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Gill S, Hussain S, Purushothaman S, Sarma S, Weiss A, Chamoli S, Fasnacht M, Gandhi A, Fitzgerald PB, Simpson B, Loo CK. Prescribing electroconvulsive therapy for depression: Not as simple as it used to be. Aust N Z J Psychiatry 2023; 57:1202-1207. [PMID: 37353902 DOI: 10.1177/00048674231183368] [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] [Indexed: 06/25/2023]
Abstract
In the last century, prescribing electroconvulsive therapy usually involved considering the relative merits of unilateral versus bilateral electroconvulsive therapy, with most other parameters fixed. However, research over the last 30 years has discovered that several parameters of the electroconvulsive therapy stimulus can have a significant impact on efficacy and cognitive side effects. The stimulus dose relative to seizure threshold was shown to significantly affect efficacy, especially for right unilateral electroconvulsive therapy, where suprathreshold doses in the vicinity of 5-6 times seizure threshold were far more efficacious than doses closer to threshold. However, this did not hold for bitemporal electroconvulsive therapy, where near-threshold stimuli were equally effective as suprathreshold stimuli. Then, changes in stimulus pulse width were found to also have a significant impact on both efficacy and side effects, with ultrabrief pulse widths of 0.3 ms having significantly fewer cognitive side effects in unilateral electroconvulsive therapy than standard brief pulse widths of 1.0 ms, with only slightly reduced efficacy. Therefore, choosing the optimum electroconvulsive therapy prescription for an individual patient now requires consideration of placement, pulse width and stimulus dose relative to seizure threshold, and how these three interact with each other. This viewpoint aims to raise awareness of these issues for psychiatrists involved in electroconvulsive therapy practice.
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Affiliation(s)
- Shane Gill
- SAPBTC, Glenside Health Service, Glenside, SA, Australia
- Discipline of Psychiatry, The University of Adelaide, Adelaide, SA, Australia
| | - Salam Hussain
- Medical School, Faculty of health and medical sciences, The University of Western Australia, Nedlands, WA, Australia
- RANZCP Section of ECT & Neurostimulation Binational Committee, Melbourne, VIC, Australia
- Consultation Liaison Psychiatry & Neuromodulation, Sir Charles Gardiner Hospital Mental Health Services, Nedlands, WA, Australia
| | | | - Shanthi Sarma
- Bond University, Robina, QLD, Australia
- Gold Coast Health, Southport, QLD, Australia
| | - Alan Weiss
- School of Medicine and Public Health, The University of Newcastle, Waratah, NSW, Australia
| | - Suneel Chamoli
- TMS Specialists Clinics, Canberra, ACT, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | | | - Ashu Gandhi
- Monash Health, Monash University, Clayton, VIC, Australia
| | - Paul B Fitzgerald
- School of Medicine and Psychology, Australian National University, Acton, ACT, Australia
| | - Brett Simpson
- South Eastern Sydney Local Health District Mental Health Service, Kogarah, NSW, Australia
| | - Colleen K Loo
- Black Dog Institute and Discipline of Psychiatry & Mental Health, University of New South Wales, Sydney, NSW, Australia
- Ramsay Clinic Northside, Randwick, NSW, Australia
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Schröder S, Bönig L, Proskynitopoulos PJ, Janke E, Heck J, Mahmoudi N, Groh A, Berding G, Wedegärtner F, Deest-Gaubatz S, Maier HB, Bleich S, Frieling H, Schulze Westhoff M. Bifrontal electroconvulsive therapy leads to improvement of cerebral glucose hypometabolism in frontotemporal dementia with comorbid psychotic depression - a case report. BMC Psychiatry 2023; 23:279. [PMID: 37081424 PMCID: PMC10120124 DOI: 10.1186/s12888-023-04759-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: 01/15/2023] [Accepted: 04/07/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Differentiating depression and dementia in elderly patients represents a major clinical challenge for psychiatrists. Pharmacological and non-pharmacological treatment options for both conditions are often used cautiously due to fear of adverse effects. If a clinically indicated therapy is not initiated due to fear of adverse effects, the quality of life of affected patients may significantly be reduced. CASE PRESENTATION Here, we describe the case of a 65-year-old woman who presented to the department of psychiatry of a university hospital with depressed mood, pronounced anxiety, and nihilistic thoughts. While several pharmacological treatments remained without clinical response, further behavioral observation in conjunction with 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) revealed the diagnosis of frontotemporal dementia (FTD). To counter the pharmacological treatment resistance of psychotic depression, we decided to perform electroconvulsive therapy (ECT). Remarkably, ten sessions of ECT yielded an almost complete remission of depressive symptoms. In addition, the patient's delusional ideas disappeared. A follow-up 18F-FDG PET/CT after the ECT series still showed a frontally and parieto-temporally accentuated hypometabolism, albeit with a clear regression compared to the previous image. The follow-up 18F-FDG PET/CT thus corroborated the diagnosis of FTD, while on the other hand it demonstrated the success of ECT. CONCLUSIONS In this case, ECT was a beneficial treatment option for depressive symptoms in FTD. Also, 18F-FDG PET/CT should be discussed as a valuable tool in differentiating depression and dementia and as an indicator of treatment response.
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Affiliation(s)
- Sebastian Schröder
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Lena Bönig
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Phileas Johannes Proskynitopoulos
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Eva Janke
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Johannes Heck
- Institute for Clinical Pharmacology, Hannover Medical School, Hannover, Germany
| | - Nima Mahmoudi
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Adrian Groh
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Georg Berding
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Felix Wedegärtner
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Stephanie Deest-Gaubatz
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Hannah Benedictine Maier
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Helge Frieling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Martin Schulze Westhoff
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Castaño Ramírez OM, Gómez Bedoya CA, Lemos Buitrago R, Castro Navarro JC, Valencia Aristizábal LG, Valderrama Sánchez A, Botero PF, Reinoso Gualtero MA. Electroconvulsive Therapy Impact on Memory Performance in Patients With Depression. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2023; 52:107-112. [PMID: 37500238 DOI: 10.1016/j.rcpeng.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/23/2021] [Indexed: 07/29/2023]
Abstract
INTRODUCTION The safety of electroconvulsive therapy has improved greatly over the last decades, making the potentially adverse effects on memory and other neurocognitive functions the main clinical aspect of concern in the present. In Colombia, the general population and healthcare professionals (even some psychiatrists) seem to have mostly negative opinions towards electroconvulsive therapy treatment, but maybe this could be reconsidered if more information is provided; therefore, the aim of the present study was to evaluate the changes in memory and the severity of the symptoms in a group of patients with severe depression before and after electroconvulsive therapy. METHODS Twenty-three patients ranging in age from 23 to 70 years from the electroconvulsive therapy service at the San Juan de Dios Clinic (Manizales, Colombia) were recruited in order to assess the effect of electroconvulsive therapy on memory in patients with severe depression. Depressive symptoms and memory were assessed with the Hamilton Depression Scale (HAMD) and Rey Auditory Verbal Learning Test (RAVLT), respectively. The assessment was administered to participants before the initial treatment of electroconvulsive therapy series (0-1 day) and 2 days after their last treatment. RESULTS Electroconvulsive therapy resulted in significant improvement in the rating of depression. There were no significant differences in the five learning trials, delayed recall, learning and forgetting scores from pre-treatment to post-treatment. Significant pre-treatment/post-treatment differences were found in the delayed recognition trial. CONCLUSIONS Pre- and post- electroconvulsive therapy cognitive assessment is a feasible and useful procedure. In general, memory performance does not worsen after electroconvulsive therapy in patients with depression. Only delayed recognition is affected a few days following electroconvulsive therapy, particularly in patients with low educational level and bitemporal (BT) electrode placement.
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Affiliation(s)
| | | | - Rocío Lemos Buitrago
- Department of Mental Health and Human Behavior, University of Caldas, Manizales, Colombia
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Hartnett S, Rex S, Sienaert P. Asystole During Electroconvulsive Therapy: Does Electrode Placement Matter? A Systematic Review. J ECT 2023; 39:3-9. [PMID: 35700970 DOI: 10.1097/yct.0000000000000863] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Asystole presenting at the start of electrical stimulus application during electroconvulsive therapy (ECT) is a relatively common occurrence. It is most likely caused by vagal nerve stimulation, affecting autonomic cardiac tone. This article reviews the effect of the electrode placement (EP) on the incidence and severity of bradycardia and asystole. A systematic literature review was conducted using the Embase and PubMed databases, up to September 2021, searching for studies evaluating the effect of EP on bradycardia and/or asystole during ECT. Nine case reports describing asystole in patients receiving ECT almost exclusively reported the association with bitemporal (BT) EP. One small descriptive study found no significant effect of EP on cardiac pauses. The results from 4 cohort studies, however, suggest that a right unilateral placement bears a higher risk for developing bradycardia and asystole than BT and bifrontal ECT. The available evidence suggests that right unilateral ECT holds a greater risk for the development of bradycardia and asystole than BT and bifrontal EP.
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Affiliation(s)
- Sophie Hartnett
- From the KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven, Kortenberg
| | | | - Pascal Sienaert
- From the KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven, Kortenberg
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Nikolin S, Owens K, Francis-Taylor R, Chaimani A, Martin DM, Bull M, Sackeim HA, McLoughlin DM, Sienaert P, Kellner CH, Loo C. Comparative efficacy, cognitive effects and acceptability of electroconvulsive therapies for the treatment of depression: protocol for a systematic review and network meta-analysis. BMJ Open 2022; 12:e068313. [PMID: 36549738 PMCID: PMC9772645 DOI: 10.1136/bmjopen-2022-068313] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION There have been important advances in the use of electroconvulsive therapy (ECT) to treat major depressive episodes. These include variations to the type of stimulus the brain regions stimulated, and the stimulus parameters (eg, stimulus duration/pulse width). Our aim is to investigate ECT types using a network meta-analysis (NMA) approach and report on comparative treatment efficacy, cognitive side effects and acceptability. METHOD We will conduct a systematic review to identify randomised controlled trials that compared two or more ECT protocols to treat depression. This will be done using the following databases: Embase, MEDLINE PubMed, Web of Science, Scopus, PsycINFO, Cochrane CENTRAL and will be supplemented by personal contacts with researchers in the field. All authors will be contacted to provide missing information. Primary outcomes will be symptom severity on a validated continuous clinician-rated scale of depression, cognitive functioning measured using anterograde verbal recall, and acceptability calculated using all-cause drop-outs. Secondary outcomes will include response and remission rates, autobiographical memory following a course of ECT, and anterograde visuospatial recall.Bayesian random effects hierarchical models will compare ECT types. Additional meta-regressions may be conducted to determine the impact of effect modifiers and patient-specific prognostic factors if sufficient data are available. DISCUSSION This NMA will facilitate clinician decision making and allow more sophisticated selection of ECT type according to the balance of efficacy, cognitive side effects and acceptability. ETHICS This systematic review and NMA does not require research ethics approval as it will use published aggregate data and will not collect nor disclose individually identifiable participant data. PROSPERO REGISTRATION NUMBER CRD42022357098.
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Affiliation(s)
- Stevan Nikolin
- Department of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Black Dog Institute, Randwick, New South Wales, Australia
| | - Kieran Owens
- Department of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Rohan Francis-Taylor
- Department of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Black Dog Institute, Randwick, New South Wales, Australia
| | - Anna Chaimani
- Research Center of Epidemiology (CRESS-UMR1153), INSERM, INRA, Universite de Paris, Paris, France
| | - Donel M Martin
- Department of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Black Dog Institute, Randwick, New South Wales, Australia
| | - Michael Bull
- Department of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Black Dog Institute, Randwick, New South Wales, Australia
| | - Harold A Sackeim
- Department of Psychiatry, Columbia University, New York, New York, USA
| | | | - Pascal Sienaert
- Department of Neurosciences, KU Leuven Psychiatric University Hospital KU Leuven, Leuven, Belgium
| | - Charles H Kellner
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Colleen Loo
- Department of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Black Dog Institute, Randwick, New South Wales, Australia
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Bahji A. The Rise, Fall, and Resurgence of Electroconvulsive Therapy. J Psychiatr Pract 2022; 28:440-444. [PMID: 36355582 DOI: 10.1097/pra.0000000000000666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Electroconvulsive therapy (ECT) is one of the most effective treatments for depression. However, significant stigma from the media and the antipsychiatry movement has biased the public toward ECT, leading to underutilization, particularly among those most in need. This report reviews some of the key historical events in the rise, fall, and resurgence of ECT and how modern ECT knowledge and practice are more refined, including an improved understanding of its mechanisms of action and optimal treatment parameters.
