptoms. An increase in rsFC between the left amygdala and left dorsolateral prefrontal cortex (DLPFC) after ECT was related to overall symptom reduction (Bonferroni-corrected p = 0.033) as well as to a reduction in specific symptoms such as sadness (r = 0.524, uncorrected p = 0.014), negative thoughts (r = 0.700, Bonferroni-corrected p = 0.002) and detachment (r = 0.663, p = 0.004), but not in neurovegetative symptoms. Furthermore, high baseline rsFC between the left amygdala and the right frontal pole (FP) predicted treatment outcome (uncorrected p = 0.039). We conclude that changes in FC in regions of the limbic-prefrontal network are associated with symptom improvement, particularly in affective and cognitive dimensions. Frontal-limbic connectivity has the potential to predict symptom improvement after ECT. Further research combining functional imaging biomarkers and a symptom-based approach might be promising.
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Affiliation(s)
- Ann-Kathrin Domke
- Department of Psychiatry, Centre for Affective Neuroscience (CAN), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Moritz Hempel
- Department of Psychology, MSB Medical School Berlin, Rüdesheimer Straße 50, 14197, Berlin, Germany
| | - Corinna Hartling
- Department of Psychiatry, Centre for Affective Neuroscience (CAN), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Anna Stippl
- Department of Psychiatry, Centre for Affective Neuroscience (CAN), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Luisa Carstens
- Department of Psychology, MSB Medical School Berlin, Rüdesheimer Straße 50, 14197, Berlin, Germany
| | - Rebecca Gruzman
- Department of Psychology, MSB Medical School Berlin, Rüdesheimer Straße 50, 14197, Berlin, Germany
| | - Ana Lucia Herrera Melendez
- Department of Psychiatry, Centre for Affective Neuroscience (CAN), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Malek Bajbouj
- Department of Psychiatry, Centre for Affective Neuroscience (CAN), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Matti Gärtner
- Department of Psychiatry, Centre for Affective Neuroscience (CAN), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
- Department of Psychology, MSB Medical School Berlin, Rüdesheimer Straße 50, 14197, Berlin, Germany
| | - Simone Grimm
- Department of Psychiatry, Centre for Affective Neuroscience (CAN), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
- Department of Psychology, MSB Medical School Berlin, Rüdesheimer Straße 50, 14197, Berlin, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
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Movahed P, Nordenskjöld A, Kellner CH. Ketamine versus ECT for Nonpsychotic Treatment-Resistant Major Depression. N Engl J Med 2023; 389:960-961. [PMID: 37672704 DOI: 10.1056/nejmc2308757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
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Rhee TG, Shim SR, Popp J, Trikalinos T, Rosenheck R, Kellner C, Seiner S, Espinoza R, Forester B, McIntyre R. Efficacy and Safety of Ketamine-assisted Electroconvulsive Therapy in Major Depressive Episode: A Systematic Review and Network Meta-Analysis. RESEARCH SQUARE 2023:rs.3.rs-3182771. [PMID: 37609159 PMCID: PMC10441463 DOI: 10.21203/rs.3.rs-3182771/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Objective To meta-analyze clinical efficacy and safety of ketamine compared with other anesthetic agents in the course of electroconvulsive therapy (ECT) in major depressive episode (MDE). Methods PubMed/MEDLINE, Cochrane Library, Embase, GoogleScholar, and US and European trial registries were searched from inception through May 23, 2023, with no language limits. We included RCTs with (1) a diagnosis of MDE; (2) ECT intervention with ketamine and/or other anesthetic agents; and (3) measures included: depressive symptoms, cognitive performance, remission or response rates, and serious adverse events. Network meta-analysis (NMA) was performed to compare ketamine and 7 other anesthetic agents. Hedges' g standardized mean differences (SMDs) were used for continuous measures, and relative risks (RRs) were used for other binary outcomes using random-effects models. Results Twenty-two studies were included in the systematic review. A total of 2,322 patients from 17 RCTs were included in the NMA. The overall pooled SMD of ketamine, as compared with a propofol reference group, was -2.21 (95% confidence interval [CI], -3.79 to -0.64) in depressive symptoms, indicating that ketamine had better antidepressant efficacy than propofol. In a sensitivity analysis, however, ketamine-treated patients had a worse outcome in cognitive performance than propofol-treated patients (SMD, -0.18; 95% CI, -0.28 to -0.09). No other statistically significant differences were found. Conclusions Ketamine-assisted ECT is tolerable and may be efficacious in improving depressive symptoms, but a relative adverse impact on cognition may be an important clinical consideration. Anesthetic agents should be considered based on patient profiles and/or preferences to improve effectiveness and safety of ECT use.
