Clinical Neuroscience of ECT (CNECT)

Out on PubMed, from investigators in Prague, Czech Republic, is this review: Brain Tumors and  Electroconvulsive  Therapy: A Literature Overview of the Last 80 Years. Buday J, Albrecht J, Mareš T, Podgorná G, Horáčková K, Kališová L, Raboch J, Anders M. Front Neurol. 2020 Jul 31;11:723. doi: 10.3389/fneur.2020.00723. eCollection 2020. PMID:  32849199   The abstract is copied below: The safety and efficacy of electroconvulsive therapy (ECT) in patients with a brain tumor have been debated in the past without a clear conclusion. In the last large review published by Maltbie et al. in 1980, it was concluded that the presence of an intracranial mass should be considered an absolute contraindication to ECT. In our updated review, we investigated a total of 33 published and indexed case reports, case report series, and reviews of 75 individual patients who underwent ECT in the presence of a brain tumor over the last 80 years. Mounting case reports after the original Maltbi...

Out on PubMed, from researchers in India, is this study: Efficacy of donepezil for the attenuation of memory deficits associated with  electroconvulsive  therapy. Dutta LCB, Sarkar CP, Andrade C. Psychiatry Res. 2020 Aug 18;293:113397. doi: 10.1016/j.psychres.2020.113397. Online ahead of print. PMID:  32835925 The abstract is copied below: We sought to confirm and extend the findings of studies that reported that acetylcholinesterase inhibitor drugs protect against electroconvulsive therapy (ECT)-induced cognitive impairment. We randomized 30 patients with depression (n=24) or schizophrenia (n=6) to receive either donepezil (10 mg/day; n=15) or placebo (n=15) during a fixed course of 6 thrice-weekly, modified, bifrontotemporal sine wave ECT, and for 30 days subsequently. We assessed memory using the Postgraduate Institute Memory Scale (PGI-MS) at baseline, and again at days 2, 7, and 30 after the ECT course. At baseline, memory functioning was comparable in the 2 groups. ...

Out on PubMed, from Lee Wachtel, in JECT, is this commentary: Far From an Elective Procedure: Electroconvulsive Therapy and Autism in the Era of COVID-19. Wachtel LE. J ECT. 2020 Aug 18. doi: 10.1097/YCT.0000000000000720. Online ahead of print. PMID:  32826708 The pdf is here . In this commentary, Lee Wachtel, from the Kennedy Krieger Institute in Baltimore, makes the case for the the urgent need to continue uninterrupted maintenance ECT for patients with autism and catatonic and self-injurious behaviors. She illustrates this point with two compelling case vignettes. Dr. Wachtel has pioneered the use of ECT for this vulnerable population and is among the handful of child psychiatrists in the United States with in-depth ECT experience. In this piece, she makes the additional important observation that patients with disabilities are are more vulnerable to be infected with, and have more severe symptoms from, COVID-19 than the general population.

Out on Pubmed, first-authored by an anesthesiologist in Munich, Germany, is this article: [Anesthesia for electroconvulsive therapy]. Ninke T, Bayerl S, Groene P. Anaesthesist. 2020 Aug 24. doi: 10.1007/s00101-020-00831-5. Online ahead of print. PMID:  32833079   The article is in German.  The abstract is copied here: Electroconvulsive therapy (ECT) is an important component in the treatment of depression and schizophrenia in Germany. For this intervention patients undergo short-term general anesthesia and muscle relaxation. Before anesthesia can be carried out patients are subject to a comprehensive examination. For general anesthesia all established hypnotics can be used, but differences with respect to the success of the ECT have been described. Short-acting or reversible relaxants should be preferentially used. The risks of general anesthesia during ECT are estimated to be low but a transient hemodynamic instability of patients can occur. Treatment can be perform...

Out on PubMed, from researchers at the University of Toronto is this paper: Magnetic Seizure Therapy for Suicidality in Treatment-Resistant Depression. Weissman CR, Blumberger DM, Dimitrova J, Throop A, Voineskos D, Downar J, Mulsant BH, Rajji TK, Fitzgerald PB, Daskalakis ZJ. JAMA Netw Open. 2020 Aug 3;3(8):e207434. doi: 10.1001/jamanetworkopen.2020.7434. PMID:  32809030 The abstract is copied below: Importance:  There is an unmet need for effective treatments for suicidality in mental disorders. Magnetic seizure therapy (MST) has been investigated as an alternative to electroconvulsive therapy, a known effective treatment for suicidality, in the management of treatment-resistant major depressive disorder, with promising findings. Yet, there are very limited data on the association of MST with suicidality directly. It is important to explore the potential of MST as a viable treatment alternative to electroconvulsive therapy for suicidality. Objective:  To determine the a...

