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Martínez-Amorós E, Cardoner N, Gálvez V, de Arriba-Arnau A, Soria V, Palao DJ, Menchón JM, Urretavizcaya M. Can the Addition of Maintenance Electroconvulsive Therapy to Pharmacotherapy Improve Relapse Prevention in Severe Major Depressive Disorder? A Randomized Controlled Trial. Brain Sci 2021; 11:brainsci11101340. [PMID: 34679404 PMCID: PMC8534103 DOI: 10.3390/brainsci11101340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/03/2021] [Indexed: 12/22/2022] Open
Abstract
Few systematic evaluations have been performed of the efficacy of electroconvulsive therapy (ECT) as a relapse prevention strategy in major depressive disorder (MDD). This is a single-blind, multicenter, randomized controlled trial to compare the efficacy and tolerability of pharmacotherapy plus maintenance ECT (M-Pharm/ECT) versus pharmacotherapy alone (M-Pharm) in the prevention of MDD relapse. Subjects with MDD who had remitted with bilateral acute ECT (n = 37) were randomly assigned to receive M-Pharm/ECT (n = 19, 14 treatments) or M-Pharm (n = 18) for nine months. The subjects were followed up for 15 months. The main outcome was relapse of depression, defined as a score of 18 or more on the Hamilton Depression Rating Scale. At nine months, 35% of the subjects treated with M-Pharm/ECT relapsed as compared with 61% of the patients treated with M-Pharm. No statistically significant differences between groups were indicated by either Kaplan–Meier or Cox proportional hazards regression analyses. The subjects without psychotic features were at higher risk of relapse. There were no statistically significant differences in the MMSE scores of the two groups at the end of the study. Further studies are needed to better define the indications for M-ECT in order to improve its efficacy as a relapse prevention strategy.
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Affiliation(s)
- Erika Martínez-Amorós
- Department of Mental Health, Parc Taulí University Hospital, Institut d’Investigació i Innovació Sanitària Parc Taulí (I3PT), 08208 Sabadell, Spain; (E.M.-A.); (V.G.); (D.J.P.)
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, 28029 Madrid, Spain; (V.S.); (J.M.M.)
| | - Narcís Cardoner
- Department of Mental Health, Parc Taulí University Hospital, Institut d’Investigació i Innovació Sanitària Parc Taulí (I3PT), 08208 Sabadell, Spain; (E.M.-A.); (V.G.); (D.J.P.)
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, 28029 Madrid, Spain; (V.S.); (J.M.M.)
- Correspondence: (N.C.); (M.U.)
| | - Verònica Gálvez
- Department of Mental Health, Parc Taulí University Hospital, Institut d’Investigació i Innovació Sanitària Parc Taulí (I3PT), 08208 Sabadell, Spain; (E.M.-A.); (V.G.); (D.J.P.)
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Aida de Arriba-Arnau
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group—Psychiatry and Mental Health, 08907 L’Hospitalet de Llobregat, Spain;
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, 08007 Barcelona, Spain
| | - Virginia Soria
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, 28029 Madrid, Spain; (V.S.); (J.M.M.)
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group—Psychiatry and Mental Health, 08907 L’Hospitalet de Llobregat, Spain;
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, 08007 Barcelona, Spain
| | - Diego J. Palao
- Department of Mental Health, Parc Taulí University Hospital, Institut d’Investigació i Innovació Sanitària Parc Taulí (I3PT), 08208 Sabadell, Spain; (E.M.-A.); (V.G.); (D.J.P.)
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, 28029 Madrid, Spain; (V.S.); (J.M.M.)
| | - José M. Menchón
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, 28029 Madrid, Spain; (V.S.); (J.M.M.)
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group—Psychiatry and Mental Health, 08907 L’Hospitalet de Llobregat, Spain;
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, 08007 Barcelona, Spain
| | - Mikel Urretavizcaya
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, 28029 Madrid, Spain; (V.S.); (J.M.M.)
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group—Psychiatry and Mental Health, 08907 L’Hospitalet de Llobregat, Spain;
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, 08007 Barcelona, Spain
- Correspondence: (N.C.); (M.U.)
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Short B, Dong V, Gálvez V, Vulovic V, Martin D, Bayes AJ, Zarate CA, Murrough JW, McLoughlin DM, Riva-Posse P, Schoevers R, Fraguas R, Glue P, Fam J, McShane R, Loo CK. Development of the Ketamine Side Effect Tool (KSET). J Affect Disord 2020; 266:615-620. [PMID: 32056935 PMCID: PMC7693479 DOI: 10.1016/j.jad.2020.01.120] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/20/2019] [Accepted: 01/20/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Currently, no specific, systematic assessment tool for the monitoring and reporting of ketamine-related side effects exists. Our aim was to develop a comprehensive Ketamine Side Effect Tool (KSET) to capture acute and longer-term side effects associated with repeated ketamine treatments. METHODS Informed by systematic review data and clinical research, we drafted a list of the most commonly reported side effects. Face and content validation were obtained via feedback from collaborators with expertise in psychiatry and anaesthetics, clinical trial piloting and a modified Delphi Technique involving ten international experts. RESULTS The final version consisted of four forms that collect information at time points: screening, baseline, immediately after a single treatment, and longer-term follow-up. Instructions were developed to guide users and promote consistent utilisation. LIMITATIONS Further evaluation of feasibility, construct validity and reliability is required, and is planned across multiple international sites. CONCLUSIONS The structured Ketamine Side Effect Tool (KSET) was developed, with confirmation of content and face validity via a Delphi consensus process. This tool is timely, given the paucity of data regarding ketamine's safety, tolerability and abuse potential over the longer term, and its recent adoption internationally as a clinical treatment for depression. Although based on data from depression studies, the KSET has potential applicability for ketamine (or derivatives) used in other medical disorders, including chronic pain. We recommend its utilisation for both research and clinical scenarios, including data registries.
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Affiliation(s)
- Brooke Short
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia,Gosford Hospital Gosford, Australia
| | - Vanessa Dong
- School of Psychiatry, University of New South Wales and Black Dog Institute, Sydney, Australia
| | - Verònica Gálvez
- Corporacio Sanitaria Parc Tauli, Universitat Autonoma de Barcelona, I3PT, Institut d’Investigacio i Innovacio Parc Tauli Sabadell Barcelona, Spain
| | | | - Donel Martin
- School of Psychiatry, University of New South Wales and Black Dog Institute, Sydney, Australia
| | - Adam J Bayes
- School of Psychiatry, University of New South Wales, Sydney, Australia,Black Dog Institute, Sydney, Australia
| | - Carlos A Zarate
- Division of Intramural Research Program, National Institute of Mental Health, MD, United States
| | - James W Murrough
- Depression and Anxiety Centre for Discovery and Treatment, Icahn School of Medicine at Mount Sinai New York, NY, United States
| | - Declan M McLoughlin
- Department of Psychiatry, Trinity College Institute of Neuroscience, Trinity College, Dublin, Ireland
| | - Patricio Riva-Posse
- Department of Psychiatry and Behavioral Sciences at Emory University, Atlanta, GA, United States
| | - Robert Schoevers
- The University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Renerio Fraguas
- Department and Institute of Psychiatry, University of Sao Paulo (USP), School of Medicine, Division of Psychiatry and Psychology, University Hospital (HU), USP Laboratório de Investigação Médica, Recife, Brazil
| | - Paul Glue
- Southern DHB and Hazel Buckland Chair in Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Johnson Fam
- Department of Psychological Medicine, National University Hospital,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Rupert McShane
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Colleen K Loo
- School of Psychiatry, University of New South Wales, Sydney, Australia; St George Hospital, Sydney, Australia; Black Dog Institute, Sydney, Australia; Wesley Hospital, Sydney, Australia.
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Abstract
INTRODUCTION The use of electroconvulsive therapy (ECT) in Singapore dates back to 1947. However, there is little local information on the clinical practice of ECT and its standards. We aimed to conduct a comprehensive national survey of ECT practice in Singapore. METHODS A cross-sectional structured questionnaire assessing the types of ECT (e.g. electrode placement, stimulus parameters), indications, anaesthetic technique, dosing methods, monitoring of outcomes and credentialing was sent in 2015 to all ECT centres in Singapore via email to collect qualitative and quantitative data regarding ECT. RESULTS Data was obtained from all ECT centres (n = 6), which represented that ECT was available in 23.1% of all hospitals and 50.0% of all psychiatric specialist centres. The rate of ECT was 5.89 treatments per 10,000 residents per year, and each patient received an average of 5.4 ECT per course. Only 7.0% of ECT was administered for continuation/maintenance ECT. The most common indication for ECT was depression in 5 (83.3%) out of six centres, with schizophrenia being the second most common. In 5 (83.3%) out of six centres, ECT was brief (0.5 ms) bitemporal ECT with age-based dosing, and 93.0% of the sessions were conducted in an inpatient setting. All ECT was conducted under general anaesthesia, with propofol (66.7%) being the most common type of anaesthetic used. CONCLUSION The practice of ECT in Singapore was highly uniform. The rates and indications for ECT were consistent with those of other developed countries, with greater use of ECT for schizophrenia. Future advances for ECT in Singapore include the use of individualised dosing based on empirical seizure threshold titration, expanded electrode placements and increased utilisation of continuation/maintenance ECT.