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Affiliation(s)
| | | | | | | | | | | | | | - Randall Espinoza
- Departments of Neurology, Psychiatry and Biobehavioral Sciences, University of California
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Bellini H, Cretaz E, Carneiro AM, da Silva PHR, dos Santos LA, Gallucci-Neto J, Brunoni AR. Magnetic Waves vs. Electric Shocks: A Non-Inferiority Study of Magnetic Seizure Therapy and Electroconvulsive Therapy in Treatment-Resistant Depression. Biomedicines 2023; 11:2150. [PMID: 37626647 PMCID: PMC10452083 DOI: 10.3390/biomedicines11082150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/22/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023] Open
Abstract
Treatment-resistant depression (TRD), characterized by the failure to achieve symptomatic remission despite multiple pharmacotherapeutic treatments, poses a significant challenge for clinicians. Electroconvulsive therapy (ECT) is an effective but limited option due to its cognitive side effects. In this context, magnetic seizure therapy (MST) has emerged as a promising alternative, offering comparable antidepressant efficacy with better cognitive outcomes. However, the clinical outcomes and cognitive effects of MST require further investigation. This double-blinded, randomized, non-inferiority study aims to compare the efficacy, tolerability, cognitive adverse effects, and neurophysiological biomarkers of MST with bilateral ECT (BT ECT) in patients with TRD. This study will employ multimodal nuclear magnetic resonance imaging (MRI) and serum neurotrophic markers to gain insight into the neurobiological basis of seizure therapy. Additionally, neurophysiological biomarkers will be evaluated as secondary outcomes to predict the antidepressant and cognitive effects of both techniques. The study design, recruitment methods, ethical considerations, eligibility criteria, interventions, and blinding procedures are described. The expected outcomes will advance the field by offering a potential alternative to ECT with improved cognitive outcomes and a better understanding of the underlying pathophysiology of depression and antidepressant therapies.
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Affiliation(s)
- Helena Bellini
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; (H.B.); (E.C.); (A.M.C.); (P.H.R.d.S.); (L.A.d.S.); (J.G.-N.)
- Service of Electroconvulsive Therapy, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Eric Cretaz
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; (H.B.); (E.C.); (A.M.C.); (P.H.R.d.S.); (L.A.d.S.); (J.G.-N.)
- Service of Electroconvulsive Therapy, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Adriana Munhoz Carneiro
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; (H.B.); (E.C.); (A.M.C.); (P.H.R.d.S.); (L.A.d.S.); (J.G.-N.)
- Service of Electroconvulsive Therapy, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Pedro Henrique Rodrigues da Silva
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; (H.B.); (E.C.); (A.M.C.); (P.H.R.d.S.); (L.A.d.S.); (J.G.-N.)
- Service of Electroconvulsive Therapy, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Leonardo Afonso dos Santos
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; (H.B.); (E.C.); (A.M.C.); (P.H.R.d.S.); (L.A.d.S.); (J.G.-N.)
- Service of Electroconvulsive Therapy, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - José Gallucci-Neto
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; (H.B.); (E.C.); (A.M.C.); (P.H.R.d.S.); (L.A.d.S.); (J.G.-N.)
- Service of Electroconvulsive Therapy, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - André Russowsky Brunoni
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; (H.B.); (E.C.); (A.M.C.); (P.H.R.d.S.); (L.A.d.S.); (J.G.-N.)
- Service of Electroconvulsive Therapy, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil
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Wiechers M, Strupf M, Bajbouj M, Böge K, Karnouk C, Goerigk S, Kamp-Becker I, Banaschewski T, Rapp M, Hasan A, Falkai P, Jobst-Heel A, Habel U, Stamm T, Heinz A, Hoell A, Burger M, Bunse T, Hoehne E, Mehran N, Kaiser F, Hahn E, Plener P, Übleis A, Padberg F. Empowerment group therapy for refugees with affective disorders: results of a multicenter randomized controlled trial. Eur Psychiatry 2023; 66:e64. [PMID: 37458215 PMCID: PMC10594347 DOI: 10.1192/j.eurpsy.2023.2431] [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: 10/10/2022] [Revised: 01/12/2023] [Accepted: 04/13/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Against the background of missing culturally sensitive mental health care services for refugees, we developed a group intervention (Empowerment) for refugees at level 3 within the stratified Stepped and Collaborative Care Model of the project Mental Health in Refugees and Asylum Seekers (MEHIRA). We aim to evaluate the effectiveness of the Empowerment group intervention with its focus on psychoeducation, stress management, and emotion regulation strategies in a culturally sensitive context for refugees with affective disorders compared to treatment-as-usual (TAU). METHOD At level 3 of the MEHIRA project, 149 refugees and asylum seekers with clinically relevant depressive symptoms were randomized to the Empowerment group intervention or TAU. Treatment comprised 16 therapy sessions conducted over 12 weeks. Effects were measured with the Patient Health Questionnaire-9 (PHQ-9) and the Montgomery-Åsberg Depression Rating Scale (MÅDRS). Further scales included assessed emotional distress, self-efficacy, resilience, and quality of life. RESULTS Intention-to-treat analyses show significant cross-level interactions on both self-rated depressive symptoms (PHQ-9; F(1,147) = 13.32, p < 0.001) and clinician-rated depressive symptoms (MÅDRS; F(1,147) = 6.91, p = 0.01), indicating an improvement in depressive symptoms from baseline to post-intervention in the treatment group compared to the control group. The effect sizes for both scales were moderate (d = 0.68, 95% CI 0.21-1.15 for PHQ-9 and d = 0.51, 95% CI 0.04-0.99 for MÅDRS). CONCLUSION In the MEHIRA project comparing an SCCM approach versus TAU, the Empowerment group intervention at level 3 showed effectiveness for refugees with moderately severe depressive symptoms.
