Improved Safety of Hybrid Electroconvulsive Therapy Compared With Standard Electroconvulsive Therapy in Patients With Major Depressive Disorder: A Randomized, Double-Blind, Parallel-Group Pilot Trial

Objectives

ECT is a rapid and effective treatment for depression. While efficacy is often remarkable over the initial 3-4 sessions, the efficacy of later sessions is less rapid, and the side-effects, especially cognitive impairment limit its use. To preliminarily compare the efficacy and acceptability of a novel hybrid-ECT (HECT) protocol for patients with major depressive disorder (MDD) with standard ECT, we conducted this pilot trial.

Methods

Thirty patients were randomly assigned to ECT or HECT. Both arms received three ECT sessions (phase 1) but, in phase 2, the HECT arm received low-charge electrotherapy instead of ECT. The primary outcome was the change in 24-item Hamilton depression rating scale (HAMD-24) scores between baseline and the end of treatment. Cognitive function was assessed by repeatable battery for the assessment of neuropsychological status (RBANS), Stroop color word, and orientation recovery tests (ORT). Safety was measured by the drop-out rate and adverse events (AEs). Four visits were conducted at baseline, post-phase 1, post-phase 2, and at 1-month follow-up. Trial registration: Chinese Clinical Trial Registry (http://www.chictr.org.cn/), identifier: ChiCTR1900027701.

Results

Patients in both arms showed significant within-group improvements in HAMD-24, but the between-group differences were non-significant. Participants in the HECT arm outperformed ECT patients for most cognitive tests at the end of treatment or at follow-up. There was a significantly lower AE rate and shorter ORT in phase 2 of the HECT ar.

Conclusion

In this pilot trial, HECT was associated with fewer AEs and better cognitive function including executive and memory function, but its possible similar antidepressive efficacy needs to be further investigated in future.

Cloning and characterization of AWP1, a novel protein that associates with serine/threonine kinase PRK1 in vivo

We describe the cloning and expression of cDNAs encoding a novel human protein of 208 amino acid residues with a predicted molecular mass of 22.6kDa and its mouse homologue. We name this protein as AWP1 (associated with PRK1). AWP1 is a ubiquitously expressed protein, and the Awp1 gene is switched on during early human and mouse development. When expressed in COS-1 cells, the Myc-tagged AWP1 has an apparent molecular mass higher than that deduced from its amino acid sequence. AWP1 possesses a conserved zf-A20 zinc finger domain at its N-terminal and a zf-AN1 zinc finger domain at its C-terminal. Co-immunoprecipitation experiments revealed that mouse AWP1 specifically interacts with a rat serine/threonine protein kinase PRK1 in vivo. Hence, AWP1 may play a regulatory role in mammalian signal transduction pathways.

Utility of biological membranes as indicators for radiation exposure: alterations in membrane structure and function over time

In addition to interacting with genomic DNA, ionizing radiation may directly and indirectly alter the structure and function of components of the plasma membrane of eukaryotic cells. Water radiolysis generates reactive species, including superoxide, hypochlorous acid and chloride radicals that may in turn react with biological membranes, as well as with cellular DNA. Reaction of plasma membrane lipids with molecular oxygen results in lipid peroxidation of both reconstituted membranes and biological membranes, an effect that increases with decreasing dose rate. Both ionizing radiation and ultraviolet light alter functions of membrane-anchored molecules, including adhesion molecules, histocompatibility complex antigens and membrane-bound growth factors. The latter growth factors represent a repertoire of growth and differentiation signals that are expressed in a nondiffusible fashion at the cell surface, and in soluble forms appearing after cleavage of their extracellular domain. The importance of cell-cell signaling via the membrane-anchored form of growth factors is becoming increasingly recognized. Expression of membrane-bound hematopoietic cytokines by eukaryotic cells is impaired after exposure to ultraviolet light, a defect in cell-cell signaling that may lead to impaired hematopoiesis. While studies suggest that permanent changes in membrane structure and function may result from radiation-induced injury to the plasma membrane and reconstituted "pure" membranes, reversibility of these defects over time requires additional study.

Assessment of the neural defect in a dog with idiopathic megaesophagus

In a dog with megaesophagus, we studied the upper (UES) and lower (LES) esophageal sphincter responses to swallowing, the UES response to intraesophageal balloon distension and acid perfusion, the fasting LES, stomach and upper small bowel motor activity, and the LES response to intraesophageal balloon distension. The findings were compared to those in two normal dogs. In normal dogs, balloon distension (10-40 cc) and acid perfusion (0.1-0.4 N HCl) at 5, 10, and 15 cm distal to the UES produced up to 200% and 100% increases in UES pressure, respectively. Fasting LES activity in these dogs was coupled to the cyclical migrating motor complex (MMC) activity of the stomach and intestine, with phase I, random phase II, and phase III employing 40%, 40%, and 20% of cycle time, respectively. Balloon distension (10-40 cc) at 5, 10, and 15 cm proximal to the LES in phases I, II, and III produced 80-100% relaxation of the sphincter. In the dog with megaesophagus: the UES and LES response to swallowing was normal; balloon distension (10-40 cc) in the upper esophagus produced no significant increase (P greater than 0.05) in UES pressure while acid perfusion (0.1-0.4 N HCl) produced a significant but relatively smaller increase (50%) in UES pressures; phase I MMC activity in this dog was absent or very short in duration (less than 5% cycle time), the activity mostly alternating between phases II and III (75-80% and 20% cycle time, respectively); and balloon distension in the distal esophagus (up to 80 cc) induced no observable relaxation (less than 10%) of the LES.

CONCLUSION

The normal UES and LES response to swallowing and the presence of cyclical MMC activity in the LES indicates that the efferent neural pathways, at least to these areas, are intact in the dog with megaesophagus. Absence or decreased response of the UES and LES to intraluminal stimuli suggests that at least the afferent component of the reflex neural pathways is faulty in idiopathic megaesophagus. The location of the defect is yet to be determined.