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Affiliation(s)
- Phern-Chern Tor
- Department of General Psychiatry, Institute of Mental Health, Singapore
| | - Verònica Gálvez
- School of Psychiatry, University of New South Wales, Sydney, Australia.,Black Dog Institute, Sydney, Australia
| | - Aaron Ang
- Department of Psychological Medicine, Tan Tock Seng Hospital, Singapore
| | - Johnson Fam
- Department of Psychological Medicine, National University Hospital, Singapore
| | - Herng-Nieng Chan
- Department of Psychological Medicine, Singapore General Hospital, Singapore
| | - Sheng-Neng Tan
- Department of Psychological Medicine, Changi General Hospital, Singapore
| | - Colleen K Loo
- School of Psychiatry, University of New South Wales, Sydney, Australia.,Black Dog Institute, Sydney, Australia.,Department of Psychiatry, St George Hospital, Sydney, Australia
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Martínez-Amorós E, Goldberg X, Gálvez V, de Arriba-Arnau A, Soria V, Menchón JM, Palao DJ, Urretavizcaya M, Cardoner N. Early improvement as a predictor of final remission in major depressive disorder: New insights in electroconvulsive therapy. J Affect Disord 2018; 235:169-175. [PMID: 29656263 DOI: 10.1016/j.jad.2018.03.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 02/07/2018] [Accepted: 03/27/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Early improvement to antidepressant drugs predicts remission, but the predictive value of early improvement to electroconvulsive therapy (ECT) is still unclear. The main aim of this study was to determine the optimal definition of early improvement in the treatment of major depressive disorder (MDD) with ECT, by analyzing its value as a predictor of remission. METHODS A naturalistic study was conducted in 87 adult MDD patients treated with acute ECT. ROC curves were generated to identify the best time point (week 1 or 2 of treatment) predicted remission. Sensibility, specificity, and predictive values were calculated for several definitions of early improvement previously proposed in the literature (20%, 25%, 30%, and 35%). Complementary, time to remission was analyzed and a logistic regression model was performed to further characterize the impact of the optimal definition of early improvement on remission while adjusting for other clinically relevant variables. RESULTS A 30% reduction in the HAM-D score after 2 weeks was identified as the optimal definition of early improvement, with acceptable sensitivity (76%), and specificity (67%). Complementary analyses provided further support for this definition showing a shorter time to remission and a significant effect adjusted for the rest of variables. LIMITATIONS Relatively small sample size, ECT restricted to brief bilateral treatment. CONCLUSIONS Early improvement, defined as a 30% of reduction in the HAM-D21 score at week 2, is a good predictor of remission in MDD patients treated with bilateral ECT, with potential clinical impact. Lack of early improvement could indicate a need for further changes in treatment strategies.
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Affiliation(s)
- Erika Martínez-Amorós
- Mental Health Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain
| | - Ximena Goldberg
- Mental Health Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain
| | - Verònica Gálvez
- School of Psychiatry, University of NSW. Black Dog Institute, Sydney, Randwick, Australia
| | - Aida de Arriba-Arnau
- Department of Psychiatry, Neurosciences Group - Psychiatry and Mental Health, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Virginia Soria
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain; Department of Psychiatry, Neurosciences Group - Psychiatry and Mental Health, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - José M Menchón
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain; Department of Psychiatry, Neurosciences Group - Psychiatry and Mental Health, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Diego J Palao
- Mental Health Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain
| | - Mikel Urretavizcaya
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain; Department of Psychiatry, Neurosciences Group - Psychiatry and Mental Health, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain.
| | - Narcís Cardoner
- Mental Health Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain.
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Gálvez V, Li A, Huggins C, Glue P, Martin D, Somogyi AA, Alonzo A, Rodgers A, Mitchell PB, Loo CK. Repeated intranasal ketamine for treatment-resistant depression - the way to go? Results from a pilot randomised controlled trial. J Psychopharmacol 2018. [PMID: 29542371 DOI: 10.1177/0269881118760660] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Ketamine research in depression has mostly used intravenous, weight-based approaches, which are difficult to translate clinically. Intranasal (IN) ketamine is a promising alternative but no controlled data has been published on the feasibility, safety and potential efficacy of repeated IN ketamine treatments. METHODS This randomised, double-blind, placebo-controlled pilot study compared a 4-week course of eight treatments of 100 mg ketamine or 4.5 mg midazolam. Each treatment was given as 10 separate IN sprays, self-administered 5 min apart. The study was stopped early due to poor tolerability after five treatment-resistant depressed participants were included. Feasibility, safety (acute and cumulative), cognitive and efficacy outcomes were assessed. Plasma ketamine and norketamine concentrations were assayed after the first treatment. RESULTS Significant acute cardiovascular, psychotomimetic and neurological side effects occurred at doses < 100 mg ketamine. No participants were able to self-administer all 10 ketamine sprays due to incoordination; treatment time occasionally had to be extended (>45 min) due to acute side effects. No hepatic, cognitive or urinary changes were observed after the treatment course in either group. There was an approximately two-fold variation in ketamine and norketamine plasma concentrations between ketamine participants. At course end, one participant had remitted in each of the ketamine and midazolam groups. CONCLUSIONS IN ketamine, with the drug formulation and delivery device used, was not a useful treatment approach in this study. Absorption was variable between individuals and acute tolerability was poor, requiring prolonged treatment administration time in some individuals. The drug formulation, the delivery device, the insufflation technique and individual patient factors play an important role in tolerability and efficacy when using IN ketamine for TRD.
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Affiliation(s)
- Verònica Gálvez
- 1 School of Psychiatry, University of New South Wales, Sydney, Australia.,2 Black Dog Institute, Sydney, Australia
| | - Adrienne Li
- 1 School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Christina Huggins
- 1 School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Paul Glue
- 3 Department of Psychological Medicine, University of Otago, New Zealand
| | - Donel Martin
- 1 School of Psychiatry, University of New South Wales, Sydney, Australia.,2 Black Dog Institute, Sydney, Australia
| | - Andrew A Somogyi
- 4 Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Australia
| | - Angelo Alonzo
- 1 School of Psychiatry, University of New South Wales, Sydney, Australia.,2 Black Dog Institute, Sydney, Australia
| | - Anthony Rodgers
- 5 The George Institute for Global Health, University of Sydney, Australia
| | - Philip B Mitchell
- 1 School of Psychiatry, University of New South Wales, Sydney, Australia.,2 Black Dog Institute, Sydney, Australia
| | - Colleen K Loo
- 1 School of Psychiatry, University of New South Wales, Sydney, Australia.,2 Black Dog Institute, Sydney, Australia.,6 Wesley Hospital, Sydney, Australia.,7 St George Hospital, Sydney, Australia
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Glue P, Loo C, Rodgers A, Gálvez V, Somogyi AA, Mitchell PB. Comments on Cooper et al.'s review on strategies to mitigate dissociative and psychotomimetic effects from ketamine when used as a fast-acting antidepressant. World J Biol Psychiatry 2017; 18:489. [PMID: 27232768 DOI: 10.1080/15622975.2016.1181782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Paul Glue
- a Dunedin School of Medicine , Otago , New Zealand
| | - Colleen Loo
- b School of Psychiatry , University of New South Wales & Black Dog Institute , Sydney , Australia
| | - Anthony Rodgers
- c The George Institute for Global Health, the University of Sydney , Sydney , Australia
| | - Verònica Gálvez
- b School of Psychiatry , University of New South Wales & Black Dog Institute , Sydney , Australia
| | - Andrew A Somogyi
- d School of Medicine , University of Adelaide , Adelaide , Australia
| | - Philip B Mitchell
- b School of Psychiatry , University of New South Wales & Black Dog Institute , Sydney , Australia
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Gálvez V, McGuirk L, Loo CK. The use of ketamine in ECT anaesthesia: A systematic review and critical commentary on efficacy, cognitive, safety and seizure outcomes. World J Biol Psychiatry 2017; 18:424-444. [PMID: 27892759 DOI: 10.1080/15622975.2016.1252464] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES This review will discuss ECT efficacy and cognitive outcomes when using ketamine as an ECT anaesthetic compared to other anaesthetics, taking into account important moderator variables that have often not been considered to date. It will also include information on safety and other ECT outcomes (seizure threshold and quality). METHODS A systematic search through MEDLINE, PubMed, PsychINFO, Cochrane Databases and reference lists from retrieved articles was performed. Search terms were: "ketamine" and "Electroconvulsive Therapy", from 1995 to September 2016. Meta-analyses, randomised controlled trials, open-label and retrospective studies published in English of depressed samples receiving ECT with ketamine anaesthesia were included (n = 24). RESULTS Studies were heterogeneous in the clinical populations included and ECT treatment and anaesthetic methods. Frequently, studies did not report on ECT factors (i.e., pulse-width, treatment schedule). Findings regarding efficacy were mixed. Tolerance from repeated use may explain why several studies found that ketamine enhanced efficacy early in the ECT course but not at the end. The majority of studies did not comprehensively examine cognition and adverse effects were not systematically studied. Only a minority of the studies reported on seizure threshold and expression. CONCLUSIONS The routine use of ketamine anaesthesia for ECT in clinical settings cannot yet be recommended based on published data. Larger randomised controlled trials, taking into account moderator variables, specifically reporting on ECT parameters and systematically assessing outcomes are encouraged.