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Affiliation(s)
- Maren Wiechers
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - Michael Strupf
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
| | - Kerem Böge
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
| | - Carine Karnouk
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
| | - Stephan Goerigk
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
- Department of Psychological Methodology and Assessment, Ludwig-Maximilians-University, Munich, Germany
- Charlotte Fresenius Hochschule, University of Applied Sciences, Munich, Germany
| | - Inge Kamp-Becker
- Department of Child and Adolescent Psychiatry, Philipps-University Marburg, Marburg, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Rapp
- Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - Andrea Jobst-Heel
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - Ute Habel
- Department of Psychiatry and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | | | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
| | - Andreas Hoell
- Department of Psychiatry and Psychotherapy, Central Institute for Mental Health, Medical Faculty Mannheim, Mannheim, Germany
| | - Max Burger
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - Tilmann Bunse
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany
| | - Edgar Hoehne
- Department of Child and Adolescent Psychiatry, Philipps-University Marburg, Marburg, Germany
| | - Nassim Mehran
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
| | - Franziska Kaiser
- Department of Psychiatry and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
| | - Paul Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Aline Übleis
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
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van der Does Y, Turner RJ, Bartels MJH, Hagoort K, Metselaar A, Scheepers F, Grünwald PD, Somers M, van Dellen E. Outcome prediction of electroconvulsive therapy for depression. Psychiatry Res 2023; 326:115328. [PMID: 37429173 DOI: 10.1016/j.psychres.2023.115328] [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: 02/15/2023] [Revised: 06/26/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION We developed and tested a Bayesian network(BN) model to predict ECT remission for depression, with non-response as a secondary outcome. METHODS We performed a systematic literature search on clinically available predictors. We combined these predictors with variables from a dataset of clinical ECT trajectories (performed in the University Medical Center Utrecht) to create priors and train the BN. Temporal validation was performed in an independent sample. RESULTS The systematic literature search yielded three meta-analyses, which provided prior knowledge on outcome predictors. The clinical dataset consisted of 248 treatment trajectories in the training set and 44 trajectories in the test set at the same medical center. The AUC for the primary outcome remission estimated on an independent validation set was 0.686 (95%CI 0.513-0.859) (AUC values of 0.505 - 0.763 observed in 5-fold cross validation of the model within the train set). Accuracy 0.73 (balanced accuracy 0.67), sensitivity 0.55, specificity 0.79, after temporal validation in the independent sample. Prior literature information marginally reduced CI width. DISCUSSION A BN model comprised of prior knowledge and clinical data can predict remission of depression after ECT with reasonable performance. This approach can be used to make outcome predictions in psychiatry, and offers a methodological framework to weigh additional information, such as patient characteristics, symptoms and biomarkers. In time, it may be used to improve shared decision-making in clinical practice.
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Affiliation(s)
- Yuri van der Does
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, the Netherlands.
| | - Rosanne J Turner
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, the Netherlands; Machine Learning Group, CWI (national research institute for mathematics and computer science), Amsterdam, the Netherlands
| | - Miel J H Bartels
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, the Netherlands
| | - Karin Hagoort
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, the Netherlands
| | - Aäron Metselaar
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, the Netherlands
| | - Floortje Scheepers
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, the Netherlands
| | - Peter D Grünwald
- Machine Learning Group, CWI (national research institute for mathematics and computer science), Amsterdam, the Netherlands; Department of Mathematics, Leiden University, Leiden, Netherlands
| | - Metten Somers
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, the Netherlands
| | - Edwin van Dellen
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, the Netherlands; Department of Neurology, UZ Brussel and Vrije Universiteit Brussel, Brussels, Belgium
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Pape A, Kittel-Schneider S. [Practice of anaesthesia for electroconvulsive therapy]. Anasthesiol Intensivmed Notfallmed Schmerzther 2023; 58:422-435. [PMID: 37582353 DOI: 10.1055/a-1925-6993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
Electroconvulsive therapy (ECT) is an established therapeutic method for the treatment of severe mental disorders refractory to pharmaco- and psychotherapy. ECT is a first-line treatment option in delusional disorders, severe depression with acute suicidal tendency or life-threatening catatonia. Usually, ECT is performed as a treatment series. Under short-term anaesthesia and muscle relaxation, tonic-clonic seizures are induced using an external stimulation electrode. Convulsion can be exerted by uni- or bipolar stimulation using an electric charge up to 1000 millicoulomb (mC) with an amperage of 900 mA. Muscular relaxation is necessary to prevent injuries caused by uncontrolled movements during convulsion. During paralysis, consciousness is blocked by general anaesthesia, although ECT is associated with antegrade amnesia for seizure induction and the seizure itself. In the context of ECT, the ideal hypnotic should be characterised by rapid onset, short duration of action and negligible anticonvulsive effects (i.e., least possible impact on seizure quality and duration). As mutual awareness of psychiatric and anaesthesiologic techniques is essential for safe and effective conduction of ECT, this article presents ECT both from the psychiatrist's and the anaesthesiologist's perspective.