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Affiliation(s)
- Anees Bahji
- BAHJI: Department of Psychiatry and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Rosson S, de Filippis R, Croatto G, Collantoni E, Pallottino S, Guinart D, Brunoni AR, Dell'Osso B, Pigato G, Hyde J, Brandt V, Cortese S, Fiedorowicz JG, Petrides G, Correll CU, Solmi M. Brain stimulation and other biological non-pharmacological interventions in mental disorders: An umbrella review. Neurosci Biobehav Rev 2022; 139:104743. [PMID: 35714757 DOI: 10.1016/j.neubiorev.2022.104743] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND The degree of efficacy, safety, quality, and certainty of meta-analytic evidence of biological non-pharmacological treatments in mental disorders is unclear. METHODS We conducted an umbrella review (PubMed/Cochrane Library/PsycINFO-04-Jul-2021, PROSPERO/CRD42020158827) for meta-analyses of randomized controlled trials (RCTs) on deep brain stimulation (DBS), transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), electro-convulsive therapy (ECT), and others. Co-primary outcomes were standardized mean differences (SMD) of disease-specific symptoms, and acceptability (for all-cause discontinuation). Evidence was assessed with AMSTAR/AMSTAR-Content/GRADE. RESULTS We selected 102 meta-analyses. Effective interventions compared to sham were in depressive disorders: ECT (SMD=0.91/GRADE=moderate), TMS (SMD=0.51/GRADE=moderate), tDCS (SMD=0.46/GRADE=low), DBS (SMD=0.42/GRADE=very low), light therapy (SMD=0.41/GRADE=low); schizophrenia: ECT (SMD=0.88/GRADE=moderate), tDCS (SMD=0.45/GRADE=very low), TMS (prefrontal theta-burst, SMD=0.58/GRADE=low; left-temporoparietal, SMD=0.42/GRADE=low); substance use disorder: TMS (high frequency-dorsolateral-prefrontal-deep (SMD=1.16/GRADE=moderate), high frequency-left dorsolateral-prefrontal (SMD=0.77/GRADE=very low); OCD: DBS (SMD=0.89/GRADE=moderate), TMS (SMD=0.64/GRADE=very low); PTSD: TMS (SMD=0.46/GRADE=moderate); generalized anxiety disorder: TMS (SMD=0.68/GRADE=low); ADHD: tDCS (SMD=0.23/GRADE=moderate); autism: tDCS (SMD=0.97/GRADE=very low). No significant differences for acceptability emerged. Median AMSTAR/AMSTAR-Content was 8/2 (suggesting high-quality meta-analyses/low-quality RCTs), GRADE low. DISCUSSION Despite limited certainty, biological non-pharmacological interventions are effective and safe for numerous mental conditions. Results inform future research, and guidelines. FUNDING None.
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Affiliation(s)
- Stella Rosson
- Department of Mental Health, Azienda ULSS 3 Serenissima, Venice, Italy; Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, New York, NY, USA; Department of Neurosciences, University of Padua, Padua, Italy
| | - Renato de Filippis
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, New York, NY, USA; Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Giovanni Croatto
- Department of Mental Health, Azienda ULSS 3 Serenissima, Venice, Italy; Department of Neurosciences, University of Padua, Padua, Italy
| | | | | | - Daniel Guinart
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, New York, NY, USA; Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, Institut Hospital del Mard'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Andre R Brunoni
- Service of Interdisciplinary Neuromodulation (SIN), Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da USP, Brazil; Departamentos de Clínica Médica e Psiquiatria, Faculdade de Medicina da USP, Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da USP, Brazil
| | - Bernardo Dell'Osso
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy; Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford University, Stanford, CA, USA; Aldo Ravelli" Center for Nanotechnology and Neurostimulation, University of Milan, Milan, Italy
| | - Giorgio Pigato
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Joshua Hyde
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
| | - Valerie Brandt
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA
| | - Jess G Fiedorowicz
- Department of Psychiatry, University of Ottawa, Ontario, Canada; Department of Mental Health, The Ottawa Hospital, Ontario, Canada
| | - Georgios Petrides
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, New York, NY, USA; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Division of ECT, The Zucker Hillside Hospital, Northwell Health, New York, NY, USA
| | - Christoph U Correll
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, New York, NY, USA; Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Germany
| | - Marco Solmi
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK; Department of Psychiatry, University of Ottawa, Ontario, Canada; Department of Mental Health, The Ottawa Hospital, Ontario, Canada; Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Germany; Ottawa Hospital Research Institute (OHRI), Clinical Epidemiology Program University of Ottawa, Ottawa, Ontario, Canada.
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Rodin I, Sung JH, Appel-Cresswell S, Chauhan H, Smith K, Vila-Rodriguez F, Ainsworth NJ. Psychiatric, Motor, and Autonomic Effects of Bifrontal ECT in Depressed Parkinson's Disease Patients. J Neuropsychiatry Clin Neurosci 2022; 33:161-166. [PMID: 33626885 DOI: 10.1176/appi.neuropsych.20050133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Depressive symptoms are a source of significant morbidity in Parkinson's disease (PD). Electroconvulsive therapy (ECT) is a promising treatment for depression in PD (dPD); however, data remain limited, including data on optimal electrode placement. In this retrospective study, the investigators aimed to characterize the effects of bifrontal ECT for dPD on psychiatric and motor symptoms, as well as autonomic response. METHODS Clinical data were retrieved from a university-affiliated ECT service in Vancouver, British Columbia, for patients with dPD receiving bifrontal ECT between 2014 and 2018. Clinical Global Impression (depressive symptoms) and Unified Parkinson's Disease Rating Scale (motor symptoms) scores and cardiovascular measurements during ECT, as well as doses of dopaminergic medications, were recorded. RESULTS Eight patients met criteria for inclusion. Six patients (75%) met response criteria for improvement of depressive symptoms, including 83% of patients who completed a full ECT course. Five patients went on to receive maintenance ECT, with only one patient relapsing by the 1-year follow-up (20%). For patients with motor scales reported, 60% showed a clinically significant improvement in motor symptoms. Among patients who completed ECT, a reduction in the median dopaminergic medication dose was also observed (-350 mg). Two patients discontinued ECT as a result of tolerability concerns. Participants demonstrated a relatively typical pattern of autonomic response to ECT, with low incidence of bradycardic events. CONCLUSIONS The results provide preliminary evidence of the benefit of bifrontal ECT in dPD for both depressive and motor symptoms. The autonomic data suggest that most patients with dPD respond in a typical physiological manner to ECT stimulus; however, further investigation is needed.
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Affiliation(s)
- Isaac Rodin
- Faculty of Medicine, University of British Columbia, Vancouver, Canada (Rodin, Appel-Cresswell, Vila-Rodriguez, Ainsworth); Department of Psychiatry, University of British Columbia (Sung, Vila-Rodriguez, Ainsworth); Department of Neurology, University of British Columbia (Appel-Cresswell); Department of Psychiatry, St. Paul's Hospital, Vancouver, Canada (Chauhan, Smith); Djavad Mowafaghian Centre for Brain Health, University of British Columbia (Appel-Cresswell); and Department of Psychiatry, Non-Invasive Neurostimulation Laboratory, University of British Columbia (Vila-Rodriguez, Ainsworth)
| | - Je Hun Sung
- Faculty of Medicine, University of British Columbia, Vancouver, Canada (Rodin, Appel-Cresswell, Vila-Rodriguez, Ainsworth); Department of Psychiatry, University of British Columbia (Sung, Vila-Rodriguez, Ainsworth); Department of Neurology, University of British Columbia (Appel-Cresswell); Department of Psychiatry, St. Paul's Hospital, Vancouver, Canada (Chauhan, Smith); Djavad Mowafaghian Centre for Brain Health, University of British Columbia (Appel-Cresswell); and Department of Psychiatry, Non-Invasive Neurostimulation Laboratory, University of British Columbia (Vila-Rodriguez, Ainsworth)
| | - Silke Appel-Cresswell
- Faculty of Medicine, University of British Columbia, Vancouver, Canada (Rodin, Appel-Cresswell, Vila-Rodriguez, Ainsworth); Department of Psychiatry, University of British Columbia (Sung, Vila-Rodriguez, Ainsworth); Department of Neurology, University of British Columbia (Appel-Cresswell); Department of Psychiatry, St. Paul's Hospital, Vancouver, Canada (Chauhan, Smith); Djavad Mowafaghian Centre for Brain Health, University of British Columbia (Appel-Cresswell); and Department of Psychiatry, Non-Invasive Neurostimulation Laboratory, University of British Columbia (Vila-Rodriguez, Ainsworth)
| | - Harpreet Chauhan
- Faculty of Medicine, University of British Columbia, Vancouver, Canada (Rodin, Appel-Cresswell, Vila-Rodriguez, Ainsworth); Department of Psychiatry, University of British Columbia (Sung, Vila-Rodriguez, Ainsworth); Department of Neurology, University of British Columbia (Appel-Cresswell); Department of Psychiatry, St. Paul's Hospital, Vancouver, Canada (Chauhan, Smith); Djavad Mowafaghian Centre for Brain Health, University of British Columbia (Appel-Cresswell); and Department of Psychiatry, Non-Invasive Neurostimulation Laboratory, University of British Columbia (Vila-Rodriguez, Ainsworth)
| | - Kevin Smith
- Faculty of Medicine, University of British Columbia, Vancouver, Canada (Rodin, Appel-Cresswell, Vila-Rodriguez, Ainsworth); Department of Psychiatry, University of British Columbia (Sung, Vila-Rodriguez, Ainsworth); Department of Neurology, University of British Columbia (Appel-Cresswell); Department of Psychiatry, St. Paul's Hospital, Vancouver, Canada (Chauhan, Smith); Djavad Mowafaghian Centre for Brain Health, University of British Columbia (Appel-Cresswell); and Department of Psychiatry, Non-Invasive Neurostimulation Laboratory, University of British Columbia (Vila-Rodriguez, Ainsworth)
| | - Fidel Vila-Rodriguez
- Faculty of Medicine, University of British Columbia, Vancouver, Canada (Rodin, Appel-Cresswell, Vila-Rodriguez, Ainsworth); Department of Psychiatry, University of British Columbia (Sung, Vila-Rodriguez, Ainsworth); Department of Neurology, University of British Columbia (Appel-Cresswell); Department of Psychiatry, St. Paul's Hospital, Vancouver, Canada (Chauhan, Smith); Djavad Mowafaghian Centre for Brain Health, University of British Columbia (Appel-Cresswell); and Department of Psychiatry, Non-Invasive Neurostimulation Laboratory, University of British Columbia (Vila-Rodriguez, Ainsworth)
| | - Nicholas J Ainsworth
- Faculty of Medicine, University of British Columbia, Vancouver, Canada (Rodin, Appel-Cresswell, Vila-Rodriguez, Ainsworth); Department of Psychiatry, University of British Columbia (Sung, Vila-Rodriguez, Ainsworth); Department of Neurology, University of British Columbia (Appel-Cresswell); Department of Psychiatry, St. Paul's Hospital, Vancouver, Canada (Chauhan, Smith); Djavad Mowafaghian Centre for Brain Health, University of British Columbia (Appel-Cresswell); and Department of Psychiatry, Non-Invasive Neurostimulation Laboratory, University of British Columbia (Vila-Rodriguez, Ainsworth)
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9
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Bergsholm P, Bjølseth TM. Dosing methods in electroconvulsive therapy: should the Scandinavian time-titration method be resumed? Nord J Psychiatry 2022; 76:170-176. [PMID: 34338117 DOI: 10.1080/08039488.2021.1946590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIM To describe and evaluate the different dosing methods in ECT, and bringing back into focus the Scandinavian time-titration method. METHOD A narrative, unsystematic, and selective review and discussion. RESULTS There are five dosing methods: 1) The Scandinavian time-titration to tonic convulsion, using low-frequency pulses and a long maximal pulse train duration, was highly efficacious with right unilateral (RUL) ECT, comparable to bitemporal (BT) ECT. However, the device used went out of production in the 1990s. Because US devices until 1990 had a short maximal pulse train duration, time-titration went out of use. 2) Fixed high dosing at 50-100% of the device's maximal output, and 3) Formula-based dosing, initially the Age method, long prevailed in USA. Later, the Half-Age method was introduced for BT ECT. 4) Charge-dosing as a multiple of titrated seizure threshold (ST) demonstrated RUL and BT ECT to have comparable outcomes when dosed about six and two times the ST, respectively. 5) Dosing from benchmark is based on a high dose at the first session, to ensure a high peak heart rate and tonic-clonic convulsions. In later sessions the lowest dose producing similar outcomes is chosen. CONCLUSIONS No dosing method is documented superior to the others. Seizure threshold-based and benchmark dosing seems to be more accurate than fixed high and formula-based dosing. However, time-titration dosing makes it possible to adjust the dose at every session, and may be the most efficient method.