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Affiliation(s)
- Verònica Gálvez
- a School of Psychiatry, University of New South Wales (UNSW) , Sydney , NSW , Australia.,b Black Dog Institute , Sydney , NSW , Australia
| | - Lucy McGuirk
- a School of Psychiatry, University of New South Wales (UNSW) , Sydney , NSW , Australia.,b Black Dog Institute , Sydney , NSW , Australia
| | - Colleen K Loo
- a School of Psychiatry, University of New South Wales (UNSW) , Sydney , NSW , Australia.,b Black Dog Institute , Sydney , NSW , Australia.,c St. George Hospital , Sydney , Australia.,d Wesley Hospital , Sydney , Australia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Gálvez V, Nikolin S, Ho KA, Alonzo A, Somogyi AA, Loo CK. Increase in PAS-induced neuroplasticity after a treatment course of intranasal ketamine for depression. Report of three cases from a placebo-controlled trial. Compr Psychiatry 2017; 73:31-34. [PMID: 27886522 DOI: 10.1016/j.comppsych.2016.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 10/27/2016] [Accepted: 10/29/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Animal studies suggest that neural plasticity may play a role in the antidepressant effects of a single ketamine dose. However, the potential effects of repeated ketamine treatments on human neuroplasticity are unknown. METHODS This pilot RCT study measured plasticity-induced changes before and after a ketamine course, in three treatment-resistant depressed subjects, who were randomized to receive 8 intranasal treatments of 100mg ketamine or 4.5mg midazolam. Mood ratings were performed by a trained blinded rater at baseline and 24h-48h after the ketamine course, using the Montgomery Asberg Depression Rating Scale (MADRS). Neuroplasticity was assessed in the motor cortex using a paired associative stimulation (PAS) paradigm at baseline and 24h-48h after the treatment course. No changes in current psychotropic medication or dosage were permitted for 4weeks prior to trial entry and throughout the trial. RESULTS The subject receiving ketamine, but not those receiving midazolam, presented a marked increase in neural plasticity after the treatment course. However, mood changes were not associated with changes in neural plasticity. LIMITATIONS Pilot study with small sample size. Concomitant antidepressant medications taken. Plasticity was tested in the motor cortex only, thus the generalizability of these findings to other brain areas cannot be assumed. CONCLUSIONS These results suggest that a course of intranasal ketamine may enhance synaptic plasticity in subjects with depression, but this was not associated with antidepressant effects. Further research on this topic is warranted.
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Affiliation(s)
- Verònica Gálvez
- School of Psychiatry, University of New South Wales, Hospital Road, 2031, Randwick, Sydney, NSW, Australia; Black Dog Institute, Hospital Road, 2031, Randwick, Sydney, NSW, Australia.
| | - Stevan Nikolin
- School of Psychiatry, University of New South Wales, Hospital Road, 2031, Randwick, Sydney, NSW, Australia; Black Dog Institute, Hospital Road, 2031, Randwick, Sydney, NSW, Australia
| | - Kerrie-Anne Ho
- School of Psychiatry, University of New South Wales, Hospital Road, 2031, Randwick, Sydney, NSW, Australia; Black Dog Institute, Hospital Road, 2031, Randwick, Sydney, NSW, Australia
| | - Angelo Alonzo
- School of Psychiatry, University of New South Wales, Hospital Road, 2031, Randwick, Sydney, NSW, Australia; Black Dog Institute, Hospital Road, 2031, Randwick, Sydney, NSW, Australia
| | - Andrew A Somogyi
- Discipline of Pharmacology, School of Medicine, University of Adelaide, Adelaide, 5005, SA, Australia
| | - Colleen K Loo
- School of Psychiatry, University of New South Wales, Hospital Road, 2031, Randwick, Sydney, NSW, Australia; Black Dog Institute, Hospital Road, 2031, Randwick, Sydney, NSW, Australia; St. George Hospital, Department of Psychiatry, Gray St, Kogarah, 2217, NSW, Australia
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11
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Cano M, Martínez-Zalacaín I, Bernabéu-Sanz Á, Contreras-Rodríguez O, Hernández-Ribas R, Via E, de Arriba-Arnau A, Gálvez V, Urretavizcaya M, Pujol J, Menchón JM, Cardoner N, Soriano-Mas C. Brain volumetric and metabolic correlates of electroconvulsive therapy for treatment-resistant depression: a longitudinal neuroimaging study. Transl Psychiatry 2017; 7:e1023. [PMID: 28170003 PMCID: PMC5438019 DOI: 10.1038/tp.2016.267] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 10/12/2016] [Accepted: 11/13/2016] [Indexed: 02/08/2023] Open
Abstract
Recent research suggests that neuroplastic and neuroinflammatory changes may account for the mode of action of electroconvulsive therapy (ECT), although extant data do not allow for a clear disambiguation between these two hypotheses. Multimodal neuroimaging approaches (for example, combining structural and metabolic information) may help in clarifying this issue. Here we aimed to assess longitudinal changes in (i) regional gray matter (GM) volumes and (ii) hippocampal metabolite concentrations throughout an acute course of bitemporal ECT, as well as (iii) to determine the association between imaging changes and clinical improvement. We assessed 12 patients with treatment-resistant depression (TRD) at four time points (pre-treatment, after the first ECT session, after the ninth ECT session and 15 days after ECT course completion) and 10 healthy participants at two time points, 5 weeks apart. Patients with TRD showed bilateral medial temporal lobe (MTL) and perigenual anterior cingulate cortex volume increases. Left MTL volume increase was associated with (i) a hippocampal N-acetylaspartate concentration decrease, (ii) a hippocampal Glutamate+Glutamine concentration increase and (iii) significant clinical improvement. The observed findings are, in part, compatible with both neuroplastic and neuroinflammatory changes induced by ECT. We postulate that such phenomena may be interrelated, therefore reconciling the neuroplasticity and neuroinflammatory hypotheses of ECT action.
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Affiliation(s)
- M Cano
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - I Martínez-Zalacaín
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Á Bernabéu-Sanz
- Magnetic Resonance Department, Inscanner SL, Alicante, Spain
| | - O Contreras-Rodríguez
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain,Carlos III Health Institute, CIBERSAM, Madrid, Spain
| | - R Hernández-Ribas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain,Carlos III Health Institute, CIBERSAM, Madrid, Spain
| | - E Via
- Mental Health Department, Parc Taulí Sabadell, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A de Arriba-Arnau
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - V Gálvez
- School of Psychiatry, University of New South Wales (UNSW) and Black Dog Institute, Randwick, Sydney, NSW, Australia
| | - M Urretavizcaya
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain,Carlos III Health Institute, CIBERSAM, Madrid, Spain
| | - J Pujol
- Carlos III Health Institute, CIBERSAM, Madrid, Spain,MRI Research Unit, Radiology Department, Hospital del Mar, Barcelona, Spain
| | - J M Menchón
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain,Carlos III Health Institute, CIBERSAM, Madrid, Spain,Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Feixa Llarga s/n, Hospitalet de Llobregat, 08907 Barcelona, Spain E-mail:
| | - N Cardoner
- Mental Health Department, Parc Taulí Sabadell, Universitat Autònoma de Barcelona, Barcelona, Spain,Mental Health Department, Parc Taulí Sabadell, Universitat Autònoma de Barcelona, Parc Taulí 1, Sabadell, 08208 Barcelona, Spain. E-mail:
| | - C Soriano-Mas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain,Carlos III Health Institute, CIBERSAM, Madrid, Spain,Department of Psychobiology and Methodology in Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain
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12
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Gálvez V, Tor PC, Bassa A, Hadzi-Pavlovic D, MacPherson R, Marroquin-Harris M, Loo CK. Does remifentanil improve ECT seizure quality? Eur Arch Psychiatry Clin Neurosci 2016; 266:719-724. [PMID: 27038445 DOI: 10.1007/s00406-016-0690-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 02/06/2016] [Indexed: 12/01/2022]
Abstract
Studies have reported that co-adjuvant remifentanil can enhance electroconvulsive therapy (ECT) seizure quality, putatively by allowing a reduction in the dosage of the main anaesthetic agents, as the latter have anticonvulsant properties. However, whether remifentanil also has direct effects on ECT seizure quality, and by implication, treatment efficacy, is unknown. This is the first study examining the effect of adjuvant remifentanil on ECT seizure quality when the dose of conventional anaesthesia remained unchanged. A total of 96 ECT sessions (from 36 patients) were retrospectively analysed. Subjects received ECT with and without remifentanil (1 µg/kg), while the dose of thiopentone (3-5 mg/kg) or propofol (1-2 mg/kg) was unchanged. Seizure quality indices (time to slow wave activity or TSLOW, amplitude, regularity, stereotypy, post-ictal suppression) and duration were assessed through a structured rating scale by a single trained blinded rater. Linear mixed-effects models with random subject effects analysed the effect of remifentanil on seizure parameters, controlling for other variables that can affect seizure quality or duration. Remifentanil was given in 47.9 % of the ECT sessions. Co-adjuvant remifentanil had no effects on any of the seizure quality parameters analysed [TSLOW (E = -0.21, p > 0.1), amplitude (E = 0.08, p > 0.5), regularity (E = -0.05, p > 0.5), stereotypy (E = -0.02, p > 0.5), suppression (E = -0.3, p > 0.05)] or on seizure duration (E = -0.25, p > 0.1). While adjuvant remifentanil may be a useful strategy for reducing anaesthetic dosage in ECT, present evidence suggests that remifentanil does not have intrinsic properties that enhance ECT seizures.
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Affiliation(s)
- Verònica Gálvez
- School of Psychiatry, University of New South Wales (UNSW), Randwick, NSW, Australia.,Black Dog Institute, Randwick, NSW, Australia
| | - Phern-Chern Tor
- Department of General Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - Adriana Bassa
- School of Psychiatry, University of New South Wales (UNSW), Randwick, NSW, Australia.,Black Dog Institute, Randwick, NSW, Australia.,Department of Psychiatry, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Dusan Hadzi-Pavlovic
- School of Psychiatry, University of New South Wales (UNSW), Randwick, NSW, Australia.,Black Dog Institute, Randwick, NSW, Australia
| | - Ross MacPherson
- Department of Anaesthesia and Pain Management, Royal North Shore Hospital, Sydney, NSW, Australia.,Department of Anaesthesia, The Northside Clinic, Sydney, NSW, Australia
| | - Mincho Marroquin-Harris
- Department of Anaesthesia and Pain Management, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Colleen K Loo
- School of Psychiatry, University of New South Wales (UNSW), Randwick, NSW, Australia. .,Black Dog Institute, Randwick, NSW, Australia. .,Department of Psychiatry, St George Hospital, Kogarah, NSW, Australia.