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Deng ZD, Ousdal OT, Oltedal L, Angulo B, Baradits M, Spitzberg A, Kessler U, Sartorius A, Dols A, Narr K, Espinoza R, Van Waarde J, Tendolkar I, van Eijndhoven P, van Wingen G, Takamiya A, Kishimoto T, Jorgensen M, Jorgensen A, Paulson O, Yrondi A, Peran P, Soriano-Mas C, Cardoner N, Cano M, van Diermen L, Schrijvers D, Belge JB, Emsell L, Bouckaert F, Vandenbulcke M, Kiebs M, Hurlemann R, Mulders P, Redlich R, Dannlowski U, Kavakbasi E, Kritzer M, Ellard K, Camprodon J, Petrides G, Maholtra A, Abbott C, Argyelan M. Electroconvulsive therapy-induced volumetric brain changes converge on a common causal circuit in depression. RESEARCH SQUARE 2023:rs.3.rs-2925196. [PMID: 37398308 PMCID: PMC10312966 DOI: 10.21203/rs.3.rs-2925196/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Neurostimulation is a mainstream treatment option for major depression. Neuromodulation techniques apply repetitive magnetic or electrical stimulation to some neural target but significantly differ in their invasiveness, spatial selectivity, mechanism of action, and efficacy. Despite these differences, recent analyses of transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS)-treated individuals converged on a common neural network that might have a causal role in treatment response. We set out to investigate if the neuronal underpinnings of electroconvulsive therapy (ECT) are similarly associated with this common causal network (CCN). Our aim here is to provide a comprehensive analysis in three cohorts of patients segregated by electrode placement (N = 246 with right unilateral, 79 with bitemporal, and 61 with mixed) who underwent ECT. We conducted a data-driven, unsupervised multivariate neuroimaging analysis (Principal Component Analysis, PCA) of the cortical and subcortical volume changes and electric field (EF) distribution to explore changes within the CCN associated with antidepressant outcomes. Despite the different treatment modalities (ECT vs TMS and DBS) and methodological approaches (structural vs functional networks), we found a highly similar pattern of change within the CCN in the three cohorts of patients (spatial similarity across 85 regions: r = 0.65, 0.58, 0.40, df = 83). Most importantly, the expression of this pattern correlated with clinical outcomes. This evidence further supports that treatment interventions converge on a CCN in depression. Optimizing modulation of this network could serve to improve the outcome of neurostimulation in depression.
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Affiliation(s)
| | | | - Leif Oltedal
- Department of Clinical Medicine, University of Bergen
| | - Brian Angulo
- Department of Clinical Medicine, University of Bergen
| | - Mate Baradits
- Department of Clinical Medicine, University of Bergen
| | | | - Ute Kessler
- Department of Clinical Medicine, University of Bergen
| | | | - Annemiek Dols
- Geffen School of Medicine at the University of California, Los Angeles
| | - Katherine Narr
- Geffen School of Medicine at the University of California, Los Angeles
| | - Randall Espinoza
- Departments of Neurology, Psychiatry and Biobehavioral Sciences, University of California
| | | | - Indira Tendolkar
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry
| | | | | | | | | | | | | | | | | | | | | | - Narcís Cardoner
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau. Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Sa
| | | | | | | | | | | | | | | | | | - Rene Hurlemann
- Institute for Translational Psychiatry, University of Münster
| | - Peter Mulders
- Institute for Translational Psychiatry, University of Münster
| | - Ronny Redlich
- Institute for Translational Psychiatry, University of Münster
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster
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Baba H. Treatment strategy for late-life depression. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2023; 2:e91. [PMID: 38868144 PMCID: PMC11114258 DOI: 10.1002/pcn5.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/07/2023] [Indexed: 06/14/2024]
Abstract
With the unprecedented aging of the world's population, the number of elderly patients with depression is expected to increase. However, management and treatment of late-life depression (LLD) is more difficult than in early adults. Prior to treatment, diagnosis must take into account the differentiation from, and comorbidity with, organic brain diseases such as dementia and delirium, as well as depression caused by other physical diseases or medications. As clinical features of LLD, treatment response tends to be poor in older patients and recurrence rates are higher than those in early adult patients, therefore psycho-social interventions on the basis of the patient's background and condition are important for LLD. The first-line treatment strategy generally depends on the severity of the depression. Systematic psychotherapies, including cognitive behavioral therapy and problem-solving therapy, have been reported to reduce depressive symptoms in LLD. Regarding pharmacotherapy, newer antidepressants are recommended for LLD, but careful attention to adverse events is required. Treatment using neuromodulation is also reported to be useful for LLD. In the current review, for further-line treatment, treatment strategies were divided according to the level of first-line treatment response. Evidence indicates that LLD is more heterogeneous than depression in younger adults, therefore when treating LLD patients it is necessary to take various conditions and situations into consideration, and to provide detailed treatment that is tailored to each patient.