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Affiliation(s)
- Per Bergsholm
- Department of Psychiatry, District General Hospital of Førde, ISP, Sogndal, Norway
| | - Tor Magne Bjølseth
- Diakonhjemmet Hospital, Department of Geriatric Psychiatry, Oslo, Norway
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10
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Subramanian S, Lopez R, Zorumski CF, Cristancho P. Electroconvulsive therapy in treatment resistant depression. J Neurol Sci 2022; 434:120095. [PMID: 34979372 DOI: 10.1016/j.jns.2021.120095] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 11/02/2021] [Accepted: 12/12/2021] [Indexed: 12/28/2022]
Abstract
Electroconvulsive therapy (ECT) is a treatment modality for patients with treatment resistant depression (TRD), defined as failure of two adequate antidepressant medication trials. We provide a qualitative review of ECT's effectiveness for TRD, methods to optimize ECT parameters to improve remission rates and side effect profiles, and ECT's proposed neurobiological mechanisms. Right unilateral (RUL) electrode placement has been shown to be as effective for major depression as bilateral ECT, and RUL is associated with fewer cognitive side effects. There is mixed evidence on how to utilize ECT to sustain remission (i.e., continuation ECT, psychotropic medications alone, or a combination of ECT and psychotropic medications). Related to neurobiological mechanisms, an increase in gray matter volume in the hippocampus-amygdala complex is reported post-ECT. High connectivity between the subgenual anterior cingulate and the middle temporal gyrus before ECT is associated with better treatment response. Rodent models have implicated changes in neurotransmitters including glutamate, GABA, serotonin, and dopamine in ECT's efficacy; however, findings in humans are limited. Altogether, while ECT remains a highly effective therapy, the neurobiological underpinnings associated with improvement of depression remain uncertain.
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Affiliation(s)
- Subha Subramanian
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, MO, USA; Department of Psychiatry, University of Texas Rio Grande Valley School of Medicine, Harlingen, TX, USA.
| | - Ruthzaine Lopez
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, MO, USA; Department of Psychiatry, University of Texas Rio Grande Valley School of Medicine, Harlingen, TX, USA
| | - Charles F Zorumski
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, MO, USA; Department of Psychiatry, University of Texas Rio Grande Valley School of Medicine, Harlingen, TX, USA
| | - Pilar Cristancho
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, MO, USA; Department of Psychiatry, University of Texas Rio Grande Valley School of Medicine, Harlingen, TX, USA
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11
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Khoodoruth MAS, Estudillo-Guerra MA, Pacheco-Barrios K, Nyundo A, Chapa-Koloffon G, Ouanes S. Glutamatergic System in Depression and Its Role in Neuromodulatory Techniques Optimization. Front Psychiatry 2022; 13:886918. [PMID: 35492692 PMCID: PMC9047946 DOI: 10.3389/fpsyt.2022.886918] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/28/2022] [Indexed: 11/17/2022] Open
Abstract
Depressive disorders are among the most common psychiatric conditions and contribute to significant morbidity. Even though the use of antidepressants revolutionized the management of depression and had a tremendous positive impact on the patient's outcome, a significant proportion of patients with major depressive disorder (MDD) show no or partial or response even with adequate treatment. Given the limitations of the prevailing monoamine hypothesis-based pharmacotherapy, glutamate and glutamatergic related pathways may offer an alternative and a complementary option for designing novel intervention strategies. Over the past few decades, there has been a growing interest in understanding the neurobiological underpinnings of glutamatergic dysfunctions in the pathogenesis of depressive disorders and the development of new pharmacological and non-pharmacological treatment options. There is a growing body of evidence for the efficacy of neuromodulation techniques, including transcranial magnetic stimulation, transcutaneous direct current stimulation, transcranial alternating current stimulation, and photo-biomodulation on improving connectivity and neuroplasticity associated with depression. This review attempts to revisit the role of glutamatergic neurotransmission in the etiopathogenesis of depressive disorders and review the current neuroimaging, neurophysiological and clinical evidence of these neuromodulation techniques in the pathophysiology and treatment of depression.
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Affiliation(s)
| | - Maria Anayali Estudillo-Guerra
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Harvard Medical School, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, MA, United States.,Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Azan Nyundo
- Department of Psychiatry and Mental Health, School of Medicine and Dental Health, The University of Dodoma, Dodoma, Tanzania
| | | | - Sami Ouanes
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
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12
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Di Iorio R, Rossi S, Rossini PM. One century of healing currents into the brain from the scalp: From electroconvulsive therapy to repetitive transcranial magnetic stimulation for neuropsychiatric disorders. Clin Neurophysiol 2021; 133:145-151. [PMID: 34864511 DOI: 10.1016/j.clinph.2021.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/01/2021] [Accepted: 10/30/2021] [Indexed: 11/27/2022]
Abstract
Electroconvulsive therapy (ECT) was applied for the first time in humans in 1938: after 80 years, it remains conceptually similar today except for modifications of the original protocol aimed to reduce adverse effects (as persistent memory deficits) without losing clinical efficacy. We illustrate the stages of development as well as ups and downs of ECT use in the last eighty years, and the impact that it still maintains for treatment of certain psychiatric conditions. Targeted, individualized and safe noninvasive neuromodulatory interventions are now possible for many neuropsychiatric disorders thanks to repetitive transcranial magnetic stimulation (rTMS) that injects currents in the brain through electromagnetic induction, powerful enough to depolarize cortical neurons and related networks. Although ECT and rTMS differ in basic concepts, mechanisms, tolerability, side effects and acceptability, and beyond their conceptual remoteness (ECT) or proximity (rTMS) to "precision medicine" approaches, the two brain stimulation techniques may be considered as complementary rather than competing in the current treatment of certain neuropsychiatric disorders.
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Affiliation(s)
- Riccardo Di Iorio
- Neurology Unit, Policlinic A. Gemelli Foundation IRCCS, Rome, Italy.
| | - Simone Rossi
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Section of Neurology and Clinical Neurophysiology, Policlinico Le Scotte, University of Siena, Italy
| | - Paolo M Rossini
- Department of Neuroscience & Neurorehabilitation, IRCCS San Raffaele-Pisana, Rome, Italy
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13
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Adjunctive Nonconvulsive Electrotherapy for Patients with Depression: a Systematic Review. Psychiatr Q 2021; 92:1645-1656. [PMID: 34159503 DOI: 10.1007/s11126-021-09936-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 12/31/2022]
Abstract
The efficacy and safety of adjunctive nonconvulsive electrotherapy (NET) for patients with depression are undetermined. This systematic review was conducted to examine the efficacy and safety of adjunctive NET for patients with depression. Chinese (WanFang and Chinese Journal Net) and English (PubMed, EMBASE, PsycINFO and the Cochrane Library) databases were systematically searched from their inception until Jan 27, 2021 by three independent investigators. One randomized controlled trial (RCT) with 3 treatment arms (n = 108) and two observational studies (single-group, before-after design, n = 31) were included. In the RCT, the antidepressant efficacy of NET on depression was similar to that of electroconvulsive therapy (ECT) (P > 0.05) but with significantly fewer neurocognitive impairments as measured by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) (P < 0.05). In two observational studies, the 17-item Hamilton Depression Rating Scale (HAMD-17) scores decreased significantly from baseline to post-NET (all Ps < 0.05), without adverse neurocognitive effects. In the RCT, adverse drug reactions (ADRs) were not separately reported among the 3 treatment arms but a similar rate of discontinuation was reported. The currently available limited evidence from 3 studies suggests that NET as an adjunctive treatment may be a safe, well-tolerated, effective therapy for depression without serious neurocognitive impairments.
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14
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Kirov G, Jauhar S, Sienaert P, Kellner CH, McLoughlin DM. Electroconvulsive therapy for depression: 80 years of progress. Br J Psychiatry 2021; 219:594-597. [PMID: 35048827 DOI: 10.1192/bjp.2021.37] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Electroconvulsive therapy is the most effective treatment for severe, psychotic or treatment-resistant depression. However, its effectiveness continues to be questioned, both in mainstream media and narratives within the scientific literature. In this analysis, we use an evidence-based approach to demonstrate the efficacy and safety of modern electroconvulsive therapy.
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Affiliation(s)
- George Kirov
- MRC Centre for Neuropsychiatric Genetics & Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, UK
| | - Sameer Jauhar
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Pascal Sienaert
- Academic Center for ECT and Neuromodulation, University Psychiatric Center, KU Leuven, Belgium
| | - Charles H Kellner
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, South Carolina, USA
| | - Declan M McLoughlin
- Department of Psychiatry and Trinity College Institute of Neuroscience, Trinity College Dublin, St Patrick's University Hospital, Ireland
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15
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Castaño Ramírez OM, Gómez Bedoya CA, Lemos Buitrago R, Castro Navarro JC, Valencia Aristizábal LG, Valderrama Sánchez A, Botero PF, Reinoso Gualtero MA. Electroconvulsive Therapy Impact on Memory Performance in Patients With Depression. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 52:S0034-7450(21)00069-X. [PMID: 34074454 DOI: 10.1016/j.rcp.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/15/2021] [Accepted: 03/23/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The safety of electroconvulsive therapy has improved greatly over the last decades, making the potentially adverse effects on memory and other neurocognitive functions the main clinical aspect of concern in the present. In Colombia, the general population and healthcare professionals (even some psychiatrists) seem to have mostly negative opinions towards electroconvulsive therapy treatment, but maybe this could be reconsidered if more information is provided; therefore, the aim of the present study was to evaluate the changes in memory and the severity of the symptoms in a group of patients with severe depression before and after electroconvulsive therapy. METHODS Twenty-three patients ranging in age from 23 to 70 years from the electroconvulsive therapy service at the San Juan de Dios Clinic (Manizales, Colombia) were recruited in order to assess the effect of electroconvulsive therapy on memory in patients with severe depression. Depressive symptoms and memory were assessed with the Hamilton Depression Scale (HAMD) and Rey Auditory Verbal Learning Test (RAVLT), respectively. The assessment was administered to participants before the initial treatment of electroconvulsive therapy series (0-1 day) and 2 days after their last treatment. RESULTS Electroconvulsive therapy resulted in significant improvement in the rating of depression. There were no significant differences in the five learning trials, delayed recall, learning and forgetting scores from pre-treatment to post-treatment. Significant pre-treatment/post-treatment differences were found in the delayed recognition trial. CONCLUSIONS Pre- and post- electroconvulsive therapy cognitive assessment is a feasible and useful procedure. In general, memory performance does not worsen after electroconvulsive therapy in patients with depression. Only delayed recognition is affected a few days following electroconvulsive therapy, particularly in patients with low educational level and bitemporal (BT) electrode placement.
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Affiliation(s)
| | | | - Rocío Lemos Buitrago
- Department of Mental Health and Human Behavior, University of Caldas, Manizales, Colombia
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16
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Dominiak M, Antosik-Wójcińska AZ, Goetz Z, Sikorska O, Stefanowski B, Gorostiza D, Święcicki Ł. Efficacy, safety and tolerability of formula-based unilateral vs bilateral electroconvulsive therapy in the treatment of major depression: A randomized open label controlled trial. J Psychiatr Res 2021; 133:52-59. [PMID: 33310500 DOI: 10.1016/j.jpsychires.2020.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 11/28/2020] [Accepted: 12/01/2020] [Indexed: 12/14/2022]
Abstract
Electroconvulsive therapy (ECT) remains the most effective treatment of depression, though it is still unclear which of its type is the most beneficial. The aim of this study was to compare the formula-based right unilateral ECT (RUL) with the fronto-temporal bilateral ECT (BT), in terms of their efficacy, safety and tolerability in patients with bipolar or unipolar depression. Ninety-one patients were randomly assigned to either BT (n = 45) or RUL (n = 46) ECT. Brief pulse width (0.5 ms) and a formula-based dosing method were applied. The clinical efficacy was assessed using the Hamilton Depression Rating Scale (HDRS-21).The somatic state was monitored throughout the ECT course and cognitive examination included: general cognitive performance, executive functions, visual-spatial functions, verbal fluency, verbal memory and autobiographical memory. Efficacy outcomes were not found to be significantly different between groups when using higher doses of energy in RUL ECT. Patients in RUL group were less likely to be confused and experienced increased blood pressure. The indices of general cognitive performance and verbal auditory memory were also significantly better this group, while BT ECT did not change these functions. Both ECT types resulted in a decline in the retrieval consistency of autobiographical memory that persists for at least three months and was significantly more marked in BT group as compared to RUL. In conclusion, formula-based RUL ECT does not differ from BT in antidepressant efficacy and has an advantage in terms of safety (lower incidence of increased blood pressure and fewer disturbances of consciousness) and tolerability (impact on cognitive functions).
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Affiliation(s)
- Monika Dominiak
- Department of Pharmacology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland.
| | | | - Zuzanna Goetz
- Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland
| | - Olga Sikorska
- Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland
| | - Bogdan Stefanowski
- Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland
| | - Dagny Gorostiza
- Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland
| | - Łukasz Święcicki
- Department of Affective Disorders, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland
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17
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Steward B, Bakir AA, Martin D, Dokos S, Loo CK. The left anterior right temporal (LART) placement for electroconvulsive therapy: A computational modelling study. Psychiatry Res Neuroimaging 2020; 304:111157. [PMID: 32799057 DOI: 10.1016/j.pscychresns.2020.111157] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 11/25/2022]
Abstract
Electrode placement in electroconvulsive therapy (ECT) has a major impact on treatment efficacy and cognitive side effects. Left Anterior Right Temporal (LART) is a lesser utilised bilateral montage which may produce more optimal clinical outcomes relative to standard bitemporal ECT. In this study we used computational modelling to explore how stimulation effects from LART and two novel variants (LART - F3 and LART - Frontal) compared to the more common bilateral placements of bitemporal and bifrontal ECT. High resolution finite element human head models were generated from MRI scans of three subjects with Major Depressive Disorder. Differences in regional stimulation were examined through parametric tests for regions of interest and subtraction maps. Compared to bitemporal ECT, LART - Original resulted in significantly greater stimulation of the left cingulate gyrus (hypothesised to be associated with treatment efficacy), and relatively reduced stimulation of the bilateral hippocampi (potentially associated with cognitive side effects). No additional clinical benefit was suggested with the novel LART placements compared to the original LART. The original LART placement is a promising montage for further clinical investigation.