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13
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Gálvez V, Li A, Oxley C, Waite S, De Felice N, Hadzi-Pavlovic D, Kumar D, Page AC, Hooke G, Loo CK. Health Related Quality of Life after ECT for depression: A study exploring the role of different electrode-placements and pulse-widths. J Affect Disord 2016; 206:268-272. [PMID: 27541282 DOI: 10.1016/j.jad.2016.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 07/19/2016] [Accepted: 08/07/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Prior research has shown large improvements in HRQOL after a course of ECT for depression. However, the effect of different types of ECT on HRQOL outcomes has not been explored. This is important due to the considerable range of ECT treatment modalities that currently exist in clinical practice. METHODS HRQOL data from 355 depressed patients in three Australian clinical hospitals, who received ECT given with a range of treatment modalities (combinations of pulse-width and electrode-placement), were analysed. HRQOL was measured at baseline and after ECT, using the Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF). The association between type of ECT and HRQOL after ECT was examined by regression analysis, controlling for variables that may affect HRQOL outcomes. RESULTS There was a significant increase in HRQOL scores after ECT (p<0.0001; t=-23.4). The magnitude of change was large (54% increase, Cohen's d=1.43). Multiple regression analysis yielded a significant model (P<0.001, R2=0.18). Baseline HRQOL score (t=4.83; p<0.0001), age (t=2.75, p<0.01) and type of ECT received [Right Unilateral brief vs Bitemporal Ultrabrief (t=-2.99; p<0.01) and Right Unilateral brief vs Bifrontal Ultrabrief (t=-2.70; p<0.01)] were significant predictors of HRQOL after the ECT course. LIMITATIONS Data was collected naturalistically from clinical services, thus ECT modality was not randomly assigned. Site could have confounded results. CONCLUSIONS An acute course of ECT for depression produced statistically and clinically significant improvements in HRQOL. ECT treatment modality can substantially impact HRQOL outcomes, with the possibility of bilateral ultrabrief forms of ECT being less beneficial.
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Affiliation(s)
- Verònica Gálvez
- School of Psychiatry, University of New South Wales (UNSW), Randwick, Sydney, NSW, Australia; Black Dog Institute, Randwick, Sydney, NSW, Australia
| | - Adrienne Li
- School of Psychiatry, University of New South Wales (UNSW), Randwick, Sydney, NSW, Australia; Black Dog Institute, Randwick, Sydney, NSW, Australia
| | - Cristal Oxley
- School of Psychiatry, University of New South Wales (UNSW), Randwick, Sydney, NSW, Australia; Black Dog Institute, Randwick, Sydney, NSW, Australia; Institute of Psychiatry, King's College London, London, UK
| | - Susan Waite
- The Queen Elizabeth Hospital, Woodville South, SA, Australia
| | | | - Dusan Hadzi-Pavlovic
- School of Psychiatry, University of New South Wales (UNSW), Randwick, Sydney, NSW, Australia; Black Dog Institute, Randwick, Sydney, NSW, Australia
| | - Divya Kumar
- School of Psychiatry, University of New South Wales (UNSW), Randwick, Sydney, NSW, Australia; Black Dog Institute, Randwick, Sydney, NSW, Australia
| | - Andrew C Page
- Perth Clinic, West Perth, WA, Australia; School of Psychology, The University of Western Australia, Crawley, WA, Australia
| | | | - Colleen K Loo
- School of Psychiatry, University of New South Wales (UNSW), Randwick, Sydney, NSW, Australia; Black Dog Institute, Randwick, Sydney, NSW, Australia; Department of Psychiatry, St George Hospital, Kogarah, NSW, Australia.
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14
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Brunoni AR, Moffa AH, Sampaio-Júnior B, Gálvez V, Loo CK. Treatment-emergent mania/hypomania during antidepressant treatment with transcranial direct current stimulation (tDCS): A systematic review and meta-analysis. Brain Stimul 2016; 10:260-262. [PMID: 27916405 DOI: 10.1016/j.brs.2016.11.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 11/02/2016] [Accepted: 11/10/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Treatment-emergent mania/hypomania (TEM) is a possible adverse effect of pharmacological and non-pharmacological antidepressant treatments. OBJECTIVE We performed a systematic review and meta-analysis to evaluate the risk of TEM in depressed patients during randomized, sham-controlled trials (RCTs). DATA SOURCES Medline database, from the first date available to August 12, 2016. RESULTS From 283 references, 10 RCTs were identified. Only 3 of them described TEM. In active and sham groups, respectively, only 8 of 226 (3.5%) and 1 of 190 (0.5%) participants presented TEM. This difference was not statistically significant (OR = 1.79, 95% CI = 0.6 to 5.32). There were also five additional reports of TEM in participants not on RCTs. No risk factors for TEM were identified. LIMITATIONS Low number of studies and TEM reports. CONCLUSION Despite previous reports, active vs. sham tDCS was not associated with a significantly greater number of TEM episodes.
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Affiliation(s)
- André R Brunoni
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil; Interdisciplinary Center for Applied Neuromodulation, University Hospital, University of São Paulo, São Paulo, Brazil.
| | - Adriano H Moffa
- Interdisciplinary Center for Applied Neuromodulation, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Bernardo Sampaio-Júnior
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil; Interdisciplinary Center for Applied Neuromodulation, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Verònica Gálvez
- School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, Australia
| | - Colleen K Loo
- School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, Australia; St George Hospital, Sydney, Australia
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15
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Sivakumar S, Taccone FS, Desai KA, Lazaridis C, Skarzynski M, Sekhon M, Henderson W, Griesdale D, Chapple L, Deane A, Williams L, Strickland R, Lange K, Heyland D, Chapman M, Rowland MJ, Garry P, Westbrook J, Corkill R, Antoniades CA, Pattinson KT, Fatania G, Strong AJ, Myers RB, Lazaridis C, Jermaine CM, Robertson CS, Rusin CG, Hofmeijer J, Sondag L, Tjepkema-Cloostermans MC, Beishuizen A, Bosch FH, van Putten MJAM, Carteron L, Patet C, Solari D, Oddo M, Ali MA, Dias C, Almeida R, Vaz-Ferreira A, Silva J, Monteiro E, Cerejo A, Rocha AP, Elsayed AA, Abougabal AM, Beshey BN, Alzahaby KM, Pozzebon S, Ortiz AB, Cristallini S, Lheureux O, Brasseur A, Vincent JL, Creteur J, Taccone FS, Hravnak M, Yousef K, Chang Y, Crago E, Friedlander RM, Abdelmonem SA, Tahon SA, Helmy TA, Meligy HS, Puig F, Dunn-Siegrist I, Pugin J, Gupta S, Govil D, Srinivasan S, Patel SJ, N JK, Gupta A, Tomar DS, Shafi M, Harne R, Arora DP, Talwar N, Mazumdar S, Papakrivou EE, Makris D, Manoulakas E, Tsolaki B, Karadodas B, Zakynthinos E, Garcia IP, Martin AD, Encinares VS, Ibañez MP, Montero JG, Labrador G, Cangueiro TC, Poulose V, Koh J, Kam JW, Yeter H, Stepinska J, Pérez AG, Ordoñez PF, Giribet A, Cuervo MAA, Cuervo RA, Esteban MAR, Fraile LI, Mittelbrum CP, Albaiceta GM, Kara A, Koeze J, Keus F, Dieperink W, van der Horst ICC, van Meurs M, Zijlstra JG, Roberts S, Caballero CH, Isgro G, Hall D, Aktepe O, Beitland S, Trøseid AMS, Brusletto BS, Waldum-Grevbo BE, Berg JP, Sunde K, Huertas DG, Manzano F, Quintana MMJ, Osuna A, Topeli A, Santiago-Ruiz F, Rodríguez-Mejías C, Wangensteen R, Jamaati HR, Masjedi M, Zand F, Hashemian SMR, Sabetian G, Abbasi G, Khaloo V, Tsolakoglou I, Tabei SH, Kafilzadeh A, Bakhodaei HH, Diaz JA, Silva R, Garcia DJ, Luis E, Gomez MN, Soriano R, Gonzalez PL, Intas G, Ibrahim IA, Rafik MM, Al-Ansary AM, Algendi MA, Ali AA, Fuhrmann V, Roedl K, Horvatits T, Drolz A, Rutter K, Stergiannis P, Benten D, Kluwe J, Siedler S, Kluge S, Adedugbe I, Bird GT, Kennedy RM, Sharma S, Butler MB, Yugi G, Kolaros AA, Haroon BA, Witter T, Khaliq W, Singer M, Havaldar AA, Krishna B, Sriram S, Espinoza EDV, Pozo MO, Edul VSK, Chalari E, Furche M, Motta MF, Vazquez AR, Birri PNR, Ince C, Dubin A, Dogliotti A, Ramos A, Lovesio C, Delile E, Athanasiadou E, Nevière R, Thiébaut PA, Maupoint J, Mulder P, Coquerel D, Renet S, do Rego JC, Rieusset J, Richard V, Tamion F, Martika A, Khaliq W, Andreis DT, Singer M, Smit B, Smulders