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Affiliation(s)
- Hajime Baba
- Department of Psychiatry, Faculty of Medicine, Juntendo Koshigaya HospitalJuntendo UniversitySaitamaJapan
- Department of Psychiatry & Behavioral ScienceJuntendo University Graduate School of MedicineTokyoJapan
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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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Kyuragi Y, Oishi N, Yamasaki S, Hazama M, Miyata J, Shibata M, Fujiwara H, Fushimi Y, Murai T, Suwa T. Information flow and dynamic functional connectivity during electroconvulsive therapy in patients with depression. J Affect Disord 2023; 328:141-152. [PMID: 36801417 DOI: 10.1016/j.jad.2023.02.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Electroconvulsive therapy is effectively used for treatment-resistant depression; however, its neural mechanism is largely unknown. Resting-state functional magnetic resonance imaging is promising for monitoring outcomes of electroconvulsive therapy for depression. This study aimed to explore the imaging correlates of the electroconvulsive therapy effects on depression using Granger causality analysis and dynamic functional connectivity analyses. METHODS We performed advanced analyses of resting-state functional magnetic resonance imaging data at the beginning and intermediate stages and end of the therapeutic course to identify neural markers that reflect or predict the therapeutic effects of electroconvulsive therapy on depression. RESULTS We demonstrated that information flow between the functional networks analyzed by Granger causality changes during electroconvulsive therapy, and this change was correlated with the therapeutic outcome. Information flow and the dwell time (an index reflecting the temporal stability of functional connectivity) before electroconvulsive therapy are correlated with depressive symptoms during and after treatment. LIMITATIONS First, the sample size was small. A larger group is needed to confirm our findings. Second, the influence of concomitant pharmacotherapy on our results was not fully addressed, although we expected it to be minimal because only minor changes in pharmacotherapy occurred during electroconvulsive therapy. Third, different scanners were used the groups, although the acquisition parameters were the same; a direct comparison between patient and healthy participant data was not possible. Thus, we presented the data of the healthy participants separately from that of the patients as a reference. CONCLUSIONS These results show the specific properties of functional brain connectivity.
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Affiliation(s)
- Yusuke Kyuragi
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Naoya Oishi
- Medical Innovation Center, Kyoto University Graduate School of Medicine, Kyoto 606-8397, Japan.
| | - Shimpei Yamasaki
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Masaaki Hazama
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Jun Miyata
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Mami Shibata
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Hironobu Fujiwara
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan; Artificial Intelligence Ethics and Society Team, RIKEN Center for Advanced Intelligence Project, Saitama 351-0198, Japan; The General Research Division, Research Center on Ethical, Legal and Social Issues, Osaka University, Osaka 565-0871, Japan
| | - Yasutaka Fushimi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Toshiya Murai
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Taro Suwa
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
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Kritzer MD, Peterchev AV, Camprodon JA. Electroconvulsive Therapy: Mechanisms of Action, Clinical Considerations, and Future Directions. Harv Rev Psychiatry 2023; 31:101-113. [PMID: 37171471 PMCID: PMC10198476 DOI: 10.1097/hrp.0000000000000365] [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: 05/13/2023]
Abstract
LEARNING OBJECTIVES • Outline and discuss the fundamental physiologic, cellular, and molecular mechanisms of ECT to devise strategies to optimize therapeutic outcomes• Summarize the overview of ECT, its efficacy in treating depression, the known effects on cognition, evidence of mechanisms, and future directions. ABSTRACT Electroconvulsive therapy (ECT) is the most effective treatment for a variety of psychiatric illnesses, including treatment-resistant depression, bipolar depression, mania, catatonia, and clozapine-resistant schizophrenia. ECT is a medical and psychiatric procedure whereby electrical current is delivered to the brain under general anesthesia to induce a generalized seizure. ECT has evolved a great deal since the 1930s. Though it has been optimized for safety and to reduce adverse effects on cognition, issues persist. There is a need to understand fundamental physiologic, cellular, and molecular mechanisms of ECT to devise strategies to optimize therapeutic outcomes. Clinical trials that set out to adjust parameters, electrode placement, adjunctive medications, and patient selection are critical steps towards the goal of improving outcomes with ECT. This narrative review provides an overview of ECT, its efficacy in treating depression, its known effects on cognition, evidence of its mechanisms, and future directions.