Out on PubMed, first-authored by an Irish senior psychiatry resident, is this brief commentary: Eighty Years of  Electroconvulsive  Therapy in Clinical Practice. Glynn K, Connellan L, Lyons D. Ir Med J. 2020 Mar 13;113(3):33. PMID:  32815675 The complete commentary is available on the Irish Medical Journal Website. This is a 2-page overview of ECT designed to educate physicians about ECT. It includes some history, an update on modern technique and a description of the role of ECT in current practice, with a focus on Ireland. It appears in the Irish Medical Journal, a general medical journal, not a psychiatric journal. Given the recent anti-ECT attacks emanating out of Great Britain, this is a particularly important and timely message to the overall medical community in Ireland. 

Out on PubMed, from researcher/clinicians in Singapore and Australia, is this commentary: A Model for Ethical triaging of  ECT  patients during COVID-19. Tor PC, Tan J, Loo C. BJPsych Bull. 2020 Aug 19:1-13. doi: 10.1192/bjb.2020.99. Online ahead of print. PMID:  32811589 The pdf is here . This is a well-written, thoughtful review of the application of ethical principles to ECT service delivery in a time of scarce resources. The clinical challenges are brought to life by two patient vignettes. Hopefully, conditions around the world will normalize soon, but this is a very worthwhile read, both for the current situation and to help prepare for the future.

Out on PubMed is this case report: Cerebrospinal fluid metabolomics uniquely identifies pathways suggesting risk for anesthesia reactions during  electroconvulsive  therapy for bipolar disorder. Berner J, Elsea S. Bipolar Disord. 2020 Aug 13. doi: 10.1111/bdi.12982. Online ahead of print. PMID:  32794310 The abstract is copied here: In this case report, we describe the results of next generation non‐targeted cerebrospinal spinal fluid (CSF) metabolomics in a patient presenting with a prolonged delirium and elevated serum ammonia after standard electroconvulsive therapy treatment. These studies subsequently, in part, revealed abnormalities in the citric acid cycle, a finding previously reported in the bipolar literature. The patient subsequently has had a sustained response to pioglitazone, a mitochondrially targeted agent, in contrast to established medical and interventional therapies. And from the text: Observed isocitrate elevation likely corresponds to bipolar disorde...

Out on PubMed, from Colleen Loo's group in Sydney, Australia, is this study: The left anterior right temporal (LART) placement for  electroconvulsive  therapy: A computational modelling study. Steward B, Bakir AA, Martin D, Dokos S, Loo CK. Psychiatry Res Neuroimaging. 2020 Aug 8;304:111157. doi: 10.1016/j.pscychresns.2020.111157. Online ahead of print. PMID:  32799057 The abstract is copied below: Electrode placement in electroconvulsive therapy (ECT) has a major impact on treatment efficacy and cognitive side effects. Left Anterior Right Temporal (LART) is a lesser utilised bilateral montage which may produce more optimal clinical outcomes relative to standard bitemporal ECT. In this study we used computational modelling to explore how stimulation effects from LART and two novel variants (LART - F3 and LART - Frontal) compared to the more common bilateral placements of bitemporal and bifrontal ECT. High resolution finite element human head models were generated from MRI...

Out on PubMed, from researchers at Michigan State University, is this study: Last Resort Interventions?: A Qualitative Study of Psychiatrists' Experience with and Views on Psychiatric Electroceutical Interventions. Cabrera LY, Nowak GR 3rd, McCright AM, Achtyes E, Bluhm R. Psychiatr Q. 2020 Aug 13. doi: 10.1007/s11126-020-09819-1. Online ahead of print. PMID:  32789719 The abstract is copied here: Psychiatrists play an important role in providing access to psychiatric electrical interventions (PEIs) such as electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS). As such, their views on these procedures likely influence whether they refer or provide these types of treatments for their clinically depressed patients. Despite this, scholars have too infrequently examined psychiatrists' views about specific PEIs and have not yet examined their views across different PEIs. To gain insight into psychiatrists' views about PEIs, we conducted a qualitative study ...