YM, de Waard MC, van Straaten HMO, Girbes ARJ, Eringa EC, Man AMESD, Fildisis G, Alegría L, Soto D, Luengo C, Gomez J, Jarufe N, Bruhn A, Castro R, Kattan E, Tapia P, Rebolledo R, Faivre V, Achurra P, Ospina-Tascón G, Bakker J, Hernández G, Bertini P, Guarracino F, Baldassarri R, Pinsky MR, Alegría L, Vera M, Mengelle C, Dreyse J, Carpio D, Henriquez C, Gajardo D, Bravo S, Castro R, Ospina-Tascón G, Bakker J, Hernández G, Kim S, Favier B, Lee M, Park SY, So S, Lee H, Kačar MB, Kačar SM, Uddin I, Belhaj AM, Aydın MA, Avsec D, Payen D, Kapuağası A, Kaymak Ç, Kovach L, Şencan İ, Meço B, Özçelik M, Ünal N, Lazaridis C, Jenni-Moser B, Jeitziner MM, Poppe A, Galassi MS, Sales FL, de Moraes KCL, Batista CL, Júnior JADS, Marcari TB, Lobato R, Castro CSAA, de Souza LM, Rodrigues FFP, Winkler MS, Correa NG, Pelegrini AM, Eid RAC, Timenetsky KT, Cazati D, Lobato M, Diniz PS, Rocha LL, Cavalheiro AM, Lucinio NM, Mudersbach E, Santos ER, Norrenberg M, Gleize A, Preiser JC, Simón IF, Carmona SA, Valhonrat IL, Domínguez JP, Abellán AN, Almudévar PM, Schreiber J, Dávila F, Rubio JJ, Ramos AJ, Reina ÁJR, López NP, Pérez MA, Apolo DXC, Villén LM, López FMP, García IP, Wruck ML, Izurieta JRN, Guerrero JJE, Calvert S, Quint M, Adeniji K, Young R, Shevill DD, Robertson E, Garside P, Walter E, Schwedhelm E, Isotti P, De Vecchi MM, Perduca AE, Negro A, Villa G, Manara DF, Cabrini L, Zangrillo A, Frencken JF, van Baal L, Kluge S, Peelen LM, Donker DW, Horn J, van der Poll T, van Klei WA, Bonten MJM, Cremer OL, Menard CE, Kumar A, Rimmer E, Zöllner C, Doucette S, Turgeon AF, Houston BL, Houston DS, Zarychanski R, Pinto BB, Carrara M, Ferrario M, Bendjelid K, Nunes J, Tavladaki T, Diaz P, Silva G, Escórcio S, Chaves S, Jardim M, Fernandes N, Câmara M, Duarte R, Pereira CA, Vieira J, Spanaki AM, Nóbrega JJ, Robles CMC, de Oca-Sandoval MAM, Sánchez-Rodríguez A, Joya-Galeana JG, Correa-Morales A, Camarena-Alejo G, Aguirre-Sánchez J, Franco-Granillo J, Soliman M, Dimitriou H, Al Azab A, El Hossainy R, Nagy H, Nirmalan M, Crippa IA, Cavicchi FZ, Vincent JL, Creteur J, Taccone FS, Chaari A, Kondili E, Hakim KA, Hassanein H, Etman M, El Bahr M, Bousselmi K, Khalil ES, Kauts V, Casey WF, Imahase H, Sakamoto Y, Choulaki C, Inoue S, Yamada KC, Koami H, Miike T, Nagashima F, Iwamura T, Boscolo A, Lucchetta V, Piasentini E, Bertini D, Meleti E, Manesso L, Spiezia L, Simioni P, Ori C, Souza RB, Martins AM, Liberatore AMA, Kang YR, Nakamae MN, Vieira JCF, Kafetzopoulos D, Koh IHJ, Hanslin K, Wilske F, Skorup P, Sjölin J, Lipcsey M, Long WJ, Zhen CE, Vakalos A, Avramidis V, Georgopoulos D, Wu SH, Shyu LJ, Li CH, Yu CH, Chen HC, Wang CH, Lin KH, Aray ZE, Gómez CF, Tejero AP, Briassoulis G, Monge DD, Losada VM, Tarancón CM, Cortés SD, Gutiérrez AM, Álvarez TP, Rouze A, Jaffal K, Six S, Stolz K, la Torre AGD, Cattoen V, Nseir S, Arnal JM, Saoli M, Novotni D, Garnero A, Becher T, Buchholz V, Schädler D, Frerichs I, de la Torre-Prados MV, Weiler N, Eronia N, Mauri T, Gatti S, Maffezzini E, Bronco A, Alban L, Sasso T, Marenghi C, Grasselli G, Tsvetanova-Spasova T, Pesenti A, Bellani G, Al-Fares A, Del Sorbo L, Anwar S, Facchin F, Azad S, Zamel R, Ferguson N, Cypel M, Nuevo-Ortega P, Keshavjee S, Fan E, Durlinger E, Spoelstra-de Man A, Smit B, de Grooth HJ, Girbes A, Straaten HOV, Smulders Y, Alfaro MA, Rueda-Molina C, Parrilla F, Meli A, Pellegrini M, Rodriguez N, Goyeneche JM, Morán I, Aguirre H, Mancebo J, Heines SJH, Strauch U, Fernández-Porcel A, Bergmans DCJJ, Blankman P, Shono A, Hasan D, Gommers D, Chung WY, Lee KS, Jung YJ, Park JH, Sheen SS, Camara-Sola E, Park KJ, Worral R, Denham S, Isherwood P, Rees SE, Larraza S, Dey N, Spadaro S, Brohus JB, Winding RW, Salido-Díaz L, Volta CA, Karbing DS, Ampatzidou F, Vlachou A, Kehagioglou G, Karaiskos T, Madesis A, Mauromanolis C, Michail N, Drossos G, García-Alcántara A, Saraj N, Rijkenberg S, Feijen HM, Endeman H, Donnelly AAJ, Morgan E, Garrard H, Buckley H, Russell L, Haase N, Tavladaki T, Perner A, Goh C, Mouyis K, Woodward CLN, Halliday J, Encina GB, Ros J, Lagunes L, Tabernero J, Bosch F, Spanaki AM, Rello J, Huertas DG, Manzano F, Morente-Constantin E, Rivera-Ginés B, Colmenero-Ruiz M, Abellán AN, Pérez LP, Lucendo AP, Almudévar PM, Dimitriou H, Domínguez JP, Villamizar PR, Sanz JG, Simon IF, Valbuena BL, Carmona SA, Pais M, Ramalingam S, Díaz C, Fox L, Kondili E, Santafe M, Barba P, García M, Leal S, Pérez M, Pérez MLP, Abellán AN, Lucendo AP, Almudevar PM, Domínguez JP, Choulaki C, Villamizar PR, Veganzones J, Simón IF, Valbuena BL, Martínez N, Carmona SA, Moors I, Mokart D, Pène F, Lambert J, Meleti DE, Kouatchet A, Mayaux J, Vincent F, Nyunga M, Bruneel F, Laisne L, Rabbat A, Lebert C, Perez P, Chaize M, Kafetzopoulos D, Renault A, Meert AP, Hamidfar R, Jourdain M, Darmon M, Schlemmer B, Chevret S, Lemiale V, Azoulay E, Benoit D, Georgopoulos D, Martins-Branco D, Sousa M, Marum S, Bouw MJ, Galstyan G, Makarova P, Parovichnikova E, Kuzmina L, Troitskaya V, Drize N, Briassoulis G, Gemdzhian E, Savchenko V, Chao HC, Kılıc E, Demiriz B, Uygur ML, Sürücü M, Cınar K, Yıldırım AE, Kiss K, Suberviola B, Köves B, Csernus V, Molnár Z, Ntantana A, Matamis D, Savvidou S, Giannakou M, Gouva M, Nakos G, Koulouras V, Riera J, Gaffney S, Black E, Docking R, Judge C, Drew T, Misran H, Munshi R, McGovern L, Coyle M, Dunne L, Rellan L, Deasy E, Lavin P, Fahy A, Darcy DM, Donnelly M, Ismail NH, Hall T, Wykes K, Jack J, Ngu WC, Sanchez M, Morgan P, Ruiz-Ramos J, Ramirez P, Gordon M, Villarreal E, Frasquet J, Poveda-Andrés JL, Castellanos A, 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ESICM LIVES 2016: part two. Intensive Care Med Exp 2016. [PMCID: PMC5042923 DOI: 10.1186/s40635-016-0099-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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E, Juliarena A, Bisso MC, Grando M, Tapia A, Camargo M, Ulla DV, Corzo L, dos Santos HP, Ramos A, Doglia JA, Estenssoro E, Carbonara M, Magnoni S, Donald CLM, Shimony JS, Conte V, Triulzi F, Stretti F, Macrì M, Snyder AZ, Stocchetti N, Brody DL, Podlepich V, Shimanskiy V, Savin I, Lapteva K, Chumaev A, Tjepkema-Cloostermans MC, Hofmeijer J, Beishuizen A, Hom H, Blans MJ, van Putten MJAM, Longhi L, Frigeni B, Curinga M, Mingone D, Beretta S, Patruno A, Gandini L, Vargiolu A, Ferri F, Ceriani R, Rottoli MR, Lorini L, Citerio G, Pifferi S, Battistini M, Cordolcini V, Agarossi A, Di Rosso R, Ortolano F, Stocchetti N, Lourido CM, Cabrera JLS, Santana JDM, Alzola LM, del Rosario CG, Pérez HR, Torrent RL, Eslami S, Dalhuisen A, Fiks T, Schultz MJ, Hanna AA, Spronk PE, Wood M, Maslove D. ESICM LIVES 2016: part three. Intensive Care Med Exp 2016. [PMCID: PMC5042925 DOI: 10.1186/s40635-016-0100-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Loo CK, Gálvez V, O'Keefe E, Mitchell PB, Hadzi-Pavlovic D, Leyden J, Harper S, Somogyi AA, Lai R, Weickert CS, Glue P. Placebo-controlled pilot trial testing dose titration and intravenous, intramuscular and subcutaneous routes for ketamine in depression. Acta Psychiatr Scand 2016; 134:48-56. [PMID: 27028832 DOI: 10.1111/acps.12572] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This pilot study assessed the feasibility, efficacy and safety of an individual dose-titration approach, and of the intravenous (IV), intramuscular (IM) and subcutaneous (SC) routes for treating depression with ketamine. METHOD Fifteen treatment-refractory depressed participants received ketamine or midazolam (control treatment) in a multiple crossover, double-blind study. Ketamine was administered by IV (n = 4), IM (n = 5) or SC (n = 6) injection. Dose titration commenced at 0.1 mg/kg, increasing by 0.1 mg/kg up to 0.5 mg/kg, given in separate treatment sessions separated by ≥1 week, with one placebo control treatment randomly inserted. Mood, psychotomimetic and hemodynamic effects were assessed and plasma ketamine concentrations assayed. RESULTS Twelve participants achieved response and remission criteria, achieved at doses as low as 0.1 mg/kg. All three routes of administration resulted in comparable antidepressant effects. Fewest adverse effects were noted with the SC route. Antidepressant response, adverse effects and ketamine concentrations were dose-related. CONCLUSION Antidepressant response occurred at a range of doses and at <0.5 mg/kg. The dose-titration approach is a practical method for optimizing the efficacy - side-effects trade-off on an individual patient basis. This pilot study provides preliminary evidence for SC injection as a practical, feasible and efficacious treatment approach.