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Affiliation(s)
- Michael D Kritzer
- From the Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA (Drs. Kritzer, Camprodon); Department of Psychiatry and Behavioral Sciences, Department of Biomedical Engineering, Department of Electrical and Computer Engineering, Department of Neurosurgery, Duke University, Durham, NC (Dr. Peterchev)
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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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Aarsland TIM, Haavik J, Ulvik A, Ueland PM, Dols A, Kessler U. The effect of electroconvulsive therapy (ECT) on serum kynurenine pathway metabolites in late-life depression. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2023. [DOI: 10.1016/j.jadr.2023.100578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
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Hart KL, McCoy TH, Henry ME, Seiner SJ, Luccarelli J. Factors associated with early and late response to electroconvulsive therapy. Acta Psychiatr Scand 2023; 147:322-332. [PMID: 36744383 PMCID: PMC10038910 DOI: 10.1111/acps.13537] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is an effective treatment for severe depressive symptoms, yet more research is needed to examine predictors of treatment response, and factors associated with response in patients not initially improving with treatment. This study reports factors associated with time to response (early vs. late) to ECT in a real-world setting. METHODS This was a retrospective, single-center cohort study of patients endorsing moderate to severe depressive symptoms using the Quick Inventory of Depressive Symptomatology (QIDS; QIDS>10). Response was defined as 50% or greater decrease in QIDS score from baseline. We used logistic regression to predict response at treatment #5 (early response) as well as after treatment #5 (late response) and followed patients through ECT discontinuation or through treatment #20. RESULTS Of the 1699 patients included in this study, 555 patients (32.7%) responded to ECT treatment at treatment #5 and 397 (23.4%) responded after treatment #5. Among patients who did not respond by treatment #5, those who switched to brief pulse width ECT from ultrabrief pulse ECT had increased odds of response after treatment #5 compared with patients only receiving ultrabrief pulse (aOR = 1.55, 95% CI: 1.16-2.07). Additionally, patients with less improvement in QIDS from baseline to treatment #5 had decreased odds of response after treatment #5 (aOR = 0.97, 95% CI = 0.97-0.98). CONCLUSION Among depressed patients treated with ECT, response occurred in 56.0% of patients by treatment #20. Patient receiving ultrabrief pulse ECT at baseline and who did not respond by treatment #5 had greater odds of subsequent response if switched to brief pulse ECT than if continued with ultrabrief pulse.
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Affiliation(s)
| | - Thomas H. McCoy
- Harvard Medical School, 25 Shattuck Street, Boston MA
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston MA
| | - Michael E. Henry
- Harvard Medical School, 25 Shattuck Street, Boston MA
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston MA
| | - Stephen J. Seiner
- Harvard Medical School, 25 Shattuck Street, Boston MA
- Department of Psychiatry, McLean Hospital, 115 Mill Street, Belmont MA
| | - James Luccarelli
- Harvard Medical School, 25 Shattuck Street, Boston MA
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston MA
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Blanken MAJT, Oudega ML, Hoogendoorn AW, Sonnenberg CS, Rhebergen D, Klumpers UMH, Van Diermen L, Birkenhager T, Schrijvers D, Redlich R, Dannlowski U, Heindel W, Coenjaerts M, Nordanskog P, Oltedal L, Kessler U, Frid LM, Takamiya A, Kishimoto T, Jorgensen MB, Jorgensen A, Bolwig T, Emsell L, Sienaert P, Bouckaert F, Abbott CC, Péran P, Arbus C, Yrondi A, Kiebs M, Philipsen A, van Waarde JA, Prinsen E, van Verseveld M, Van Wingen G, Ten Doesschate F, Camprodon JA, Kritzer M, Barbour T, Argyelan M, Cardoner N, Urretavizcaya M, Soriano-Mas C, Narr KL, Espinoza RT, Prudic J, Rowny S, van Eijndhoven P, Tendolkar I, Dols A. Sex-specifics of ECT outcome. J Affect Disord 2023; 326:243-248. [PMID: 36632848 DOI: 10.1016/j.jad.2022.12.144] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 12/23/2022] [Accepted: 12/25/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is the most effective treatment for patients with severe major depressive disorder (MDD). Given the known sex differences in MDD, improved knowledge may provide more sex-specific recommendations in clinical guidelines and improve outcome. In the present study we examine sex differences in ECT outcome and its predictors. METHODS Clinical data from 20 independent sites participating in the Global ECT-MRI Research Collaboration (GEMRIC) were obtained for analysis, totaling 500 patients with MDD (58.6 % women) with a mean age of 54.8 years. Severity of depression before and after ECT was assessed with validated depression scales. Remission was defined as a HAM-D score of 7 points or below after ECT. Variables associated with remission were selected based on literature (i.e. depression severity at baseline, age, duration of index episode, and presence of psychotic symptoms). RESULTS Remission rates of ECT were independent of sex, 48.0 % in women and 45.7 % in men (X2(1) = 0.2, p = 0.70). In the logistic regression analyses, a shorter index duration was identified as a sex-specific predictor for ECT outcome in women (X2(1) = 7.05, p = 0.01). The corresponding predictive margins did show overlapping confidence intervals for men and women. CONCLUSION The evidence provided by our study suggests that ECT as a biological treatment for MDD is equally effective in women and men. A shorter duration of index episode was an additional sex- specific predictor for remission in women. Future research should establish whether the confidence intervals for the corresponding predictive margins are overlapping, as we find, or not.