Out on PubMed, from investigators in Denmark, is this letter-to-the-editor: Cochlear Implant Should not be Absolute Contraindication for  Electroconvulsive  Therapy and Transcranial Magnetic Stimulation. Reveles Jensen KH, Navntoft CA, Sindahl CH, Cayé-Thomasen P, Jørgensen MB. Brain Stimul. 2020 Aug 12:S1935-861X(20)30225-4. doi: 10.1016/j.brs.2020.08.007. Online ahead of print. PMID:  32800965   The text portion of the letter about ECT is copied here: Cochlear Implants [ CIs] and ECT There are no absolute contraindications for ECT treatment, but in practice, a CI is considered one 4 . The literature on ECT and CI safety is limited to a study on cadaver heads and two case reports. Ten CIs (Nucleus CI512/N5) were implanted in fresh human cadaveric heads and administered 12 ECT sessions with maximum full pulse-width energy (576mC, 800mA, 1.0ms pulse width, 60Hz, 6s duration). Half received ECT contralateral to the CI and the other half ipsilateral. Impedance measureme...

Out on PubMed from researchers in Sydney, Australia, is this study: Wearable technology to assess bradykinesia and immobility in patients with severe depression undergoing  electroconvulsive  therapy: A pilot study. Powell A, Graham D, Portley R, Snowdon J, Hayes MW. J Psychiatr Res. 2020 Aug 4;130:75-81. doi: 10.1016/j.jpsychires.2020.07.017. Online ahead of print. PMID:  32798772 The abstract is copied here: The psychomotor retardation that may be seen in major depression represents an interesting parallel to bradykinesia, a core feature of Parkinson's disease. Psychomotor retardation has been correlated with the severity of depression and is a predictor of response to electroconvulsive therapy (ECT). Psychomotor retardation has typically been assessed by subjective clinical judgement including clinical rating scales. Gross activity levels have also been measured with actigraphy previously. The Parkinson's KinetiGraph (PKG) was developed to assess bradykinesia, dyskines...

Out on PubMed is this LTE from clinicians in Singapore: Case Report of  Electroconvulsive  Therapy after Recurrent Myocardial Infarction. Tay KH, Lee SY, Yap PP, Keh YS, Tor PC. Psychiatry Clin Neurosci. 2020 Aug 14. doi: 10.1111/pcn.13129. Online ahead of print. PMID:  32797651   This case describes a 51-year old female with a diagnosis of "catatonic schizophrenia" who apparently  had two relatively minor myocardial infarctions ( a "low-risk non-ST elevation MI," and a "Type II MI") seven and four weeks before ECT.  The cardiac events are not adequately described in terms of severity and functional  cardiac status (although ejection fraction  (EF) is reported at 65-70% after the first event). The patient recovered, with resolution of catatonia, with three bifrontal ECT. The details of intraprocedural vital signs are sparse; medication management was by additional  p.o. beta blocker the night before ECT. This case report adds very modestly to...

Out on Pubmed, from neurologists in Israel, is this   pre-clinical study: JCI Insight  2020 Aug 11;137028.   doi: 10.1172/jci.insight.137028.   Online ahead of print. Electroconvulsive stimulation attenuates chronic neuroinflammation Smadar Goldfarb   1 ,  Nina Fainstein   1 ,  Tamir Ben-Hur   1 Affiliations  expand PMID:  3278072 8 The abstract is copied below: Electroconvulsive therapy is highly effective in neuropsychiatric disorders by unknown mechanisms. Microglial toxicity plays key role in neuroinflammatory and degenerative diseases, where there is critical shortage in therapies. This study examined the effects of electroconvulsive seizures (ECS) on chronic neuroinflammation and microglial neurotoxicity.Electric brain stimulation inducing full tonic-clonic seizures during chronic relapsing-progressive experimental autoimmune encephalomyelitis (EAE) reduced spinal immune cell infiltration, reduced myelin and axonal loss, and p...

From "Classics in ECT" comes this 1991 LTE in the NEJM:   N Engl J Med .  1991 Aug 29;325(9):663.   doi: 10.1056/nejm199108293250919. Electroconvulsive therapy in a patient with a heart transplant C H Kellner ,  R R Monroe ,  C Burns ,  H J Bernstein ,  A J Crumbley PMID:  1861707 The Pdf is here . The full text is copied below: To the Editor : As heart transplantation becomes more common, physicians will be faced with the prospect of treating serious psychiatric illness in heart-transplant recipients. A recent study reported on the use of nortriptyline for the treatment of depression in nine such patients. *   When treatment with antidepressant agents is unsatisfactory, electroconvulsive therapy remains an important option. We report here the safe and successful use of electroconvulsive therapy in a patient with a heart transplant. A 35-year-old man had experienced episodes of severe depression since his cardiac transplantation 13 months pre...