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Affiliation(s)
- C K Loo
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Randwick, NSW, Australia.,Wesley Hospital, Kogarah, NSW, Australia.,St George Hospital, Kogarah, NSW, Australia
| | - V Gálvez
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Randwick, NSW, Australia
| | - E O'Keefe
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - P B Mitchell
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Randwick, NSW, Australia
| | - D Hadzi-Pavlovic
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Randwick, NSW, Australia
| | - J Leyden
- Wesley Hospital, Kogarah, NSW, Australia.,Royal North Shore Hospital, St Leonards, NSW, Australia
| | - S Harper
- Wesley Hospital, Kogarah, NSW, Australia.,University of New South Wales, Randwick, NSW, Australia
| | - A A Somogyi
- University of Adelaide, Adelaide, SA, Australia.,Royal Adelaide Hospital, Adelaide, SA, Australia
| | - R Lai
- Macquarie Hospital, Sydney, NSW, Australia
| | - C S Weickert
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Schizophrenia Research Institute, Randwick, NSW, Australia.,Neuroscience Research Australia, Randwick, NSW, Australia
| | - P Glue
- Psychological Medicine, University of Otago, Dunedin, New Zealand
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Soria V, Vives M, Martínez-Amorós È, Gálvez V, Monzón S, Crespo JM, Gili M, Menchón JM, Roca M, Parker G, Urretavizcaya M. The CORE system for sub-typing melancholic depression: Adaptation and psychometric properties of the Spanish version. Psychiatry Res 2016; 239:179-83. [PMID: 27010187 DOI: 10.1016/j.psychres.2016.03.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 03/02/2016] [Accepted: 03/09/2016] [Indexed: 11/18/2022]
Abstract
We report the development procedure for a Spanish version of the CORE measure for subtyping melancholic depression and its psychometric properties. The sample comprised two subsets of depressive patients: 117 in-patients clinically assessed after admission and before discharge; and 34 in- and out-patients who were video-recorded, with each recording being rated by independent raters and re-rated six months later. The internal consistency of the Spanish version of the CORE was high, with Cronbach's alpha coefficient of 0.93 for the total CORE score. High intra-class correlation coefficient for the total score (0.96) and the three subscales (around 0.8) indicate high inter-rater reliability. Baseline and six-month ratings of video-recordings showed high test-retest reliability. Regarding construct validity, the correlation between the CORE and the Newcastle endogeneity scale scores was 0.64. A ROC curve generated an optimal cut-off of 10 to predict the definition of endogeneity/melancholia based on the Newcastle score >=6 and the DSM-IV-TR definition of melancholia. The comparison between the CORE scores at admission and at discharge revealed large differences, indicating demonstrable sensitivity to change. The Spanish version of the CORE system is a reliable and valid instrument for sub-typing depression in terms of melancholic versus non-melancholic sub-types.
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Affiliation(s)
- Virginia Soria
- Department of Psychiatry, Bellvitge University Hospital, IDIBELL, CIBERSAM, Department of Clinical Sciences, University of Barcelona, Barcelona, Spain.
| | - Margalida Vives
- Institut Universitari d' Investigació en Ciències de la Salut (IUNICS), Red de Actividades Preventivas y de Promoción de la Salud (Rediapp), Hospital Joan March, Universitat de les Illes Balears, Palma de Mallorca, Spain
| | - Èrika Martínez-Amorós
- Department of Psychiatry, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Verònica Gálvez
- School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, Australia
| | - Saray Monzón
- Institut Universitari d' Investigació en Ciències de la Salut (IUNICS), Red de Actividades Preventivas y de Promoción de la Salud (Rediapp), Hospital Joan March, Universitat de les Illes Balears, Palma de Mallorca, Spain
| | - José M Crespo
- Department of Psychiatry, Bellvitge University Hospital, IDIBELL, CIBERSAM, Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - Margalida Gili
- Institut Universitari d' Investigació en Ciències de la Salut (IUNICS), Red de Actividades Preventivas y de Promoción de la Salud (Rediapp), Hospital Joan March, Universitat de les Illes Balears, Palma de Mallorca, Spain
| | - José M Menchón
- Department of Psychiatry, Bellvitge University Hospital, IDIBELL, CIBERSAM, Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - Miquel Roca
- Institut Universitari d' Investigació en Ciències de la Salut (IUNICS), Red de Actividades Preventivas y de Promoción de la Salud (Rediapp), Hospital Joan March, Universitat de les Illes Balears, Palma de Mallorca, Spain
| | - Gordon Parker
- School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, Australia
| | - Mikel Urretavizcaya
- Department of Psychiatry, Bellvitge University Hospital, IDIBELL, CIBERSAM, Department of Clinical Sciences, University of Barcelona, Barcelona, Spain.
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MacPherson R, Marroquin-Harris M, Gálvez V, Tor P, Loo C. The Effect of Adjuvant Remifentanil with Propofol or Thiopentone on Seizure Quality during Electroconvulsive Therapy. Anaesth Intensive Care 2016; 44:278-80. [DOI: 10.1177/0310057x1604400215] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In order to optimise outcome to electroconvulsive therapy (ECT), there has been a trend to remifentanil as an adjunct to standard intravenous induction agents. This has allowed a reduction in the dose of anaesthetic agent, and usually an improved response to stimulation. However there have been no previous studies to ascertain whether this improvement is simply as a result of the reduced dose of anaesthetic agent or whether remifentanil itself might possess epileptogenic properties. This retrospective case-controlled study examined ECT outcomes, determined by electroencephalography (EEG) quality analysis, in patients who received ECT with or without remifentanil, where there was no dose reduction in the anaesthetic agent. There were no improvements seen in the measurements of any EEG parameter, including seizure duration. These observations suggest that remifentanil does not possess any intrinsic proconvulsant activity and that any improvement in outcome seen with its use is as a result of dose reduction in the IV anaesthetic agent.
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Affiliation(s)
- R. MacPherson
- Department of Anaesthesia and Pain Management, Royal North Shore Hospital, Sydney, NSW
| | - M. Marroquin-Harris
- Department of Anaesthesia and Pain Management, Royal North Shore Hospital, Sydney, NSW
| | - V. Gálvez
- Department of Psychiatry, University of New South Wales, Sydney, NSW
| | - P. Tor
- Department of Psychiatry, University of New South Wales
| | - C. Loo
- Department of Psychiatry, University of New South Wales, Sydney, NSW
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Xu Y, Hackett M, Carter G, Loo C, Gálvez V, Glozier N, Glue P, Lapidus K, McGirr A, Somogyi AA, Mitchell PB, Rodgers A. Effects of Low-Dose and Very Low-Dose Ketamine among Patients with Major Depression: a Systematic Review and Meta-Analysis. Int J Neuropsychopharmacol 2015; 19:pyv124. [PMID: 26578082 PMCID: PMC4851268 DOI: 10.1093/ijnp/pyv124] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 11/11/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Several recent trials indicate low-dose ketamine produces rapid antidepressant effects. However, uncertainty remains in several areas: dose response, consistency across patient groups, effects on suicidality, and possible biases arising from crossover trials. METHODS A systematic search was conducted for relevant randomized trials in Medline, Embase, and PsycINFO databases up to August 2014. The primary endpoints were change in depression scale scores at days 1, 3 and 7, remission, response, suicidality, safety, and tolerability. Data were independently abstracted by 2 reviewers. Where possible, unpublished data were obtained on treatment effects in the first period of crossover trials. RESULTS Nine trials were identified, including 201 patients (52% female, mean age 46 years). Six trials assessed low-dose ketamine (0.5 mg/kg i.v.) and 3 tested very low-dose ketamine (one trial assessed 50 mg intra-nasal spray, another assessed 0.1-0.4 mg/kg i.v., and another assessed 0.1-0.5 mg/kg i.v., intramuscular, or s.c.). At day 3, the reduction in depression severity score was less marked in the very low-dose trials (P homogeneity <.05) and among bipolar patients. In analyses excluding the second period of crossover trials, response rates at day 7 were increased with ketamine (relative risk 3.4, 95% CI 1.6-7.1, P=.001), as were remission rates (relative risk 2.6, CI 1.2-5.7, P=.02). The absolute benefits were large, with day 7 remission rates of 24% vs 6% (P=.02). Seven trials provided unpublished data on suicidality item scores, which were reduced on days 1 and 3 (both P<.01) but not day 7. CONCLUSION Low-dose ketamine appears more effective than very low dose. There is substantial heterogeneity in clinical response, with remission among one-fifth of patients at 1 week but most others having benefits that are less durable. Larger, longer term parallel group trials are needed to determine if efficacy can be extended and to further assess safety.