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Affiliation(s)
- M A J T Blanken
- Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam UMC, location Vumc, Amsterdam, the Netherlands.
| | - M L Oudega
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands; Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam UMC, location Vumc, Amsterdam, the Netherlands
| | - A W Hoogendoorn
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands; Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam UMC, location Vumc, Amsterdam, the Netherlands
| | - C S Sonnenberg
- Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; GGZ Parnassia NH, Specialized Mental Health Care, Castricum, the Netherlands
| | - D Rhebergen
- Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam UMC, location Vumc, Amsterdam, the Netherlands; GGZ Centraal, Specialized Mental Health Care, Amersfoort, the Netherlands
| | - U M H Klumpers
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands; Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam UMC, location Vumc, Amsterdam, the Netherlands
| | - L Van Diermen
- Psychiatric Center Bethanië, Andreas Vesaliuslaan 39, 2980 Zoersel, Belgium; Department of Biomedical Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp. Universiteitsplein 1, 2610 Antwerp, Belgium; University Psychiatric Center (UPC) Duffel, Stationsstraat 22c, 2570 Duffel, Belgium
| | - T Birkenhager
- Department of Biomedical Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp. Universiteitsplein 1, 2610 Antwerp, Belgium; Erasmus MC, Rotterdam, the Netherlands
| | - D Schrijvers
- Department of Biomedical Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp. Universiteitsplein 1, 2610 Antwerp, Belgium; University Psychiatric Center (UPC) Duffel, Stationsstraat 22c, 2570 Duffel, Belgium
| | - R Redlich
- Department of Psychology, University of Halle, Germany; Institute for Translational Psychiatry, University of Münster Germany, Germany
| | - U Dannlowski
- Institute for Translational Psychiatry, University of Münster Germany, Germany
| | - W Heindel
- Department of Radiology, University of Münster Germany, Germany
| | - M Coenjaerts
- Division of Medical Psychology, Department of Psychiatry and Psychotherapy, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - P Nordanskog
- Center for Social and Affective Neuroscience (CSAN), Department of Biomedical and Clinical Sciences, Linköping University, Department of Psychiatry, Linköping University Hospital, Sweden
| | - L Oltedal
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - U Kessler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - L M Frid
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - A Takamiya
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan; Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Belgium
| | - T Kishimoto
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan
| | - M B Jorgensen
- Psychiatric Centre Copenhagen and Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - A Jorgensen
- Psychiatric Centre Copenhagen and Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - T Bolwig
- Psychiatric Centre Copenhagen and Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - L Emsell
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Belgium
| | - P Sienaert
- Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center (UPC) - KU Leuven, Kortenberg, Belgium
| | - F Bouckaert
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Belgium
| | - C C Abbott
- University of New Mexico Department of Psychiatry, 87131, United States of America
| | - P Péran
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - C Arbus
- Service de Psychiatrie et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU Toulouse, Hospital Purpan, ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - A Yrondi
- Service de Psychiatrie et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU Toulouse, Hospital Purpan, ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - M Kiebs
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany; Section of Medical Psychology, University of Bonn, Bonn, Germany; School of Medicine & Health Sciences University Hospital Oldenburg at the Karl-Jaspers Clinic, Germany
| | - A Philipsen
- Section of Medical Psychology, University of Bonn, Bonn, Germany
| | | | | | | | - G Van Wingen
- Amsterdam UMC, location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - F Ten Doesschate
- Rijnstate Arnhem, the Netherlands; Amsterdam UMC, location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, the Netherlands
| | - J A Camprodon
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - M Kritzer
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - T Barbour
- Massachusetts General Hospital, United States of America
| | - M Argyelan
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, United States of America
| | - N Cardoner
- Sant Pau Mental Health Research Group, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, School of Medicine Bellaterra, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBERSAM, Carlos III Health Institute, Madrid, Spain
| | - M Urretavizcaya
- CIBERSAM, Carlos III Health Institute, Madrid, Spain; Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, Barcelona, Spain; Department of Clinical Sciences, Bellvitge Campus, Universitat de Barcelona-UB, Barcelona, Spain
| | - C Soriano-Mas
- CIBERSAM, Carlos III Health Institute, Madrid, Spain; Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, Barcelona, Spain; Department of Social Psychology and Quantitative Psychology, Universitat de Barcelona-UB, Barcelona, Spain
| | - K L Narr
- Department of Neurology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, United States of America
| | - R T Espinoza
- Department of Neurology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, United States of America
| | - J Prudic
- Columbia University Irving Medical Center, United States of America
| | - S Rowny
- Columbia University Irving Medical Center, United States of America
| | | | - I Tendolkar
- Radboud University, Nijmegen, the Netherlands
