Clinical Neuroscience of ECT (CNECT)

  Among the three new articles on Pubmed today is this excellent  Swedish study of ECT's effect on quality of life: Electroconvulsive Therapy in Depression: Improvement in Quality of Life Depending on Age and Sex JECT 2020 Feb 27 [Online ahead of print] Pelin Güney   1 ,  Carl Johan Ekman   2 ,  Åsa Hammar   3   4 ,  Emelie Heintz   5 ,  Mikael Landén   6   7 ,  Johan Lundberg   2 ,  Pia Nordanskog   8   9 ,  Axel Nordenskjöld   1 PMID:  32108666 The pdf is here This is a register-basd cohort study with 1066 patients from the Swedish National Quality Register for ECT. The authors found significant increases in health-related quality of life after ECT across the board, but the improvement was greater in elderly patients, who also more often had psychotic features. This is consistent with the (intuitive) finding that  more severely ill pat...

This study is out on PubMed today. The pdf is not yet available, so I have copied the entire citation, with abstract: Cognitive Function After Electroconvulsive Therapy for Depression: Relationship to Clinical Response Ian M Anderson   1 ,  R Hamish McAllister-Williams   2 ,  Darragh Downey   3 ,  Rebecca Elliott   1 ,  Colleen Loo   4    Psychol Med, 1-10, 2020 Feb 27 [Online ahead of print]                    PMID:  32102725 Abstract Background:  As uncertainty remains about whether clinical response influences cognitive function after electroconvulsive therapy (ECT) for depression, we examined the effect of remission status on cognitive function in depressed patients 4 months after a course of ECT. Method:  A secondary analysis was undertaken on participants completing a randomised controlled trial of ketamine augmentation of ECT for depressio...

 Nothing out yet on PubMed today, but the online version of Psychiatric Times (Vol. 37, Issue 2) has a review piece: "Neuromodulation Approaches to Mood Disorders" by Wang and Widge. It has a reasonable discussion of ECT; their first bullet point is: "ECT remains the most effective treatment for depression, with response rates of 70% to 80%."

The only ne w "ECT-related" citation on Pubmed today is this Danish study : Transcranial Pulsed Electromagnetic Fields for Treatment-Resistant Depression: A Multicenter 8-week Single-Arm Cohort Study Larsen et. al. Eur Psychiatry, 63 (1) PMID 32093804 I put "ECT-related" in quotation marks because I'm not sure how related they are. 58 patients with treatment-resistant depression were treated with this new technology, T-PEMF.  Patients  administered their own treatment at home in the outpatient part of the study. Among the "severely depressed" patients only 16.7% responded. There were 19 ECT non-responders in the cohort: 10/19 with " non chronic  depression" had 50% response, 30% remission rates, 9/19 with "chronic depression" had 33% response and 11.1% remission rates. These  authors write: "The indication for T-PEMF as compared with that of rTMS and ECT thus needs to be clarified in the future. ECT seems to...

  A new Belgian neuroimaging study out today on PubMed looks at the relationship between psychomotor symptoms in depression and the basal ganglia: The Basal Ganglia: A Central Hub for the Psychomotor Effects of Electroconvulsive Therapy Jan-Baptist Belge   1 ,  Linda Van Diermen   2 ,  Didier Schrijvers   2 ,  Bernard Sabbe   2 ,  Eric Constant   3 ,  Philippe de Timary   3 ,  Sven De Keyzer   4 ,  Paul Parizel   4 ,  Kristof Vansteelandt   5 ,  Pascal Sienaert   6 ,  Philip van Eijndhoven   7 J Affect Disord ,  265, 239-246  2020 Mar 15 PMID:  32090747 This is the url to the pdf: https://drive.google.com/file/d/11Sb4SQJKlXMKdhGF57zM5bW-5Iqcxzsp/view?usp=sharing This is an excellent study, carefully conducted and the paper is well written. Psychomotor symptoms (mainly retardation and agitation) were assessed in 17 patients with se...