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Affiliation(s)
| | - Azam Ahmad Bakir
- Graduate School of Biomedical Engineering, University of New South Wales, NSW, Australia
| | - Donel Martin
- Black Dog Institute, Sydney, NSW, Australia; School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.
| | - Socrates Dokos
- Graduate School of Biomedical Engineering, University of New South Wales, NSW, Australia
| | - Colleen K Loo
- Black Dog Institute, Sydney, NSW, Australia; School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; St George Hospital, South Eastern Sydney Health, Sydney, NSW, Australia
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18
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Al-Alawi M, Brietzke E, Carvalhal A, Soares CN. The potential anti-depressant properties of dexmedetomidine infusion: a review of mechanistic, preclinical, and clinical evidence. Rev Neurosci 2020; 31:649-658. [PMID: 32573483 DOI: 10.1515/revneuro-2020-0001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 02/25/2020] [Indexed: 12/14/2022]
Abstract
Major depressive disorder (MDD) is a highly prevalent and disabling condition for which the currently available treatments are not fully effective. Existing unmet needs include rapid onset of action and optimal management of concurrent agitation. Dexmedetomidine (DEX) is a selective and potent α2-adrenergic receptor (α2-AR) agonist, with unique pharmacokinetic and pharmacodynamic properties. In this review, we discuss pre-clinical and clinical studies which focused on DEX in the context of its putative antidepressant effects for the management of MDD. Preliminary data support DEX as an antidepressant with fast onset of action, which would be especially helpful for patients experiencing treatment resistant depression, and agitation. We further explore the mechanistic and clinical implications of considering DEX as a putative antidepressant agent, and the next steps to explore the efficacy of low dose DEX infusion among patients with treatment resistant depression.
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Affiliation(s)
- Mohammed Al-Alawi
- Department of Psychiatry, Queens University School of Medicine, 752 King Street West, Postal Bag 603, Kingston, ONK7L 7X3, Canada.,Department of Behavioral Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Elisa Brietzke
- Department of Psychiatry, Queens University School of Medicine, 752 King Street West, Postal Bag 603, Kingston, ONK7L 7X3, Canada
| | - Adriana Carvalhal
- Department of Psychiatry, Queens University School of Medicine, 752 King Street West, Postal Bag 603, Kingston, ONK7L 7X3, Canada
| | - Claudio N Soares
- Department of Psychiatry, Queens University School of Medicine, 752 King Street West, Postal Bag 603, Kingston, ONK7L 7X3, Canada
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19
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Kellner CH, Obbels J, Sienaert P. When to consider electroconvulsive therapy (ECT). Acta Psychiatr Scand 2020; 141:304-315. [PMID: 31774547 DOI: 10.1111/acps.13134] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To familiarize the reader with the role of electroconvulsive therapy (ECT) in current psychiatric medicine. METHOD We review clinical indications for ECT, patient selection, contemporary ECT practice, maintenance treatment and ECT in major treatment guidelines. RESULTS ECT is underutilized largely due to persisting stigma and lack of knowledge about modern ECT technique. CONCLUSION ECT remains a vital treatment for patients with severe mood disorders, psychotic illness and catatonia.
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Affiliation(s)
- C H Kellner
- New York Community Hospital, Brooklyn, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Obbels
- Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center, KU Leuven (Catholic University of Leuven), Kortenberg, Belgium
| | - P Sienaert
- Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center, KU Leuven (Catholic University of Leuven), Kortenberg, Belgium
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20
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Borrione L, Bellini H, Razza LB, Avila AG, Baeken C, Brem AK, Busatto G, Carvalho AF, Chekroud A, Daskalakis ZJ, Deng ZD, Downar J, Gattaz W, Loo C, Lotufo PA, Martin MDGM, McClintock SM, O'Shea J, Padberg F, Passos IC, Salum GA, Vanderhasselt MA, Fraguas R, Benseñor I, Valiengo L, Brunoni AR. Precision non-implantable neuromodulation therapies: a perspective for the depressed brain. ACTA ACUST UNITED AC 2020; 42:403-419. [PMID: 32187319 PMCID: PMC7430385 DOI: 10.1590/1516-4446-2019-0741] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/10/2019] [Indexed: 12/13/2022]
Abstract
Current first-line treatments for major depressive disorder (MDD) include pharmacotherapy and cognitive-behavioral therapy. However, one-third of depressed patients do not achieve remission after multiple medication trials, and psychotherapy can be costly and time-consuming. Although non-implantable neuromodulation (NIN) techniques such as transcranial magnetic stimulation, transcranial direct current stimulation, electroconvulsive therapy, and magnetic seizure therapy are gaining momentum for treating MDD, the efficacy of non-convulsive techniques is still modest, whereas use of convulsive modalities is limited by their cognitive side effects. In this context, we propose that NIN techniques could benefit from a precision-oriented approach. In this review, we discuss the challenges and opportunities in implementing such a framework, focusing on enhancing NIN effects via a combination of individualized cognitive interventions, using closed-loop approaches, identifying multimodal biomarkers, using computer electric field modeling to guide targeting and quantify dosage, and using machine learning algorithms to integrate data collected at multiple biological levels and identify clinical responders. Though promising, this framework is currently limited, as previous studies have employed small samples and did not sufficiently explore pathophysiological mechanisms associated with NIN response and side effects. Moreover, cost-effectiveness analyses have not been performed. Nevertheless, further advancements in clinical trials of NIN could shift the field toward a more “precision-oriented” practice.
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Affiliation(s)
- Lucas Borrione
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Helena Bellini
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Lais Boralli Razza
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Ana G Avila
- Centro de Neuropsicologia e Intervenção Cognitivo-Comportamental, Faculdade de Psicologia e Ciências da Educação, Universidade de Coimbra, Coimbra, Portugal
| | - Chris Baeken
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Psychiatry, University Hospital (UZ Brussel), Brussels, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Anna-Katharine Brem
- Max Planck Institute of Psychiatry, Munich, Germany.,Division of Interventional Cognitive Neurology, Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Geraldo Busatto
- Laboratório de Neuroimagem em Psiquiatria (LIM-21), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Adam Chekroud
- Spring Health, New York, NY, USA.,Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutic & Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.,Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Jonathan Downar
- Department of Psychiatry and Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Centre for Mental Health and Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Wagner Gattaz
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas,
Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Colleen Loo
- School of Psychiatry and Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Paulo A Lotufo
- Estudo Longitudinal de Saúde do Adulto (ELSA), Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, USP, São Paulo, SP, Brazil
| | - Maria da Graça M Martin
- Laboratório de Ressonância Magnética em Neurorradiologia (LIM-44) and Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Shawn M McClintock
- Neurocognitive Research Laboratory, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jacinta O'Shea
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Ives C Passos
- Laboratório de Psiquiatria Molecular e Programa de
Transtorno Bipolar, Hospital de Clínicas de Porto Alegre (HCPA), Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Giovanni A Salum
- Departamento de Psiquiatria, Seção de Afeto Negativo e Processos Sociais (SANPS), HCPA, UFRGS, Porto Alegre, RS, Brazil
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium.,Department of Experimental Clinical and Health Psychology, Psychopathology and Affective Neuroscience Lab, Ghent University, Ghent, Belgium
| | - Renerio Fraguas
- Laboratório de Neuroimagem em Psiquiatria (LIM-21), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Hospital Universitário, USP, São Paulo, SP, Brazil
| | - Isabela Benseñor
- Estudo Longitudinal de Saúde do Adulto (ELSA), Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, USP, São Paulo, SP, Brazil
| | - Leandro Valiengo
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Andre R Brunoni
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas,
Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Hospital Universitário, USP, São Paulo, SP, Brazil
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Vanicek T, Kranz GS, Vyssoki B, Komorowski A, Fugger G, Höflich A, Micskei Z, Milovic S, Lanzenberger R, Eckert A, Kasper S, Frey R. Repetitive enhancement of serum BDNF subsequent to continuation ECT. Acta Psychiatr Scand 2019; 140:426-434. [PMID: 31369144 PMCID: PMC6856812 DOI: 10.1111/acps.13080] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2019] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Continuation electroconvulsive therapy (c-ECT) is highly effective for the prevention of depressive symptom relapse. There is a lack of understanding, about how c-ECT works in humans, particularly with regard to its effects on brain derived neurotrophic factor (BDNF) concentrations. Here, we aimed to close a gap in the literature by evaluating BDNF levels in patients receiving c-ECT. METHODS We included 13 patients with either unipolar or bipolar depression (mean age ± SD: 55.5 ± 17.1; f/m: 10/3; unipolar/bipolar: 10/3) who received between one and four c-ECT (average per patient: 2.8). Serum BDNF (sBDNF) levels were assessed before and after each c-ECT sessions. Clinical assessments were also administered both before and after treatment. RESULTS Our analysis revealed a significant increase in sBDNF after each treatment (c-ECT 1-3: P < 0.001, c-ECT 4: P = 0.018). The application of multiple c-ECT treatments was not, however, associated with further sBDNF enhancements. Psychometric scores were not significantly altered following c-ECT. DISCUSSION An increase in sBDNF concentrations subsequent to c-ECT parallel data from the animal literature, which has linked regularly applied electrical stimulation to neuroplastic processes. This finding suggests a relationship between ECT-induced sBDNF concentrations and (sustained) remission status, considering a stable clinical condition across c-ECT.
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Affiliation(s)
- T. Vanicek
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - G. S. Kranz
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
- Department of Rehabilitation SciencesThe Hong Kong Polytechnic UniversityHung HomHong Kong
- The State Key Laboratory of Brain and Cognitive SciencesThe University of Hong KongPokfulamHong Kong
| | - B. Vyssoki
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - A. Komorowski
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - G. Fugger
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - A. Höflich
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - Z. Micskei
- Departments of AnesthesiaCritical Care and Pain MedicineMedical University of ViennaViennaAustria
| | - S. Milovic
- Departments of AnesthesiaCritical Care and Pain MedicineMedical University of ViennaViennaAustria
| | - R. Lanzenberger
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - A. Eckert
- Neurobiology Laboratory for Brain Aging and Mental Health, Transfaculty Research Platform Molecular & Cognitive Neuroscience (MCN)University of BaselBaselSwitzerland
| | - S. Kasper
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - R. Frey
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
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22
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Su L, Jia Y, Liang S, Shi S, Mellor D, Xu Y. Multicenter randomized controlled trial of bifrontal, bitemporal, and right unilateral electroconvulsive therapy in major depressive disorder. Psychiatry Clin Neurosci 2019; 73:636-641. [PMID: 31260569 DOI: 10.1111/pcn.12907] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 05/02/2019] [Accepted: 06/25/2019] [Indexed: 11/27/2022]
Abstract
AIM Electroconvulsive therapy (ECT) has been shown to be the most effective and rapid treatment for severe depression. Electrode placement is one of the most important factors that affect ECT's efficacy and side-effects profile. Bifrontal, bitemporal, and unilateral are the three most used electrode placements. Very few studies have directly compared the efficacy and cognitive side-effects of the three placements. The aim of this study was to compare the efficacy and cognitive side-effects associated with bifrontal, bitemporal, and unilateral electrode placements. METHODS This multicenter randomized, blinded, controlled trial included 40 patients in each of the three groups. Most of the patients (94.8%) completed six ECT treatments. We used mixed-model analyses to compare differences in 17-item Hamilton Depression Rating Scale (HAMD-17) and Clinical Global Impression (CGI) scores among the three groups and the five times series (baseline, Week 1, Week 2, Week 3, and Week 4). The cognitive outcome was Mini-Mental State Examination (MMSE) score. RESULTS HAMD-17 and CGI scores did not differ significantly across the groups (HAMD-17 scores: z = -1.13, P = 0.259; CGI scores: z = -0.35, P = 0.729). MMSE scores at pre- and post-ECT were similar across the three groups (F = 2.06, P = 0.133). However, subgroup analysis using paired t-tests showed that MMSE scores improved in the right unilateral and bifrontal groups (t = 2.745, P = 0.0098; t = 2.464, P = 0.0204), but did not change in the bitemporal group (t = 1.188, P = 0.2461). CONCLUSION The efficacy of right unilateral and bifrontal ECT placement was similar to that of bitemporal ECT. The physical side-effects were also similar across the three groups. Right unilateral and bifrontal ECT placement were associated with improved cognitive outcomes, but bitemporal ECT placement was not.