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Affiliation(s)
| | | | | | - Colleen Loo
- The George Institute for Global Health, The University of Sydney, Sydney, Australia (Drs Xu, Hackett, and Rodgers); Centre for Translational Neuroscience and Mental Health, University of Newcastle, Australia (Dr Carter); School of Psychiatry, University of New South Wales & Black Dog Institute, Sydney, Australia (Drs Loo, Gálvez, and Mitchell); Brain and Mind Research Institute, University of Sydney, Australia (Dr Glozier); Department of Psychiatry, University of Otago, New Zealand (Dr Glue); Departments of Psychiatry and Neurobiology, Stony Brook University, Stony Brook, NY (Dr Lapidus); Department of Psychiatry, University of British Colombia, Canada (Dr McGirr); Discipline of Pharmacology, Faculty of Health Sciences, The University of Adelaide, Adelaide, Australia (Dr Somogyi).
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Gálvez V, Hadzi-Pavlovic D, Wark H, Harper S, Leyden J, Loo CK. The Anaesthetic-ECT Time Interval in Electroconvulsive Therapy Practice--Is It Time to Time? Brain Stimul 2015; 9:72-7. [PMID: 26452698 DOI: 10.1016/j.brs.2015.09.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 09/03/2015] [Accepted: 09/08/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Because most common intravenous anaesthetics used in ECT have anticonvulsant properties, their plasma-brain concentration at the time of seizure induction might affect seizure expression. The quality of ECT seizure expression has been repeatedly associated with efficacy outcomes. The time interval between the anaesthetic bolus injection and the ECT stimulus (anaesthetic-ECT time interval) will determine the anaesthetic plasma-brain concentration when the ECT stimulus is administered. OBJECTIVE The aim of this study was to examine the effect of the anaesthetic-ECT time interval on ECT seizure quality and duration. METHODS The anaesthetic-ECT time interval was recorded in 771 ECT sessions (84 patients). Right unilateral brief pulse ECT was applied. Anaesthesia given was propofol (1-2 mg/kg) and succinylcholine (0.5-1.0 mg/kg). Seizure quality indices (slow wave onset, amplitude, regularity, stereotypy and post-ictal suppression) and duration were rated through a structured rating scale by a single blinded trained rater. Linear Mixed Effects Models analysed the effect of the anaesthetic-ECT time interval on seizure quality indices, controlling for propofol dose (mg), ECT charge (mC), ECT session number, days between ECT, age (years), initial seizure threshold (mC) and concurrent medication. RESULTS Longer anaesthetic-ECT time intervals lead to significantly higher quality seizures (p < 0.001 for amplitude, regularity, stereotypy and post-ictal suppression). CONCLUSIONS These results suggest that the anaesthetic-ECT time interval is an important factor to consider in ECT practice. This time interval should be extended to as long as practically possible to facilitate the production of better quality seizures. Close collaboration between the anaesthetist and the psychiatrist is essential.
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Affiliation(s)
- Verònica Gálvez
- School of Psychiatry, University of New South Wales (UNSW), Hospital Road, Randwick, NSW 2031, Australia; Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia; The Wesley Hospital, 7 Blake St, Kogarah, NSW 2217, Australia
| | - Dusan Hadzi-Pavlovic
- School of Psychiatry, University of New South Wales (UNSW), Hospital Road, Randwick, NSW 2031, Australia; Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia
| | - Harry Wark
- School of Psychiatry, University of New South Wales (UNSW), Hospital Road, Randwick, NSW 2031, Australia; The Wesley Hospital, 7 Blake St, Kogarah, NSW 2217, Australia; The Sydney Clinic, 22-24 Murray St, Bronte, NSW 2024, Australia; Children's Hospital Westmead, Hawkesbury Road & Hainsworth Street, Westmead, NSW 2145, Australia
| | - Simon Harper
- The Wesley Hospital, 7 Blake St, Kogarah, NSW 2217, Australia; Faculty of Medicine, University of New South Wales, Samuels Ave, Kensington, NSW 2052, Australia
| | - John Leyden
- The Wesley Hospital, 7 Blake St, Kogarah, NSW 2217, Australia; Department of Anaesthesia and Pain Management, Royal North Shore Hospital, Reserve Rd, St Leonards, NSW 2065, Australia
| | - Colleen K Loo
- School of Psychiatry, University of New South Wales (UNSW), Hospital Road, Randwick, NSW 2031, Australia; Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia; The Wesley Hospital, 7 Blake St, Kogarah, NSW 2217, Australia; St. George Hospital, Gray St, Kogarah, NSW 2217, Australia.
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Ho KA, Taylor JL, Chew T, Gálvez V, Alonzo A, Bai S, Dokos S, Loo CK. The Effect of Transcranial Direct Current Stimulation (tDCS) Electrode Size and Current Intensity on Motor Cortical Excitability: Evidence From Single and Repeated Sessions. Brain Stimul 2015; 9:1-7. [PMID: 26350410 DOI: 10.1016/j.brs.2015.08.003] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 08/03/2015] [Accepted: 08/10/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Current density is considered an important factor in determining the outcomes of tDCS, and is determined by the current intensity and electrode size. Previous studies examining the effect of these parameters on motor cortical excitability with small sample sizes reported mixed results. OBJECTIVE/HYPOTHESIS This study examined the effect of current intensity (1 mA, 2 mA) and electrode size (16 cm(2), 35 cm(2)) on motor cortical excitability over single and repeated tDCS sessions. METHODS Data from seven studies in 89 healthy participants were pooled for analysis. Single-session data were analyzed using mixed effects models and repeated-session data were analyzed using mixed design analyses of variance. Computational modeling was used to examine the electric field generated. RESULTS The magnitude of increases in excitability after anodal tDCS was modest. For single-session tDCS, the 35 cm(2) electrodes produced greater increases in cortical excitability compared to the 16 cm(2) electrodes. There were no differences in the magnitude of cortical excitation produced by 1 mA and 2 mA tDCS. The repeated-sessions data also showed that there were greater increases in excitability with the 35 cm(2) electrodes. Further, repeated sessions of tDCS with the 35 cm(2) electrodes resulted in a cumulative increase in cortical excitability. Computational modeling predicted higher electric field at the motor hotspot for the 35 cm(2) electrodes. CONCLUSIONS 2 mA tDCS does not necessarily produce larger effects than 1 mA tDCS in healthy participants. Careful consideration should be given to the exact positioning, size and orientation of tDCS electrodes relative to cortical regions.
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Affiliation(s)
- Kerrie-Anne Ho
- School of Psychiatry, University of New South Wales, Prince of Wales Hospital, Hospital Road, Randwick, NSW 2031, Australia; Black Dog Institute, Prince of Wales Hospital, Hospital Road, Randwick, NSW 2031, Australia
| | - Janet L Taylor
- Neuroscience Research Australia, Margarete Ainsworth Building, Barker Street, Randwick, NSW 2031, Australia; School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Taariq Chew
- School of Psychiatry, University of New South Wales, Prince of Wales Hospital, Hospital Road, Randwick, NSW 2031, Australia; Black Dog Institute, Prince of Wales Hospital, Hospital Road, Randwick, NSW 2031, Australia
| | - Verònica Gálvez
- School of Psychiatry, University of New South Wales, Prince of Wales Hospital, Hospital Road, Randwick, NSW 2031, Australia; Black Dog Institute, Prince of Wales Hospital, Hospital Road, Randwick, NSW 2031, Australia
| | - Angelo Alonzo
- School of Psychiatry, University of New South Wales, Prince of Wales Hospital, Hospital Road, Randwick, NSW 2031, Australia; Black Dog Institute, Prince of Wales Hospital, Hospital Road, Randwick, NSW 2031, Australia
| | - Siwei Bai
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, NSW 2052, Australia; IMETUM, Technische Universität München, Garching 85748, Germany
| | - Socrates Dokos
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, NSW 2052, Australia
| | - Colleen K Loo
- School of Psychiatry, University of New South Wales, Prince of Wales Hospital, Hospital Road, Randwick, NSW 2031, Australia; Black Dog Institute, Prince of Wales Hospital, Hospital Road, Randwick, NSW 2031, Australia; St George Hospital, South Eastern Sydney Health, Level 2, James Laws House, Gray St, Kogarah, NSW 2217, Australia.
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Abstract
Depression is frequent in old age and its prognosis is poorer than in younger populations. The use of pharmacological treatments in geriatric depression is limited by specific pharmacodynamic age-related factors that can diminish tolerability and increase the risk of drug interactions. The possibility of modulating cerebral activity using brain stimulation techniques could result in treating geriatric depression more effectively while reducing systemic side effects and medication interactions. This may subsequently improve treatment adherence and overall prognosis in the older patient. Among clinically available neuromodulatory techniques, electroconvulsive therapy (ECT) remains the gold standard for the treatment of severe depression in the elderly. Studies have proven that ECT is more effective and has a faster onset of action than antidepressants in the treatment of severe, unipolar, geriatric depression and that older age is a predictor of rapid ECT response and remission. The application of novel and more tolerable forms of ECT for geriatric depression is currently being examined. Preliminary results suggest that right unilateral ultrabrief ECT (RUL-UB ECT) is a promising intervention, with similar efficacy to brief-pulse ECT and fewer adverse cognitive effects. Overall findings in repetitive transcranial magnetic stimulation (rTMS) suggest that it is a safe intervention in geriatric depression. Higher rTMS stimulation intensity and more treatments may need to be given in the elderly to achieve optimal results. There is no specific data on vagus nerve stimulation in the elderly. Transcranial direct current stimulation, magnetic seizure therapy and deep brain stimulation are currently experimental, and more data from geriatric samples is needed.