I have alway been surprised by how little attention has been paid to the pharmacological modification of the cognitive profile of ECT. This new study is a clinical trial of two agents administered during an acute course of ECT: Comparison of the efficacy and safety of melatonin and memantine in the alleviation of cognitive impairments induced by electroconvulsive therapy: A randomized clinical trial Sarraf N, et al. J Clin Neurosci 2020. PMID  32081599 Here is the url for the pdf: https://drive.google.com/file/d/14sSKoeOSGPt_ZeLm4Y7hNhs1qzkHMJOu/view?usp=sharing These authors report a beneficial effect of memantine (trade name:  Namenda, an NMDA receptor antagonist), but given the many methodological shortcomings of this study, not much weight can be attached to these findings. Rather, the main point is that this is an understudied area, with good potential to improve the tolerability profile of ECT. I always thought that the old finding of thyroid supplements decr...

Today's post is about NMDA receptor antibody encephalitis again and the prevalence of catatonia in this diagnosis: Catatonia in Nmethyl-d-aspartate Receptor Antibody Encephalitis: Phenomenological Characteristics From a Systematic Review of Case Reports Jordi Serra-Mestres   1 ,  Beatriz Villagrasa-Blasco   2 ,  Vikram Thacker   3 ,  Walter Jaimes-Albornoz   4 ,  Puja Sharma   3 ,  Marco Isetta   5 Gen Hosp Psychiatry  2020 Jan 28 [Online ahead of print] The url for the pdf is: https://drive.google.com/file/d/1qxfVbBuHYFT7LzJuGNX9Kq0JcaHDOwMW/view?usp=sharing   In this literature review, these authors found that catatonic symptoms were present in 60% of cases. Please see the blog post of 2/8 for some discussion of the role of ECT in this diagnosis.

Well, today's post is about basic science, not clinical, but translatable and interesting. This article is new on PubMed today: Sox11 is an Activity-Regulated Gene with Dentate-Gyrus-Specific Expression Upon General Neural Activation von Wittgenstein J, et al. Cereb Cortex 2020. PMID  32080705 Here is the url for the Pdf: https://drive.google.com/file/d/1DeZCm_DKJyZjfGddNGv3ofoStJyMY7k4/view?usp=sharing This is a very complex animal study, the main finding of which is that ECS (the animal analog of ECT in humans) induced the transcription factor Sox11 selectively in the dentate gyrus of mice, and not in other hippocampal subfields.  Such information adds to the understanding of neuronal plasticity and dovetails interestingly with the recently discussed neuroimaging work of the UCLA group showing ECT-induced structural changes only in certain hippocampal regions ( Hippocampal subregions and networks linked with antidepressant response to electroconvulsive therapy. ...

Today's post is about esketamine, and its lack of equivalence to ECT. The below letter, "Approval of esketamine for treatment-resistant depression," by Singh et al. just came out in Lancet Psychiatry. Here is the url for the pdf: https://drive.google.com/file/d/16Rlxt6goVF5Gwsp1udl5wX7GuQS12Dbo/view?usp=sharing This letter (accompanied by another rebuttal) is in response to two editorials in Lancet Psychiatry several months ago that were critical of ketamine for depression. This was brought to my attention today by a piece in the online site MedPage Today, entitled "Spravato Debate Still rages." Several things to point out, including that Singh and co-authors are all employees of Janssen. Whether ketamine in its various forms will be the panacea claimed by its discoverers remains to be seen. What is clear is that the evidence base for ketamine in depression remains thin compared to a vast evidence base for ECT. Also, the concept of treatment-resista...

Another fairly recent ECT overview from Psychiatric Clinics of North America that I highly recommend is: Electroconvulsive  Therapy in Depression: Current Practice and Future Direction. Hermida AP , et al. Psychiatr Clin North Am 2018 -  Review . PMID  30098649 The url for the pdf is: https://drive.google.com/file/d/1PopFi_mTTcnJfMyXMJI2nKRNE8QUHesI/view?usp=sharing Particularly helpful sections are those on technique and special populations. CK

A new review of catatonia, by Mormando and Francis, is out on PubMed today: Catatonia revived: a unique syndrome updated Mormando C and Francis A. Int Rev Psychiatry 2020. PMID  32067538 Here is the url for the pdf: https://drive.google.com/file/d/13VaiZNUGK67OC1r2sD3c_pqfZTIrCRin/view?usp=sharing This is a concise, authoritative and well written review. ECT, of course, is a very important treatment option for catatonia. These authors are experts (yes, this is the Francis of the Bush-Francis Catatonia Rating Scale).  The revival of catatonia as a diagnosis in contemporary psychiatry, led by Dr. Max Fink and others, is  important not only because it allows appropriate recognition/treatment of this serious condition,  but also because it has brought renewed positive attention to ECT. We should recall that catatonia and depression were the two diagnoses recognized in the recent FDA reclassification of ECT devices. While the number of patients treated ...