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Affiliation(s)
- Liang Su
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Psychiatry, Huashan Hospital, Fudan University School of Medicine, Shanghai, China
| | - Yuping Jia
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shiqiao Liang
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shenxun Shi
- Department of Psychiatry, Huashan Hospital, Fudan University School of Medicine, Shanghai, China
| | - David Mellor
- School of Psychology, Deakin University, Melbourne, Australia
| | - Yifeng Xu
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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23
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Weiss A, Hussain S, Ng B, Sarma S, Tiller J, Waite S, Loo C. Royal Australian and New Zealand College of Psychiatrists professional practice guidelines for the administration of electroconvulsive therapy. Aust N Z J Psychiatry 2019; 53:609-623. [PMID: 30966782 DOI: 10.1177/0004867419839139] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To provide guidance for the optimal administration of electroconvulsive therapy, in particular maintaining the high efficacy of electroconvulsive therapy while minimising cognitive side-effects, based on scientific evidence and supplemented by expert clinical consensus. METHODS Articles and information were sourced from existing guidelines and the published literature. Information was revised and discussed by members of the working group of the Royal Australian and New Zealand College of Psychiatrists' Section for Electroconvulsive Therapy and Neurostimulation, and findings were then formulated into consensus-based recommendations and guidance. The guidelines were subjected to rigorous successive consultation and external review within the Royal Australian and New Zealand College of Psychiatrists, involving the full Section for Electroconvulsive Therapy and Neurostimulation membership, and expert and clinical advisors and professional bodies with an interest in electroconvulsive therapy administration. RESULTS The Royal Australian and New Zealand College of Psychiatrists' professional practice guidelines for the administration of electroconvulsive therapy provide up-to-date advice regarding the use of electroconvulsive therapy in clinical practice and are informed by evidence and clinical experience. The guidelines are intended for use by psychiatrists and also others with an interest in the administration of electroconvulsive therapy. The guidelines are not intended as a directive about clinical practice or instructions as to what must be done for a given patient, but provide guidance to facilitate best practice to help optimise outcomes for patients. The outcome is guidelines that strive to find the appropriate balance between promoting best evidence-based practice and acknowledging that electroconvulsive therapy is a continually evolving practice. CONCLUSION The guidelines provide up-to-date advice for psychiatrists to promote optimal standards of electroconvulsive therapy practice.
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Affiliation(s)
- Alan Weiss
- 1 School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Australia, Callaghan, NSW, Australia
| | - Salam Hussain
- 2 School of Psychiatry, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
- 3 Sir Charles Gairdner Hospital Mental Health Service, Perth, WA, Australia
| | - Bradley Ng
- 4 Mental Health and Specialist Services, Robina Hospital, Robina, QLD, Australia
| | - Shanthi Sarma
- 5 Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - John Tiller
- 6 Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
- 7 Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, VIC, Australia
| | - Susan Waite
- 8 Department of Mental Health Services, The Queen Elizabeth Hospital, Adelaide, SA, Australia
- 9 Discipline of Psychiatry, The University of Adelaide, Adelaide, SA, Australia
| | - Colleen Loo
- 10 School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
- 11 Sydney Neurostimulation Centre, Black Dog Institute, Randwick, NSW, Australia
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24
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Computational comparison of conventional and novel electroconvulsive therapy electrode placements for the treatment of depression. Eur Psychiatry 2019; 60:71-78. [PMID: 31234010 DOI: 10.1016/j.eurpsy.2019.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/17/2019] [Accepted: 05/18/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is a highly effective treatment for severe psychiatric disorders. Despite its high efficacy, the use of ECT would be greater if the risk of cognitive side effects were reduced. Over the last 20 years, developments in ECT technique, including improvements in the dosing methodology and modification of the stimulus waveform, have allowed for improved treatment methods with reduced adverse cognitive effects. There is increasing evidence that the electrode placement is important for orienting the electrical stimulus and therefore modifying treatment outcomes, with potential for further improvement of the placements currently used in ECT. OBJECTIVE We used computational modelling to perform an in-depth examination into regional differences in brain excitation by the ECT stimulus for several lesser known and novel electrode placements, in order to investigate the potential for an electrode placement that may optimise clinical outcomes. METHODS High resolution finite element human head models were generated from MRI scans of three subjects. The models were used to compare regional differences in average electric field (EF) magnitude among a total of thirteen bipolar ECT electrode placements, i.e. three conventional placements as well as ten lesser known and novel placements. RESULTS AND CONCLUSION In this exploratory study on a systemic comparison of thirteen ECT electrode placements, the EF magnitude at regions of interest (ROIs) was highly dependent upon the position of both electrodes, especially the ROIs close to the cortical surface. Compared to conventional right-unilateral (RUL) ECT using a temporo-parietal placement, fronto-parietal and supraorbito-parietal RUL also robustly stimulated brain regions considered important for efficacy, while sparing regions related to cognitive functions, and may be a preferrable approach to the currently used placement for RUL ECT. The simulations also found that regional average EF magnitude varied between individual subjects, due to factors such as head size, and results also depended on the size of the defined ROI.
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25
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Sinha P, Reddy RV, Srivastava P, Mehta UM, Bharath RD. Network neurobiology of electroconvulsive therapy in patients with depression. Psychiatry Res Neuroimaging 2019; 287:31-40. [PMID: 30952030 DOI: 10.1016/j.pscychresns.2019.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 03/16/2019] [Accepted: 03/19/2019] [Indexed: 12/22/2022]
Abstract
Graph theory, a popular analytic tool for resting state fMRI (rsfMRI) has provided important insights in the neurobiology of depression. We aimed to analyze the changes in the network measures of segregation and integration associated with the administration of ECT in patients with depression and to correlate with both clinical response and cognitive deficits. Changes in normalised clustering coefficient (γ), path length (λ) and small-world (σ) index were explored in 17 patients with depressive episode before 1st and after 6th brief-pulse bifrontal ECT (BFECT) sessions. Significant brain regions were then correlated with differences in clinical and cognitive scales. There was significantly increased γ and σ despite significant increase in λ in several brain regions after ECT in patients with depression. The brain areas revealing significant differences in γ before and after ECT were medial left superior frontal gyrus, left paracentral lobule, right pallidum and left inferior frontal operculum; correlating with changes in verbal fluency, HAM-D scores and delayed verbal memory (last two regions) respectively. BFECT reorganized the brain network topology in patients with depression and made it more segregated and less integrated; these correlated with clinical improvement and associated cognitive deficits.
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Affiliation(s)
- Preeti Sinha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560029, India
| | - R Venkateswara Reddy
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560029, India; Cognitive Neuroscience Centre, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560029, India
| | - Prerna Srivastava
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560029, India
| | - Urvakhsh M Mehta
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560029, India
| | - Rose Dawn Bharath
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560029, India; Cognitive Neuroscience Centre, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560029, India.
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26
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Zhang QE, Zhou FC, Zhang L, Ng CH, Ungvari GS, Wang G, Xiang YT. Knowledge and attitudes of older psychiatric patients and their caregivers towards electroconvulsive therapy. Psychogeriatrics 2018; 18:343-350. [PMID: 29987864 DOI: 10.1111/psyg.12326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/22/2017] [Accepted: 02/03/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is an effective treatment for older patients with severe psychiatric disorders, but their knowledge and attitudes regarding ECT have not been well studied. This study examined the knowledge and attitudes of older Chinese patients and their caregivers towards ECT. METHOD A total of 216 participants comprising older patients treated with ECT (n = 108) and their caregivers (n = 108) were recruited. Their knowledge and attitudes regarding ECT were assessed using self-reported questionnaires. RESULTS Most caregivers received sufficient information on the therapeutic effects of ECT, but inadequate information about the ECT process, its adverse effects, and risks was provided to caregivers and patients before treatment. Although ECT was generally viewed as beneficial, effective, and safe, around two-thirds of patients and caregivers believed that ECT should be used only for critically ill patients. Over half of the patients reported adverse effects caused by ECT, with memory impairment being the most commonly reported. CONCLUSIONS Clinicians in Chinese psychiatric hospitals need to provide sufficient information on ECT to older patients and their caregivers before treatment, particularly regarding the treatment process and adverse effects.
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Affiliation(s)
- Qing-E Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Faculty of Health Sciences, University of Macau, Macau, China
| | - Fu-Chun Zhou
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Ling Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Gabor S Ungvari
- University of Notre Dame Australia / Graylands Hospital, Perth, Western Australia, Australia
| | - Gang Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yu-Tao Xiang
- Faculty of Health Sciences, University of Macau, Macau, China
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27
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Pinna M, Manchia M, Oppo R, Scano F, Pillai G, Loche AP, Salis P, Minnai GP. Clinical and biological predictors of response to electroconvulsive therapy (ECT): a review. Neurosci Lett 2018; 669:32-42. [DOI: 10.1016/j.neulet.2016.10.047] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 10/24/2016] [Indexed: 01/04/2023]
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28
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A Randomized, Nonblind, Naturalistic Comparison of Efficacy and Cognitive Outcomes With Right Unilateral, Bifrontal, and Bitemporal Electroconvulsive Therapy in Schizophrenia. J ECT 2018; 34:26-30. [PMID: 28937546 DOI: 10.1097/yct.0000000000000454] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is little literature on the relative efficacy and cognitive safety of right unilateral (RUL), bifrontal (BF), and bitemporal (BT) electroconvulsive therapy (ECT) in schizophrenia. METHODS We present a randomized, nonblind, naturalist comparison of a fixed course of 8 moderately high-dose RUL (n = 24), threshold BF (n = 27), and threshold BT (n = 31) ECT in patients with schizophrenia. Assessments included the Positive and Negative Syndrome Scale (PANSS), the Wechsler Memory Scale-Revised, and an autobiographical memory interview. A completer analysis was planned and conducted to capture the cognitive outcomes. RESULTS The sample as a whole improved significantly on all efficacy outcomes and deteriorated significantly on all cognitive outcomes. The primary efficacy outcome, improvement in PANSS total scores, did not differ significantly across groups. The PANSS positive score (but no other subscale score) improved significantly less with RUL relative to BF and BT ECT. For autobiographical memory and for almost all Wechsler Memory Scale subtests, including memory quotient (the primary adverse effect outcome), BT ECT was associated with greater impairment than RUL or BF ECT. Importantly, all statistically significant differences between treatments were clinically small in magnitude. CONCLUSIONS In patients with schizophrenia who receive a fixed course of 8 ECTs, threshold BT ECT is associated with greater cognitive impairment across a range of measures, and moderately high-dose RUL ECT is associated with poorer efficacy against positive symptoms. Threshold BF ECT exhibits the best efficacy-cum-neurocognitive safety profile. All differences between groups, however, are small and perhaps clinically insignificant.
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29
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Stojanovic Z, Andric S, Soldatovic I, Dolic M, Spiric Z, Maric NP. Executive function in treatment-resistant depression before and after electroconvulsive therapy. World J Biol Psychiatry 2017; 18:624-632. [PMID: 27072874 DOI: 10.3109/15622975.2016.1174299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The aim of this study was to examine executive functions (EF) in patients with treatment-resistant depression (TRD) before and after bitemporal electroconvulsive therapy (ECT) and to evaluate possible associations between the depression severity and executive tasks performances. METHODS Patients (n = 29), treated with bitemporal ECT, underwent assessment at three time points: baseline, immediately after ECT course and 1 month later. The Stockings of Cambridge (SOC, CANTAB) was used to assess EF: (1) number of problems solved in minimum moves (SOC-P), (2) initial thinking time (SOC-I) and (3) subsequent thinking time (SOC-T). RESULTS The scores on the Hamilton Depression Rating Scale and the Clinical Global Impression scale were significantly reduced over time, with no negative effects on the EF. Among SOC subtests, only SOC-I improved over time, which was significantly correlated with the depressive symptoms reduction. SOC-T and SOC-P remained unchanged and did not correlate with mood. Interestingly, the patients with more lifetime psychiatric hospitalisations and more ECT applications were more likely to drop-out and to have longer SOC-T while performing the test. CONCLUSIONS Our results support the view that ECT does not produce long-lasting EF deficits, nor exacerbates the pre-existing ones. The improvement of the EF performances during and after the ECT-induced alleviation of mood symptoms in TRD is based mostly on the reduction of time needed to plan the problem solution.