| | - A Dols
- Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam UMC, location Vumc, Amsterdam, the Netherlands; Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
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Hsieh MH. Electroconvulsive therapy for treatment-resistant depression. PROGRESS IN BRAIN RESEARCH 2023; 281:69-90. [PMID: 37806717 DOI: 10.1016/bs.pbr.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Electroconvulsive therapy (ECT), the oldest brain stimulation procedure in psychiatry, is associated with rapid response and remission in majority of patients with resistant, severe, and sometimes life-threatening depression. ECT has been included as an essential component in the definition of treatment-resistant depression (TRD) to display the course and diversification of TRD. On the other hand, ECT remains the treatment of choice for the most severe incapacitating forms of TRD and is a cost-effective treatment. In this chapter, we reviewed some essential studies, meta-analysis, and expert guidelines regarding ECT in TRD. ECT should not be considered as a treatment of last resort, and its administration should be considered on the basis of individual patient and illness factors. The clinical role of ECT vs other neurostimulation treatments for TRD, that is, repetitive transcranial magnetic stimulation, were also explored. Much effort has been directed toward the clinical and basic research about mechanisms of action of ECT in depression. A thorough understanding of the neurobiological effects of ECT may increase our understanding of its therapeutic effects, ultimately leading to improved patient care. We also showed that the distinct mechanisms of ECT in biological treatments of major depressive disorder (MDD) and some recent approaches to understand this most common psychiatric disorder. ECT should remain a standard part of modern psychiatric medicine. We recommend a more careful and thoughtful application of this traditional but effective technology.
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Affiliation(s)
- Ming H Hsieh
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
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49
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Salani D, Goldin D, Valdes B, DeSantis J. Electroconvulsive Therapy for Treatment-Resistant Depression: Dispelling the Stigma. J Psychosoc Nurs Ment Health Serv 2023:1-7. [PMID: 36853035 DOI: 10.3928/02793695-20230222-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The current article is a comprehensive overview of electroconvulsive therapy (ECT) for treatment-resistant depression (TRD), especially with suicidality and psychosis. Common misconceptions and stigma associated with ECT are discussed. Major depressive disorder, one of the most prevalent lifetime mental disorders, is often associated with significant impairments that impacts one's ability to function. Antidepressants may be efficacious in treating depression; however, approximately one third of individuals do not respond to psychotropic medications. Therefore, other treatment options, such as ECT, must be considered for those who do not respond to medications, have psychosis, or are suicidal. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].
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50
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Nygren A, Reutfors J, Brandt L, Bodén R, Nordenskjöld A, Tiger M. Response to electroconvulsive therapy in treatment-resistant depression: nationwide observational follow-up study. BJPsych Open 2023; 9:e35. [PMID: 36786152 PMCID: PMC9970162 DOI: 10.1192/bjo.2023.5] [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] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Previous studies have not investigated response rates after electroconvulsive therapy (ECT) in patients with non-psychotic treatment-resistant depression (TRD). AIMS To assess and compare the response rate of ECT for patients with TRD and non-TRD, in a large and clinically representative patient sample. METHOD Patients aged ≥18 years, who were treated for a unipolar, non-psychotic depressive episode with at least one ECT session as part of a first-time, index ECT series between 1 January 2011 and 31 December 2017 were included from the Swedish National Quality Register for ECT. Patients who had initiated a third consecutive trial of antidepressants or add-on medications before start of ECT were classified as having TRD. Patients not meeting criteria for TRD were classified as non-TRD. The main outcome was response to ECT according to the Clinical Global Impressions - Improvement Scale (CGI-I), scored as 1 or 2 ('very much' or 'much improved' after ECT, respectively). Logistic regression was used to compare outcome measures between TRD and non-TRD, adjusting for potential confounders. RESULTS A total of 4244 patients were included. Of these, 1121 patients had TRD and 3123 patients had non-TRD. The CGI-I response rate was 65.9% in the TRD group compared with 75.9% in the non-TRD group (adjusted odds ratio 0.64, 95% CI 0.54-0.75). Older age and more severe depression were predictors of response in patients with TRD. CONCLUSIONS A clear majority of patients with TRD, as well as patients with non-TRD, responded to ECT, although the response rate was somewhat lower for TRD.
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Affiliation(s)
- Adam Nygren
- Centre for Pharmacoepidemiology, Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Sweden
| | - Johan Reutfors
- Centre for Pharmacoepidemiology, Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Sweden
| | - Lena Brandt
- Centre for Pharmacoepidemiology, Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Sweden
| | - Robert Bodén
- Department of Medical Sciences, Psychiatry, Uppsala University, Sweden
| | - Axel Nordenskjöld
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Sweden
| | - Mikael Tiger
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden
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