For a recent review article on ECT, please consider this in Acta Psychiatrica Scandinavica, written with my Belgian colleagues  Jasmien Obbels and Pascal Sienaert: When to consider electroconvulsive therapy ( ECT ). Kellner CH , et al. Acta Psychiatr Scand 2019. PMID  31774547 Here is the url to the pdf: https://drive.google.com/file/d/1gJx7Nj1jEHU3iOYZB1X_SeIGkkpFS_4U/view?usp=sharing I think you will find it a good overview of current ECT practice (but I am biased) and suitable for ECT practitioners, non-psychiatric colleagues, and trainees alike. Feel free to comment, thanks.

Today's post features a new fMRI study from investigators at Anhui Medical University in China: Improved and residual functional abnormalities in major depressive disorder after electroconvulsive therapy Wang J, et al. Prog Neuropsychopharmacol Biol Psychiatry 2020. PMID  32061788 Here is the url for the pdf: https://drive.google.com/file/d/1z5wVmbtNBG6g9DNFlUUZ7V97bdwk8K7e/view?usp=sharing The authors state that the goal of their study was "to identify the specific circuit for fast remission of depression and circuit for residual functional impairments." Their main finding was increased whole brain functional connectivity homogeneity (FcHo) in the right dorsomedial prefrontal cortex and left angular gyrus in a group of 23 depressed patients after ECT. What they meant by "residual functional impairments" was not clear to me. While the specific finding of this study may or may not be accurate or a critical piece of the puzzle, or even hold up to...

Colleagues from Singapore and Australia published this informative study (out on PubMed yesterday): Outcomes in patients with and without capacity in electroconvulsive therapy Tor PC, et al. J Affect Disord 2020. PMID  32056870 The url for the pdf is: https://drive.google.com/file/d/155Xuna_7S5kMk6m7Um27EN9wJVVQGJPN/view?usp=sharing This is a retrospective study of 175 patients treated at the Singapore Institute of Mental Health (88 with a diagnosis of schizophrenia, 49 with depression, and 38 with mania). Patients were assessed for capacity to provide informed consent and were rated on symptoms, cognition, quality of life (QOL) and global assessment of function.  75% of the total sample were assessed to lack capacity, likely a reflection of the severity of illness/diagnostic mix of the cohort and possibly the specific criteria used to make this determination. The main findings of the study were that "mood, cognition, QOL and function improved in both groups [with ...

Among the 4 new ECT articles out on PubMed today (3/4 in Journal of Affective Disorders) is this interesting French study of how long it takes for ECT to be prescribed in patients with depression: Adherence to treatment guidelines in clinical practice for using electroconvulsive therapy in major depressive episode Samalin L, et al. J Affect Disord 2020. PMID  32056767 Here is the url for the pdf: https://drive.google.com/file/d/1N6yqi3EzNU1mvzj_ZE-IzsoMjaPymUTy/view?usp=sharing This is a multi center, retrospective chart review that included 745 patients who received ECT in France for an episode of either unipolar of bipolar depression. The authors looked at how these "first line indications" for ECT (taken from international guidelines) influenced the prescription of ECT: high suicidality, urgency (severe depression associated with insufficient oral intake), catatonic features, psychotic features, prior ECT response, and patient preference...

The below editorial, "interventional Psychiatry" appeared on PubMed today: Postgrad Med, 1-2    Interventional Psychiatry Kathy M Vincent   1 ,  Maureen Ryan   2 ,  Emma Palmer   3 ,  Jeramie L Rosales   1 ,  Steven Lippmann   1 ,  Rif S El-Mallakh   1 PMID:  32053020 The url for the pdf is: https://drive.google.com/file/d/1a0r5NAqw3fDJlMmQ5o8wqlc9Aq79vMQb/view?usp=sharing The premise of the editorial is that psychiatric residents should be broadly educated in emerging psychiatric treatments and that "interventional psychiatry" should include not just neuromodulation techniques (ECT, rTMS, VNS, DBS), but also "implants, intramuscular, subcutaneous or intravenous medications and treatments requiring utilization of Risk, Evaluation and Mitigation Strategy (REMS) protocols." They suggest that futures additions to the list might be acupuncture and botulinum toxin injections. The authors cite evidence t...