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Affiliation(s)
| | - Sanja Andric
- b Clinic for Psychiatry Clinical Center of Serbia , Belgrade , Serbia
| | - Ivan Soldatovic
- c School of Medicine, University of Belgrade , Belgrade , Serbia
| | - Mirko Dolic
- a Clinic for Psychiatry , Military Medical Academy , Belgrade , Serbia
| | - Zeljko Spiric
- a Clinic for Psychiatry , Military Medical Academy , Belgrade , Serbia.,d Faculty of Medicine of the Military Medical Academy , University of Defense , Belgrade , Serbia
| | - Nadja P Maric
- b Clinic for Psychiatry Clinical Center of Serbia , Belgrade , Serbia.,c School of Medicine, University of Belgrade , Belgrade , Serbia
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30
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Getty SS, Faziola LR. Adverse effects of electroconvulsive therapy on cognitive performance. Ment Illn 2017; 9:7181. [PMID: 29142661 PMCID: PMC5661121 DOI: 10.4081/mi.2017.7181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 04/11/2017] [Indexed: 11/23/2022] Open
Affiliation(s)
- Sasha S Getty
- University of California at Irvine, School of Medicine
| | - Lawrence R Faziola
- Department of Psychiatry and Human Behavior, University of California, Irvine Medical Center, CA, USA
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31
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Müller HHO, Reike M, Grosse-Holz S, Röther M, Lücke C, Philipsen A, Kornhuber J, Grömer TW. Electroconvulsive Therapy Hasn't Negative Effects on Short-Term Memory Function, as Assessed Using a Bedside Hand-Held Device. Ment Illn 2017; 9:7093. [PMID: 28748058 PMCID: PMC5509960 DOI: 10.4081/mi.2017.7093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/31/2017] [Accepted: 03/31/2017] [Indexed: 11/23/2022] Open
Abstract
Electroconvulsive therapy (ECT) is effective in the treatment of treatment-resistant major depression. The fear of cognitive impairment after ECT often deters patients from choosing this treatment option. There is little reliable information regarding the effects of ECT on overall cognitive performance, while short-term memory deficits are well known but not easy to measure within clinical routines. In this pilot study, we examined ECT recipients' pre- and post-treatment performances on a digital ascending number tapping test. We found that cognitive performance measures exhibited good reproducibility in individual patients and that ECT did not significantly alter cognitive performance up to 2 hours after this therapy was applied. Our results can help patients and physicians make decisions regarding the administration of ECT. Digital measurements are recommended, especially when screening for the most common side effects on cognitive performance and short-term memory.
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Affiliation(s)
- Helge H O Müller
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen.,Department of Psychiatry and Psychotherapy, Medical Campus University of Oldenburg, School of Medicine and Health Sciences, University Hospital Karl-Jaspers-Klinik, Bad Zwischenahn, Germany
| | - Mareen Reike
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen
| | - Simon Grosse-Holz
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen
| | - Mareike Röther
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen
| | - Caroline Lücke
- Department of Psychiatry and Psychotherapy, Medical Campus University of Oldenburg, School of Medicine and Health Sciences, University Hospital Karl-Jaspers-Klinik, Bad Zwischenahn, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, Medical Campus University of Oldenburg, School of Medicine and Health Sciences, University Hospital Karl-Jaspers-Klinik, Bad Zwischenahn, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen
| | - Teja W Grömer
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen
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Bai S, Gálvez V, Dokos S, Martin D, Bikson M, Loo C. Computational models of Bitemporal, Bifrontal and Right Unilateral ECT predict differential stimulation of brain regions associated with efficacy and cognitive side effects. Eur Psychiatry 2017; 41:21-29. [PMID: 28049077 DOI: 10.1016/j.eurpsy.2016.09.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/21/2016] [Accepted: 09/24/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Extensive clinical research has shown that the efficacy and cognitive outcomes of electroconvulsive therapy (ECT) are determined, in part, by the type of electrode placement used. Bitemporal ECT (BT, stimulating electrodes placed bilaterally in the frontotemporal region) is the form of ECT with relatively potent clinical and cognitive side effects. However, the reasons for this are poorly understood. OBJECTIVE This study used computational modelling to examine regional differences in brain excitation between BT, Bifrontal (BF) and Right Unilateral (RUL) ECT, currently the most clinically-used ECT placements. Specifically, by comparing similarities and differences in current distribution patterns between BT ECT and the other two placements, the study aimed to create an explanatory model of critical brain sites that mediate antidepressant efficacy and sites associated with cognitive, particularly memory, adverse effects. METHODS High resolution finite element human head models were generated from MRI scans of three subjects. The models were used to compare differences in activation between the three ECT placements, using subtraction maps. RESULTS AND CONCLUSION In this exploratory study on three realistic head models, Bitemporal ECT resulted in greater direct stimulation of deep midline structures and also left temporal and inferior frontal regions. Interpreted in light of existing knowledge on depressive pathophysiology and cognitive neuroanatomy, it is suggested that the former sites are related to efficacy and the latter to cognitive deficits. We hereby propose an approach using binarised subtraction models that can be used to optimise, and even individualise, ECT therapies.
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Affiliation(s)
- S Bai
- Department of Electrical and Computer Engineering, Technische Universität München, 80333 München, Germany; Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales (UNSW), NSW 2052, Australia
| | - V Gálvez
- School of Psychiatry, UNSW, NSW 2052, Australia; Black Dog Institute, NSW 2031, Australia
| | - S Dokos
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales (UNSW), NSW 2052, Australia
| | - D Martin
- School of Psychiatry, UNSW, NSW 2052, Australia; Black Dog Institute, NSW 2031, Australia
| | - M Bikson
- Department of Biomedical Engineering, The City College of The City University of New York, New York, USA
| | - C Loo
- School of Psychiatry, UNSW, NSW 2052, Australia; Black Dog Institute, NSW 2031, Australia; Department of Psychiatry, St George Hospital, NSW 2217, Australia.
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Kolshus E, Jelovac A, McLoughlin DM. Bitemporal v. high-dose right unilateral electroconvulsive therapy for depression: a systematic review and meta-analysis of randomized controlled trials. Psychol Med 2017; 47:518-530. [PMID: 27780482 DOI: 10.1017/s0033291716002737] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Brief-pulse electroconvulsive therapy (ECT) is the most acutely effective treatment for severe depression though concerns persist about cognitive side-effects. While bitemporal electrode placement is the most commonly used form worldwide, right unilateral ECT causes less cognitive side-effects though historically it has been deemed less effective. Several randomized trials have now compared high-dose (>5× seizure threshold) unilateral ECT with moderate-dose (1.0-2.5× seizure threshold) bitemporal ECT to investigate if it is as effective as bitemporal ECT but still has less cognitive side-effects. We aimed to systematically review these trials and meta-analyse clinical and cognitive outcomes where appropriate. METHOD We searched PubMed, PsycINFO, Web of Science, Cochrane Library and EMBASE for randomized trials comparing these forms of ECT using the terms 'electroconvulsive' OR 'electroshock' AND 'trial'. RESULTS Seven trials (n = 792) met inclusion criteria. Bitemporal ECT did not differ from high-dose unilateral ECT on depression rating change scores [Hedges's g = -0.03, 95% confidence interval (CI) -0.17 to 0.11], remission (RR 1.06, 95% CI 0.93-1.20), or relapse at 12 months (RR 1.42, 95% CI 0.90-2.23). There was an advantage for unilateral ECT on reorientation time after individual ECT sessions (mean difference in minutes = -8.28, 95% CI -12.86 to -3.70) and retrograde autobiographical memory (Hedges's g = -0.46, 95% CI -0.87 to -0.04) after completing an ECT course. There were no differences for general cognition, category fluency and delayed visual and verbal memory. CONCLUSIONS High-dose unilateral ECT does not differ from moderate-dose bitemporal ECT in antidepressant efficacy but has some cognitive advantages.
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Affiliation(s)
- E Kolshus
- Department of Psychiatry,Trinity College Dublin,St Patrick's University Hospital,Dublin,Ireland
| | - A Jelovac
- Department of Psychiatry,Trinity College Dublin,St Patrick's University Hospital,Dublin,Ireland
| | - D M McLoughlin
- Department of Psychiatry,Trinity College Dublin,St Patrick's University Hospital,Dublin,Ireland
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Rosenquist PB, McCall WV, Youssef N. Charting the Course of Electroconvulsive Therapy: Where Have We Been and Where Are We Headed? J Psychosoc Nurs Ment Health Serv 2016; 54:39-43. [DOI: 10.3928/02793695-20161208-08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rosenquist PB, McCall WV, Youssef N. Charting the Course of Electroconvulsive Therapy: Where Have We Been and Where Are We Headed? Psychiatr Ann 2016. [DOI: 10.3928/00485713-20160927-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Stormont B, Diedricks AA, Kidd G. A retrospective chart audit of electroconvulsive therapy at a regional Australian hospital. Australas Psychiatry 2016; 24:493-6. [PMID: 26906439 DOI: 10.1177/1039856216632397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The objective of the current study was to provide a contemporary review of electroconvulsive therapy (ECT) practice in Far North Queensland, Australia. METHOD Demographic, diagnostic and treatment characteristics were extracted from the hospital files of people who received ECT between 2011 and 2013. Data were quantitatively analysed and described. RESULTS Depressive illnesses were the most common indicator for treatment. However, psychotic illnesses also made up a large proportion of treated cases. The technical aspects of treatment were commensurate with previous Australian findings except for the higher incidence of bifrontal ECT and maintenance treatment. CONCLUSIONS Further research is needed across Australia to determine whether the findings of the current study represent changes in Australian ECT practice.
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Affiliation(s)
- Barry Stormont
- College of Healthcare Sciences, Division of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia
| | - Angelo A Diedricks
- Consultant Psychiatrist, Older Persons Mental Health Service, Cairns and Hinterland Hospital and Health Service, Queensland Health, Cairns, QLD, Australia
| | - Garry Kidd
- Associate Professor and Head, Department of Psychology, College of Healthcare Sciences, Division of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia
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Cognitive Effects of Bifrontal Versus Right Unilateral Electroconvulsive Therapy in the Treatment of Major Depression in Elderly Patients: A Randomized, Controlled Trial. J ECT 2016; 32:151-8. [PMID: 26909824 DOI: 10.1097/yct.0000000000000310] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Bifrontal (BF) electrode placement has been explored to refine the electroconvulsive therapy (ECT) technique. No previous study has compared the cognitive effects of BF versus right unilateral (RUL) ECT by only including the subgroup that is most likely to receive it: elderly patients with major depression. METHODS Nondemented patients (n = 65) with major depression, aged 60 to 85 years, were randomly allocated to BF ECT and RUL formula-based ECT. Cognitive function was assessed at baseline (T1), within 1 week after a course of ECT (T2), and 3 months after T2 (T3). Six neuropsychological test measures of memory, 5 of executive function, and 3 of information-processing speed were administered. RESULTS According to linear mixed models, there were no significant differences between the BF and RUL groups at any time. The retrograde memory score for public facts declined more for the RUL group (P < 0.001) than the BF group (P = 0.005) from baseline to the first retest and remained stable for both groups from T2 to T3. A rapid improvement in selective attention was observed in the RUL group from T1 to T2, but the scores remained stable from T2 to T3 (P < 0.001). This measure remained stable in the BF group from T1 to T3. CONCLUSIONS Our findings indicate that there were negligible differences in the cognitive effects of formula-based BF or RUL ECT. The overall cognitive effects of ECT were equally favorable for each of the groups.
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Milev RV, Giacobbe P, Kennedy SH, Blumberger DM, Daskalakis ZJ, Downar J, Modirrousta M, Patry S, Vila-Rodriguez F, Lam RW, MacQueen GM, Parikh SV, Ravindran AV. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 4. Neurostimulation Treatments. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:561-75. [PMID: 27486154 PMCID: PMC4994792 DOI: 10.1177/0706743716660033] [Citation(s) in RCA: 363] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Canadian Network for Mood and Anxiety Treatments (CANMAT) conducted a revision of the 2009 guidelines by updating the evidence and recommendations. The scope of the 2016 guidelines remains the management of major depressive disorder (MDD) in adults, with a target audience of psychiatrists and other mental health professionals. METHODS Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. "Neurostimulation Treatments" is the fourth of six sections of the 2016 guidelines. RESULTS Evidence-informed responses were developed for 31 questions for 6 neurostimulation modalities: 1) transcranial direct current stimulation (tDCS), 2) repetitive transcranial magnetic stimulation (rTMS), 3) electroconvulsive therapy (ECT), 4) magnetic seizure therapy (MST), 5) vagus nerve stimulation (VNS), and 6) deep brain stimulation (DBS). Most of the neurostimulation treatments have been investigated in patients with varying degrees of treatment resistance. CONCLUSIONS There is increasing evidence for efficacy, tolerability, and safety of neurostimulation treatments. rTMS is now a first-line recommendation for patients with MDD who have failed at least 1 antidepressant. ECT remains a second-line treatment for patients with treatment-resistant depression, although in some situations, it may be considered first line. Third-line recommendations include tDCS and VNS. MST and DBS are still considered investigational treatments.
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Affiliation(s)
- Roumen V Milev
- Department of Psychiatry, Queen's University, Kingston, Ontario
| | - Peter Giacobbe
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | | | | | - Jonathan Downar
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | | | - Simon Patry
- Department of Psychiatry, L'Université Laval, Québec City, Québec
| | - Fidel Vila-Rodriguez
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | | | - Sagar V Parikh
- Department of Psychiatry, University of Toronto, Toronto, Ontario Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario
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Sanz-Fuentenebro FJ. Stimulus characteristics in electroconvulsive therapy. A pragmatic review. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2016; 11:36-47. [PMID: 27569402 DOI: 10.1016/j.rpsm.2016.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 06/07/2016] [Accepted: 06/30/2016] [Indexed: 12/28/2022]
Abstract
The process of normalization electroconvulsive therapy (ECT) requires, among other actions, disseminating the latest information on this technique. One of the most complex aspects is the electrical stimulus, whose knowledge should be spread and put into practice. In this paper we review the available information about frequency and number of ECT sessions, and efficacy of each electrode placement. We also present two approaches to determine the ECT charge: stimulus titration versus age-based method; and the limitations of the summary metrics of charge, being necessary to expand our knowledge of the parameters that configure the stimulus: duration, current amplitude frequency and pulse width.