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Affiliation(s)
- Verònica Gálvez
- School of Psychiatry, University of New South Wales (UNSW), Hospital Road, 2031, Randwick, Sydney, NSW, Australia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Gálvez V, Hadzi-Pavlovic D, Leyden J, Harper S, Wark H, Simpson B, McGoldrick J, Han H, Loo C. The time interval between anaesthetic induction and the ECT stimulus – It’s time to time! Brain Stimul 2015. [DOI: 10.1016/j.brs.2015.01.182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Gálvez V, Hadzi-Pavlovic D, Smith D, Loo CK. Predictors of Seizure Threshold in Right Unilateral Ultrabrief Electroconvulsive Therapy: Role of Concomitant Medications and Anaesthesia Used. Brain Stimul 2015; 8:486-92. [PMID: 25683317 DOI: 10.1016/j.brs.2014.12.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 12/29/2014] [Accepted: 12/30/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND An individualized approach to maximize electroconvulsive therapy (ECT) efficacy and minimize cognitive side effects is to treat patients relative to their seizure threshold (ST). However, although Right Unilateral-Ultrabrief (0.3 ms) (RUL-UB) ECT is increasingly used in clinical settings as an effective form of ECT with minimal cognitive effects, there is sparse data regarding predictors of ST. OBJECTIVE To analyze the relationship between ST and clinical and demographic factors in a sample of patients treated with RUL-UB ECT. METHODS Clinical, demographic and ECT data from 179 patients in ECT research studies were examined. Seizure threshold was titrated at the first ECT session. ECT was performed with a Thymatron(®) or Mecta(®) device, with thiopentone (2.5-5 mg/kg) or propofol (1-2 mg/kg) anaesthesia. Medications taken at the time of ST titration were documented. The association between ST and candidate predictor variables was examined with regression analysis. RESULTS Multiple regression analyses showed that 34% of the variance in ST (P < 0.001) could be predicted. Older age (R(2) = 0.194, P < 0.001), propofol (vs thiopentone) (R(2) = 0.029, P ≤ 0.01) and higher anaesthetic dose (mg in propofol equivalents) (R(2) = 0.029, P < 0.05) were found to be predictors of higher initial ST. Treatment with lithium (R(2) = 0.043, P < 0.01) and study site (R(2) = 0.019, P < 0.05) significantly predicted lower initial ST. CONCLUSIONS Empirical titration is recommended for accurate determination of ST in patients receiving RUL-UB ECT. Novel findings of this study are that propofol anaesthesia resulted in higher ST than thiopentone and concomitant treatment with lithium treatment lowered ST.
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Affiliation(s)
- Verònica Gálvez
- School of Psychiatry, University of New South Wales (UNSW), Hospital Road, 2031, Randwick, Sydney, NSW, Australia; Black Dog Institute, Hospital Road, 2031, Randwick, Sydney, NSW Australia
| | - Dusan Hadzi-Pavlovic
- School of Psychiatry, University of New South Wales (UNSW), Hospital Road, 2031, Randwick, Sydney, NSW, Australia; Black Dog Institute, Hospital Road, 2031, Randwick, Sydney, NSW Australia
| | - Deidre Smith
- The Melbourne Clinic & Department of Psychiatry, University of Melbourne, Grattan St Parkville 3010, Melbourne, VIC, Australia
| | - Colleen K Loo
- School of Psychiatry, University of New South Wales (UNSW), Hospital Road, 2031, Randwick, Sydney, NSW, Australia; Black Dog Institute, Hospital Road, 2031, Randwick, Sydney, NSW Australia; Department of Psychiatry, St George Hospital, Level 2, James Laws House, Gray St, Kogarah 2217, Sydney, NSW, Australia.
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Gálvez V, de Arriba Arnau A, Martínez-Amorós E, Ribes C, Urretavizcaya M, Cardoner N. Acute bilateral ECT in a depressed patient with a hip-aztreonam-spacer and subsequent maintenance ECT after prosthesis collocation. Int Psychogeriatr 2014; 27:1-4. [PMID: 25381759 DOI: 10.1017/s104161021400235x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACT Electroconvulsive Therapy (ECT) has been demonstrated to be a safe and effective treatment for geriatric depression, although its application might be challenging when medical comorbidities exist. The present case reports a 78-year-old man diagnosed with recurrent unipolar major depressive disorder (MDD), who presented with a severe depressive episode with psychotic features (DSM IV). He successfully received a course of bitemporal (BT) ECT with a hip-aztreonam-spacer due to a hip fracture that occurred during hospitalization. This was followed by maintenance ECT (M-ECT) with a recent prosthesis collocation. This particular case illustrates the importance of a multidisciplinary approach in geriatric patients with somatic complications receiving ECT.
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Affiliation(s)
- Verònica Gálvez
- School of Psychiatry,University of New South Wales (UNSW),Sydney,Australia;Therapeutic Neurostimulation Group,Black Dog Institute,Sydney,Australia
| | - Aida de Arriba Arnau
- Psychiatry Department,Bellvitge University Hospital,L'Hospitalet de Llobregat,Barcelona,Spain;Mood Disorders Clinical and Research Unit,Psychiatry Department,Bellvitge University Hospital,Barcelona,Spain
| | - Erika Martínez-Amorós
- Psychiatry Department,Salut Mental Parc Taulí. Corporació Sanitària Universitària Parc Taulí,Sabadell,Spain;Institut Universitari Parc Taulí - UAB (IUFPT-UAB),Sabadell,Spain
| | - Carmina Ribes
- Department of Anesthesiology.Bellvitge University Hospital,L´Hospitalet de Llobregat,Barcelona,Spain
| | - Mikel Urretavizcaya
- ECT Unit,Psychiatry Department,Bellvitge Hospital-ICS,University of Barcelona,Bellvitge Biomedical Research Institute (IDIBELL),CIBERSAM,L'Hospitalet de Llobregat,Barcelona,Spain
| | - Narcís Cardoner
- Psychiatry Department,Bellvitge Hospital-ICS,University of Barcelona,Bellvitge Biomedical Research Institute(IDIBELL),CIBERSAM,L'Hospitalet de Llobregat,Barcelona,Spain
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Gálvez V, Loo CK, Alonzo A, Cerrillo E, Menchón JM, Crespo JM, Urretavizcaya M. Do benzodiazepines moderate the effectiveness of bitemporal electroconvulsive therapy in major depression? J Affect Disord 2013; 150:686-90. [PMID: 23668903 DOI: 10.1016/j.jad.2013.03.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 03/27/2013] [Accepted: 03/27/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is the most effective treatment for depression. However, the use of concomitant medications during ECT is controversial, especially benzodiazepines, as some past evidence suggests these may reduce the efficacy of ECT. This study analysed the effect of benzodiazepines on treatment outcomes in a group of depressed patients treated with bitemporal (BT) ECT. METHODS 90 patients with major depression who received BT ECT were analysed. Clinical, demographic and ECT data were extracted from clinical records. Mood improvement was rated by trained psychiatrists using the Hamilton Depression Rating Scale (HDRS-21) at baseline and after the final ECT treatment. The association between benzodiazepine dose and mood outcomes over the ECT course was examined with regression analyses, controlling for variables that may affect ECT efficacy. RESULTS Hierarchical multiple regression analysis found only current episode duration (t=-4.77, p<0.001) was a significant predictor of change in HDRS. Benzodiazepine dose was not associated with a change in HDRS (p>0.05, R(2)=0.39). LIMITATIONS This was a retrospective study. The use of the half-age dosing method for ECT did not permit examination of the effects of benzodiazepines on seizure threshold. CONCLUSIONS Benzodiazepines did not affect the efficacy of BT ECT with the dosing method used. However, these results may not generalise to other forms of ECT, ECT given with other methods of dose determination or to other populations less responsive to ECT.
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Affiliation(s)
- Verònica Gálvez
- Neuroscience Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
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Martínez-Amorós E, Cardoner N, Gálvez V, Urretavizcaya M. Effectiveness and pattern of use of continuation and maintenance electroconvulsive therapy. Rev Psiquiatr Salud Ment 2012; 5:241-53. [PMID: 23021297 DOI: 10.1016/j.rpsm.2012.06.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Revised: 05/29/2012] [Accepted: 06/02/2012] [Indexed: 11/27/2022]
Abstract
Patients with major depressive disorder (MDD) who require an acute course of electroconvulsive therapy (ECT) have high relapse rates. Therefore, an effective maintenance treatment strategy needs to be established. Continuation and maintenance ECT (C/M-ECT) could be an adequate treatment option, although the lack of controlled studies has led to its usefulness being questioned. This review includes a detailed description of studies on the effectiveness/efficacy of ECT in MDD. Despite their methodological limitations, the results appear to support the idea that C/M-ECT would be a safe and effective alternative, especially in patients with severe and recurrent disease. Nevertheless, more controlled studies are needed to provide new evidence and allow a more accurate assessment of the efficacy, safety and pattern of use of C/M-ECT.
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Affiliation(s)
- Erika Martínez-Amorós
- Salut Mental Parc Taulí, Corporació Sanitària Universitària Parc Taulí, Sabadell. Institut Universitari Parc Taulí - UAB, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain.
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Gálvez V, Anguera I, Soria V, Salvat-Pujol N, Sabaté X, Menchón JM, Urretavizcaya M. A patient with an implanted cardiac defibrillator not deactivated during acute and maintenance electroconvulsive therapy. Psychosomatics 2012; 53:478-81. [PMID: 22445091 DOI: 10.1016/j.psym.2011.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 11/02/2011] [Accepted: 11/04/2011] [Indexed: 10/28/2022]
Affiliation(s)
- Verònica Gálvez
- Neuroscience Group, Bellvitge Biomedical Research Institute, Barcelona, Spain
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