Clinical Neuroscience of ECT (CNECT)

Happy 102nd birthday to Max Fink, MD! Max Fink, an icon in our field, is one of the most influential ECT researchers, practitioners and advocates of all time. He has also been a friend and mentor to many of us in the ECT world, and we owe him a great debt of gratitude. Please join me in wishing him all the best today!                                                    Max Fink, October 2024, with Andrea and Charles Kellner

 Out on PubMed, from authors in Japan, is this paper: Approaches for difficult-to-induce-seizures  electroconvulsive  therapy cases (DEC): a Japanese expert consensus. Takekita Y, Suwa T, Yasuda K, Kawashima H, Omori W, Kurimoto N, Tsuboi T, Noda T, Aoki N, Wada K, Inada K, Takebayash M; Expert Consensus Development Working Group; Electroconvulsive Therapy Committee; Japanese Society of General Hospital Psychiatry. Ann Gen Psychiatry. 2025 Jan 12;24(1):2. doi: 10.1186/s12991-024-00543-9. PMID:  39800695   The abstract is copied below: Background: Seizure threshold increases with age and the frequency of electroconvulsive therapy (ECT). Therefore, therapeutic seizures can be difficult to induce, even at maximum stimulus charge with available ECT devices. Such cases are known as difficult-to-induce-seizures electroconvulsive therapy cases (DECs ). However, no clinical guidelines exist for DECs; thus, clinicians often face difficulties determining treatment strateg...

Out on PubMed, from authors in Colombia and Spain, is this case report: Bilateral hypothalamotomy plus dominant amygdalotomy with Gamma Knife radiosurgery. A non-invasive alternative when everything has failed in the management of aggressive behavior disorder. Romero OIM, Diez-Palma JC, Fonnegra-Caballero A, Segura-Hernández A, Matinez-Alvarez R, Yamhure E, Camargo JF, Fonnegra-Pardo JR. Surg Neurol Int. 2024 Dec 20;15:469. doi: 10.25259/SNI_860_2024. eCollection 2024. PMID:  39777183 The abstract is copied below: Background: Impulsive aggression is the core symptom of intermittent explosive disorder, which can be a feature of several psychiatric disorders. There is a subset of individuals who do not respond adequately to medical treatment; they are treatment refractory. The objective of this report is to describe a case of a patient with a background of schizophrenia and concomitant refractory aggressiveness disorder, treated with two-stage bilateral hypothalamotomy and unilateral...

Out on PubMed, from authors in  Electroconvulsive Therapy-Induced Mania in Bipolar Disorder: A Case Report. Van Eenoo S, Bollen O, Janssens S. Cureus. 2024 Dec 7;16(12):e75255. doi: 10.7759/cureus.75255. eCollection 2024 Dec. PMID:  39764330 The abstract is copied below: Electroconvulsive therapy (ECT) is widely recognized as a safe and effective intervention for treating severe affective episodes in patients with bipolar disorder. However, it can sometimes precipitate unexpected manic phases in patients treated for a depressive episode, a phenomenon known as ECT-induced mania. While this occurrence is recognized, it remains poorly understood and minimally addressed in the literature. This article presents a case study of a 56-year-old man diagnosed with bipolar I disorder with rapid cycling and late-onset features who received ECT to treat a severe depressive episode with psychotic and catatonic features but developed a manic episode with psychotic elements shortly after ECT ...

 Out on Pubmed, from investigators in the Netherlands, Germany, and the USA, is this study: The relationship between electric field strength induced by electroconvulsive therapy and cognitive and antidepressant outcomes. Loef D, Argyelan M, Ruhé HG, Scheepens DS, Schoevers RA, Tendolkar I, van Exel E, van Waarde JA, van Wingen GA, Verdijk JPAJ, Verwijk E, Dols A, van Eijndhoven PFP. Neuropsychopharmacology. 2025 Jan 6. doi: 10.1038/s41386-024-02050-7. Online ahead of print. PMID:  39762574 The abstract is copied below: Electroconvulsive therapy (ECT) is an effective treatment for depression but is often associated with cognitive side effects. In patients, ECT-induced electric field (E-field) strength across brain regions varies significantly due to anatomical differences, which may explain individual differences in cognitive side effects. We examined the relationship between regional E-field strength and change in verbal fluency score (i.e., category fluency animals score from...

This is about what I would have expected. Over the years, I have always suggested that in a typical, busy ECT service, the split should be about 50/50, given the usual patient mix of very severe and moderately severe illness, as well as some patients with serious medical comorbidities.