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Affiliation(s)
- Francisco Javier Sanz-Fuentenebro
- Hospital Universitario-Instituto de Investigación Hospital 12 de Octubre, Madrid, España; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), España.
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Galletly C, Castle D, Dark F, Humberstone V, Jablensky A, Killackey E, Kulkarni J, McGorry P, Nielssen O, Tran N. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Aust N Z J Psychiatry 2016; 50:410-72. [PMID: 27106681 DOI: 10.1177/0004867416641195] [Citation(s) in RCA: 518] [Impact Index Per Article: 64.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This guideline provides recommendations for the clinical management of schizophrenia and related disorders for health professionals working in Australia and New Zealand. It aims to encourage all clinicians to adopt best practice principles. The recommendations represent the consensus of a group of Australian and New Zealand experts in the management of schizophrenia and related disorders. This guideline includes the management of ultra-high risk syndromes, first-episode psychoses and prolonged psychoses, including psychoses associated with substance use. It takes a holistic approach, addressing all aspects of the care of people with schizophrenia and related disorders, not only correct diagnosis and symptom relief but also optimal recovery of social function. METHODS The writing group planned the scope and individual members drafted sections according to their area of interest and expertise, with reference to existing systematic reviews and informal literature reviews undertaken for this guideline. In addition, experts in specific areas contributed to the relevant sections. All members of the writing group reviewed the entire document. The writing group also considered relevant international clinical practice guidelines. Evidence-based recommendations were formulated when the writing group judged that there was sufficient evidence on a topic. Where evidence was weak or lacking, consensus-based recommendations were formulated. Consensus-based recommendations are based on the consensus of a group of experts in the field and are informed by their agreement as a group, according to their collective clinical and research knowledge and experience. Key considerations were selected and reviewed by the writing group. To encourage wide community participation, the Royal Australian and New Zealand College of Psychiatrists invited review by its committees and members, an expert advisory committee and key stakeholders including professional bodies and special interest groups. RESULTS The clinical practice guideline for the management of schizophrenia and related disorders reflects an increasing emphasis on early intervention, physical health, psychosocial treatments, cultural considerations and improving vocational outcomes. The guideline uses a clinical staging model as a framework for recommendations regarding assessment, treatment and ongoing care. This guideline also refers its readers to selected published guidelines or statements directly relevant to Australian and New Zealand practice. CONCLUSIONS This clinical practice guideline for the management of schizophrenia and related disorders aims to improve care for people with these disorders living in Australia and New Zealand. It advocates a respectful, collaborative approach; optimal evidence-based treatment; and consideration of the specific needs of those in adverse circumstances or facing additional challenges.
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Affiliation(s)
- Cherrie Galletly
- Discipline of Psychiatry, School of Medicine, The University of Adelaide, SA, Australia Ramsay Health Care (SA) Mental Health, Adelaide, SA, Australia Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - David Castle
- Department of Psychiatry, St Vincent's Health and The University of Melbourne, Melbourne, VIC, Australia
| | - Frances Dark
- Rehabilitation Services, Metro South Mental Health Service, Brisbane, QLD, Australia
| | - Verity Humberstone
- Mental Health and Addiction Services, Northland District Health Board, Whangarei, New Zealand
| | - Assen Jablensky
- Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, The University of Western Australia (UWA), Crawley, WA, Australia
| | - Eóin Killackey
- Orygen - The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia The University of Melbourne, Melbourne, VIC, Australia
| | - Jayashri Kulkarni
- The Alfred Hospital and Monash University, Clayton, VIC, Australia Monash Alfred Psychiatry Research Centre, Melbourne, VIC, Australia
| | - Patrick McGorry
- Orygen - The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia The University of Melbourne, Melbourne, VIC, Australia Board of the National Youth Mental Health Foundation (headspace), Parkville, VIC, Australia
| | - Olav Nielssen
- Psychiatry, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Nga Tran
- St Vincent's Mental Health, Melbourne, VIC, Australia Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
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Retrospective comparison of effectiveness of right unilateral ultra-brief pulse with brief pulse ECT in older adults (over 65) with depression. Int Psychogeriatr 2016; 28:469-75. [PMID: 26344656 DOI: 10.1017/s1041610215001325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND To compare response, remission and switch (to other pulse width and/or electrode placement) rates and number of treatments between groups receiving right unilateral ultra-brief (RUL-UB), Bitemporal brief (BT), Bifrontal Brief (BF) and Right unilateral brief (RUL-B). METHOD Data was collected from case notes in three centers. There were 133 in total, grouped as RUL-UB (50), BT (43), BF (23), RUL-B (17). Two of the three centers had a preferred electrode placement and pulse width. RESULTS Apart from age, the groups did not differ significantly on sex distribution, proportion of bipolar depression and psychotic symptoms. 56% of patients in RUL-UB switched compared to 12.5% in RUL-B, 4.9% in BT and none in BF (p value < 0.0001). When we considered patients who switched as treatment failures, remission rates were significantly different (p value < 0.0001) 40% in RUL-UB, 81.3% in RUL-B, 73.9% in BF and 78.0% in BT. Mean number of treatments in each group was significantly different (p value < 0.0001); 12.02 in RUL-UB, 10.2 in RUL-B, 7 in BF and 7.5 in BT. Post-hoc analysis indicated that RUL-UB differed significantly from BT and BF. Final response and remission rates including patients who switched were 98% and 82% in RUL-UB, 100% and 93.8% in RUL-B, 100% and 73.9% in BF and 97.7% and 83.7% in BT. CONCLUSION Majority commencing RUL-UB switched and received 4-5 more treatments compared to bilateral placements. RUL-UB ECT appears less effective and might not be appropriate as first line for all older adults as some patients at higher anaesthetic risk would benefit from having reduced number of treatments.
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Efficacy of Electroconvulsive Therapy in Bipolar Disorder with Mixed Features. DEPRESSION RESEARCH AND TREATMENT 2016; 2016:8306071. [PMID: 26881069 PMCID: PMC4736372 DOI: 10.1155/2016/8306071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/14/2015] [Accepted: 12/17/2015] [Indexed: 12/04/2022]
Abstract
Introduction. Mixed states represent a frequent presentation of bipolar disorder, associated with higher resistance to psychopharmacology. Limited evidence supports the use of ECT in these patients. We aim to report our experience on treating bipolar mixed states with ECT. Methods. Retrospective data were collected from all bipolar patients submitted to acute ECT treatment, between June 2006 and June 2011. Three groups were created in terms of affective polarity of the episode. CGI rating was used to establish clinical remission and demographic and clinical variables were compared among groups. Long-term outcome was assessed through readmission measures, considering the use of continuation or maintenance ECT. Results. During the study time frame, a total of 50 ECT course treatments were performed on 41 bipolar patients. All affective episodes, except one mixed state, showed a positive clinical response. Patients with mixed state presentation tended to be younger and have an earlier first hospitalization than depressed patients. No differences were found in terms of ECT sessions performed, length of hospital admission, referral to continuation ECT treatment, number of readmissions, and time until next readmission. Conclusions. Our results support the effectiveness of ECT in patients experiencing a mixed affective state.
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Malhi GS, Bassett D, Boyce P, Bryant R, Fitzgerald PB, Fritz K, Hopwood M, Lyndon B, Mulder R, Murray G, Porter R, Singh AB. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2015; 49:1087-206. [PMID: 26643054 DOI: 10.1177/0004867415617657] [Citation(s) in RCA: 511] [Impact Index Per Article: 56.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To provide guidance for the management of mood disorders, based on scientific evidence supplemented by expert clinical consensus and formulate recommendations to maximise clinical salience and utility. METHODS Articles and information sourced from search engines including PubMed and EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (MDC) (e.g., books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Information was reviewed and discussed by members of the MDC and findings were then formulated into consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous successive consultation and external review involving: expert and clinical advisors, the public, key stakeholders, professional bodies and specialist groups with interest in mood disorders. RESULTS The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (Mood Disorders CPG) provide up-to-date guidance and advice regarding the management of mood disorders that is informed by evidence and clinical experience. The Mood Disorders CPG is intended for clinical use by psychiatrists, psychologists, physicians and others with an interest in mental health care. CONCLUSIONS The Mood Disorder CPG is the first Clinical Practice Guideline to address both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. MOOD DISORDERS COMMITTEE Professor Gin Malhi (Chair), Professor Darryl Bassett, Professor Philip Boyce, Professor Richard Bryant, Professor Paul Fitzgerald, Dr Kristina Fritz, Professor Malcolm Hopwood, Dr Bill Lyndon, Professor Roger Mulder, Professor Greg Murray, Professor Richard Porter and Associate Professor Ajeet Singh. INTERNATIONAL EXPERT ADVISORS Professor Carlo Altamura, Dr Francesco Colom, Professor Mark George, Professor Guy Goodwin, Professor Roger McIntyre, Dr Roger Ng, Professor John O'Brien, Professor Harold Sackeim, Professor Jan Scott, Dr Nobuhiro Sugiyama, Professor Eduard Vieta, Professor Lakshmi Yatham. AUSTRALIAN AND NEW ZEALAND EXPERT ADVISORS Professor Marie-Paule Austin, Professor Michael Berk, Dr Yulisha Byrow, Professor Helen Christensen, Dr Nick De Felice, A/Professor Seetal Dodd, A/Professor Megan Galbally, Dr Josh Geffen, Professor Philip Hazell, A/Professor David Horgan, A/Professor Felice Jacka, Professor Gordon Johnson, Professor Anthony Jorm, Dr Jon-Paul Khoo, Professor Jayashri Kulkarni, Dr Cameron Lacey, Dr Noeline Latt, Professor Florence Levy, A/Professor Andrew Lewis, Professor Colleen Loo, Dr Thomas Mayze, Dr Linton Meagher, Professor Philip Mitchell, Professor Daniel O'Connor, Dr Nick O'Connor, Dr Tim Outhred, Dr Mark Rowe, Dr Narelle Shadbolt, Dr Martien Snellen, Professor John Tiller, Dr Bill Watkins, Dr Raymond Wu.
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Affiliation(s)
- Gin S Malhi
- Discipline of Psychiatry, Kolling Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Darryl Bassett
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA, Australia School of Medicine, University of Notre Dame, Perth, WA, Australia
| | - Philip Boyce
- Discipline of Psychiatry, Sydney Medical School, Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre (MAPrc), Monash University Central Clinical School and The Alfred, Melbourne, VIC, Australia
| | - Kristina Fritz
- CADE Clinic, Discipline of Psychiatry, Sydney Medical School - Northern, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Bill Lyndon
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia Mood Disorders Unit, Northside Clinic, Greenwich, NSW, Australia ECT Services Northside Group Hospitals, Greenwich, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Greg Murray
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Richard Porter
- Department of Psychological Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Ajeet B Singh
- School of Medicine, Deakin University, Geelong, VIC, Australia
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Bjølseth TM, Engedal K, Benth JŠ, Dybedal GS, Gaarden TL, Tanum L. Baseline cognitive function does not predict the treatment outcome of electroconvulsive therapy (ECT) in late-life depression. J Affect Disord 2015; 185:67-75. [PMID: 26143406 DOI: 10.1016/j.jad.2015.06.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 06/15/2015] [Accepted: 06/15/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND No prior study has investigated whether impairment of specific cognitive functions at baseline may predict the short-term treatment outcome of electroconvulsive therapy (ECT) in elderly non-demented patients with major depression (MD). METHODS This longitudinal cohort study included 65 elderly patients with unipolar or bipolar MD, aged 60-85 years, treated with formula-based ECT. Treatment outcome was assessed using the 17-item Hamilton Rating Scale for Depression (HRSD17). Cognitive function at baseline was assessed using nine neuropsychological tests or subtests measuring information processing speed, verbal learning and memory, and aspects of executive function. RESULTS A poorer performance on the word reading task of the Color Word Interference Test rendered higher odds of achieving remission during the ECT course (p=0.021). Remission was defined as an HRSD17 score of 7 or less. There were no other significant associations between the treatment outcome of ECT and cognitive performance parameters assessed at baseline. LIMITATIONS The limited number of subjects may have reduced the generalizability of the findings. Multiple statistical tests increase the risk for making a type I error. CONCLUSIONS How well patients perform on neuropsychological tests at baseline is most likely not a predictor of, or otherwise not significantly associated with the treatment outcome of formula-based ECT in elderly patients with MD.
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Affiliation(s)
- Tor Magne Bjølseth
- Department of Geriatric Psychiatry, Diakonhjemmet Hospital, Pastor Fangens vei 18, 0854 Oslo, Norway.
| | - Knut Engedal
- Norwegian Centre for Aging and Health, Vestfold Health Trust, Tønsberg, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway; HØKH, Research Centre, Akershus University Hospital, Norway
| | - Gro Strømnes Dybedal
- Department of Geriatric Psychiatry, Diakonhjemmet Hospital, Pastor Fangens vei 18, 0854 Oslo, Norway
| | - Torfinn Lødøen Gaarden
- Department of Geriatric Psychiatry, Diakonhjemmet Hospital, Pastor Fangens vei 18, 0854 Oslo, Norway
| | - Lars Tanum
- Department of Research and Development in Mental Health, Akershus University Hospital, Norway
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Martin DM, Gálvez V, Loo CK. Predicting Retrograde Autobiographical Memory Changes Following Electroconvulsive Therapy: Relationships between Individual, Treatment, and Early Clinical Factors. Int J Neuropsychopharmacol 2015; 18:pyv067. [PMID: 26091817 PMCID: PMC4675978 DOI: 10.1093/ijnp/pyv067] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 06/12/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Loss of personal memories experienced prior to receiving electroconvulsive therapy is common and distressing and in some patients can persist for many months following treatment. Improved understanding of the relationships between individual patient factors, electroconvulsive therapy treatment factors, and clinical indicators measured early in the electroconvulsive therapy course may help clinicians minimize these side effects through better management of the electroconvulsive therapy treatment approach. In this study we examined the associations between the above factors for predicting retrograde autobiographical memory changes following electroconvulsive therapy. METHODS Seventy-four depressed participants with major depressive disorder were administered electroconvulsive therapy 3 times per week using either a right unilateral or bitemporal electrode placement and brief or ultrabrief pulse width. Verbal fluency and retrograde autobiographical memory (assessed using the Columbia Autobiographical Memory Interview - Short Form) were tested at baseline and after the last electroconvulsive therapy treatment. Time to reorientation was measured immediately following the third and sixth electroconvulsive therapy treatments. RESULTS Results confirmed the utility of measuring time to reorientation early during the electroconvulsive therapy treatment course as a predictor of greater retrograde amnesia and the importance of assessing baseline cognitive status for identifying patients at greater risk for developing later side effects. With increased number of electroconvulsive therapy treatments, older age was associated with increased time to reorientation. Consistency of verbal fluency performance was moderately correlated with change in Columbia Autobiographical Memory Interview - Short Form scores following right unilateral electroconvulsive therapy. CONCLUSIONS Electroconvulsive therapy treatment techniques associated with lesser cognitive side effects should be particularly considered for patients with lower baseline cognitive status or older age.
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Affiliation(s)
- Donel M Martin
- Black Dog Institute, School of Psychiatry, University of New South Wales, Sydney, Australia (Drs Martin, Gálvez, and Loo); Wesley Hospital, Sydney, Australia (Dr Loo); St George Hospital, South Eastern Sydney Health, Sydney, Australia (Dr Loo).
| | - Verònica Gálvez
- Black Dog Institute, School of Psychiatry, University of New South Wales, Sydney, Australia (Drs Martin, Gálvez, and Loo); Wesley Hospital, Sydney, Australia (Dr Loo); St George Hospital, South Eastern Sydney Health, Sydney, Australia (Dr Loo)
| | - Colleen K Loo
- Black Dog Institute, School of Psychiatry, University of New South Wales, Sydney, Australia (Drs Martin, Gálvez, and Loo); Wesley Hospital, Sydney, Australia (Dr Loo); St George Hospital, South Eastern Sydney Health, Sydney, Australia (Dr Loo)
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Vallejo-Torres L, Castilla I, González N, Hunter R, Serrano-Pérez P, Perestelo-Pérez L. Cost-effectiveness of electroconvulsive therapy compared to repetitive transcranial magnetic stimulation for treatment-resistant severe depression: a decision model. Psychol Med 2015; 45:1459-1470. [PMID: 25354790 PMCID: PMC4413854 DOI: 10.1017/s0033291714002554] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 07/04/2014] [Accepted: 09/26/2014] [Indexed: 11/12/2022]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is widely applied to treat severe depression resistant to standard treatment. Results from previous studies comparing the cost-effectiveness of this technique with treatment alternatives such as repetitive transcranial magnetic stimulation (rTMS) are conflicting. METHOD We conducted a cost-effectiveness analysis comparing ECT alone, rTMS alone and rTMS followed by ECT when rTMS fails under the perspective of the Spanish National Health Service. The analysis is based on a Markov model which simulates the costs and health outcomes of individuals treated under these alternatives over a 12-month period. Data to populate this model were extracted and synthesized from a series of randomized controlled trials and other studies that have compared these techniques on the patient group of interest. We measure effectiveness using quality-adjusted life years (QALYs) and characterize the uncertainty using probabilistic sensitivity analyses. RESULTS ECT alone was found to be less costly and more effective than rTMS alone, while the strategy of providing rTMS followed by ECT when rTMS fails is the most expensive and effective option. The incremental cost per QALY gained of this latter strategy was found to be above the reference willingness-to-pay threshold used in these types of studies in Spain and other countries. The probability that ECT alone is the most cost-effective alternative was estimated to be around 70%. CONCLUSIONS ECT is likely to be the most cost-effective option in the treatment of resistant severe depression for a willingness to pay of €30,000 per QALY.
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Affiliation(s)
- L. Vallejo-Torres
- Departamento de Economía de las Instituciones, Estadística Económica y Econometría, Universidad de la Laguna, Spain
- Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
| | - I. Castilla
- Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Tenerife, Spain
- Fundación Canaria de Investigación y Salud (FUNCIS), Spain
| | - N. González
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
- Research Unit Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - R. Hunter
- Research Department of Primary Care and Population Health, University College London, UK
| | | | - L. Perestelo-Pérez
- Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
- Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Tenerife, Spain
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Clinical efficacy of formula-based bifrontal versus right unilateral electroconvulsive therapy (ECT) in the treatment of major depression among elderly patients: a pragmatic, randomized, assessor-blinded, controlled trial. J Affect Disord 2015; 175:8-17. [PMID: 25590761 DOI: 10.1016/j.jad.2014.12.054] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 11/26/2014] [Accepted: 12/24/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND No prior study has compared the efficacy of bifrontal (BF) vs right unilateral (RUL) electroconvulsive therapy (ECT) by including the subgroup that is most likely to receive it: only elderly patients with major depression (MD). METHODS This single-site, randomized, assessor-blinded, controlled trial was conducted from 2009 to 2013. Seventy-three elderly patients with MD, unipolar and bipolar, were treated with a course of formula-based BF ECT or RUL ECT. The 17-item Hamilton Rating Scale for Depression (HRSD17) was used to measure efficacy. Safety was assessed with the Mini Mental State Examination (MMSE). RESULTS Both electrode placements resulted in highly significant downward trends in symptom severity (all p<0.001), with a non-significant difference between methods (p=0.703). At the end of the ECT course, response rates for the BF and RUL group were 63.9% and 67.6%, respectively. Short-term remission, defined as an HRSD17 score≤7, was achieved in 14 (38.9%) patients in the BF group and 19 (51.4%) patients in the RUL group. Global cognitive function, as measured by the MMSE, did not deteriorate in the two treatment groups. LIMITATIONS The small number of subjects may have led to reduced power to detect real differences. The MMSE is not sufficient to ascertain the negative effect of ECT on cognition. CONCLUSIONS This study indicates that formula-based BF and RUL ECT are equally efficacious, and that remission rates of formula-based dosing are lower than those previously reported for titrated dosing, in a clinical sample of elderly patients with MD. TRIAL REGISTRATION ClinicalTrials.gov NCT01559324.
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Oremus C, Oremus M, McNeely H, Losier B, Parlar M, King M, Hasey G, Fervaha G, Graham AC, Gregory C, Hanford L, Nazarov A, Restivo M, Tatham E, Truong W, Hall GBC, Lanius R, McKinnon M. Effects of electroconvulsive therapy on cognitive functioning in patients with depression: protocol for a systematic review and meta-analysis. BMJ Open 2015; 5:e006966. [PMID: 25762234 PMCID: PMC4360718 DOI: 10.1136/bmjopen-2014-006966] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 02/05/2015] [Accepted: 02/07/2015] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Depression is the leading cause of disability worldwide, affecting approximately 350 million people. Evidence indicates that only 60-70% of persons with major depressive disorder who tolerate antidepressants respond to first-line drug treatment; the remainder become treatment resistant. Electroconvulsive therapy (ECT) is considered an effective therapy in persons with treatment-resistant depression. The use of ECT is controversial due to concerns about temporary cognitive impairment in the acute post-treatment period. We will conduct a meta-analysis to examine the effects of ECT on cognition in persons with depression. METHODS This systematic review and meta-analysis has been registered with PROSPERO (registration number: CRD42014009100). We developed our methods following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. We are searching MEDLINE, PsychINFO, EMBASE, CINAHL and Cochrane from the date of database inception to the end of October 2014. We are also searching the reference lists of published reviews and evidence reports for additional citations. Comparative studies (randomised controlled trials, cohort and case-control) published in English will be included in the meta-analysis. Three clinical neuropsychologists will group the cognitive tests in each included article into a set of mutually exclusive cognitive subdomains. The risk of bias of randomised controlled trials will be assessed using the Jadad scale. We will supplement the Jadad scale with additional questions based on the Cochrane risk of bias tool. The risk of bias of cohort and case-control studies will be assessed using the Newcastle-Ottawa Scale. We will employ the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess the strength of evidence. STATISTICAL ANALYSIS Separate meta-analyses will be conducted for each ECT treatment modality and cognitive subdomain using Comprehensive Meta-Analysis V.2.0.
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Affiliation(s)
- Carolina Oremus
- McMaster Integrative Neuroscience Discovery and Study (MINDS) & Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Mark Oremus
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Heather McNeely
- Clinical Neuropsychology Service & Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Bruno Losier
- Clinical Neuropsychology Service & Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Melissa Parlar
- McMaster Integrative Neuroscience Discovery and Study (MINDS) & Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Matthew King
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Gary Hasey
- Mood Disorders Program & Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Gagan Fervaha
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Allyson C Graham
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Caitlin Gregory
- Faculty of Medicine, Undergraduate Medical Education, University of Toronto, Toronto, Ontario, Canada
| | - Lindsay Hanford
- McMaster Integrative Neuroscience Discovery and Study (MINDS), McMaster University, Hamilton, Ontario, Canada
| | - Anthony Nazarov
- McMaster Integrative Neuroscience Discovery and Study (MINDS) & Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Maria Restivo
- McMaster Integrative Neuroscience Discovery and Study (MINDS) & Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Erica Tatham
- McMaster Integrative Neuroscience Discovery and Study (MINDS), McMaster University, Hamilton, Ontario, Canada
| | - Wanda Truong
- Department of Psychology, University of Calgary, Calgary, Ontario, Canada
| | - Geoffrey B C Hall
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Ruth Lanius
- Department of Psychiatry, University of Western Ontario, London, Ontario, Canada
| | - Margaret McKinnon
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, Homewood Research Institute, & Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Fernie G, Bennett DM, Currie J, Perrin JS, Reid IC. Detecting objective and subjective cognitive effects of electroconvulsive therapy: intensity, duration and test utility in a large clinical sample. Psychol Med 2014; 44:2985-2994. [PMID: 25065412 DOI: 10.1017/s0033291714000658] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is an effective treatment for depression but the extent and persistence of cognitive side-effects remain uncertain. It has been reported that there is little evidence that impairments last longer than up to 15 days post-ECT. However, relatively few studies have followed patients for even as long as 1 month post-ECT. Here we report results from a brief cognitive battery given prior to ECT and repeated five times up to 6 months post-ECT. METHOD In a retrospective case-note study of routinely collected clinical data 126 patients treated with ECT completed two neuropsychological tests [Cambridge Neuropsychological Test Automated Battery (CANTAB) spatial recognition memory (SRM) and Mini Mental State Examination (MMSE)] and two subjective reports of memory function, prior to ECT. Patients were reassessed following ECT and at 1, 3 and 6 months post-ECT although not all patients completed all assessments. RESULTS Performance relative to pre-ECT baseline was significantly poorer at each post-ECT assessment up to 3 months post-ECT using the CANTAB SRM, but was improved at 6 months. Conversely, MMSE score showed improvements relative to baseline from 1 month post-ECT. Mood and subjective memory scores improved following ECT and were correlated with one another, but not with either neuropsychological measure. CONCLUSIONS The CANTAB SRM task revealed reversible cognitive deficiencies relative to a pre-ECT baseline for at least 3 months following ECT, while MMSE score and patients' subjective reports showed only improvement. Visuospatial memory scores eventually exceeded baseline 6 months post-ECT.
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Affiliation(s)
- G Fernie
- Division of Applied Medicine (Psychiatry),University of Aberdeen,Aberdeen,UK
| | - D M Bennett
- Division of Applied Medicine (Psychiatry),University of Aberdeen,Aberdeen,UK
| | - J Currie
- Division of Applied Medicine (Psychiatry),University of Aberdeen,Aberdeen,UK
| | - J S Perrin
- Division of Applied Medicine (Psychiatry),University of Aberdeen,Aberdeen,UK
| | - I C Reid
- Division of Applied Medicine (Psychiatry),University of Aberdeen,Aberdeen,UK
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