Clinical Neuroscience of ECT (CNECT)

The below exchange of letters recently appeared on PubMed: The likeliness of 0.5 and 1.0 ms stimuli in BL  ECT . Spaans HP. Eur Arch Psychiatry Clin Neurosci. 2020 Sep 10. doi: 10.1007/s00406-020-01194-z. Online ahead of print. PMID:  32910295 Reply to the likeliness of 0.5 and 1.0 ms stimuli in bilateral electroconvulsive therapy ( ECT ). de Arriba-Arnau A, Soria V, Urretavizcaya M. Eur Arch Psychiatry Clin Neurosci. 2020 Sep 24. doi: 10.1007/s00406-020-01192-1. Online ahead of print. PMID:  32974729   The original article was this: Similar clinical improvement of depression using 0.5-ms and 1-ms pulse widths in bilateral electroconvulsive therapy. de Arriba-Arnau A, Soria V, Salvat-Pujol N, Menchón JM, Urretavizcaya M. Eur Arch Psychiatry Clin Neurosci. 2019 Dec 13. doi: 10.1007/s00406-019-01089-8. Online ahead of print. PMID:  31832757 Some of the text of each letter is copied below: From Dr. Spaans:   All patients received bilateral ECT, but s...

Out on PubMed, from nurses in Ireland, is this paper: Mental Health Nurse Experiences of delivering care to severely depressed adults receiving Electroconvulsive therapy. Lonergan A, Timmons F, Donohue G. J Psychiatr Ment Health Nurs. 2020 Sep 25. doi: 10.1111/jpm.12692. Online ahead of print. PMID:  32976647 The abstract is copied below: Background:  There is a considerable dearth of literature on attitudes towards Electroconvulsive Therapy (ECT) as a treatment for severe depression. Despite being a highly effective treatment, it is still stigmatised even among professionals. Understanding perceptions and knowledge related to ECT treatment among healthcare providers is important for ensuring that treatment can be safely explored as a treatment option with patients. Aim:  The overall aim of this study is to explore the views of mental health nurses who provide nursing care to people receiving ECT for severe depressive illness in a mental health setting. Methods:  Thi...

 "Classics in ECT" brings you this letter to the Editor in Lancet from 1988: Propofol and electroconvulsive therapy Rampton AJ, Griffin RM, Durcan JJ, Stuart CS. Lancet. 1988 Feb 6;1(8580):296-7. doi: 10.1016/s0140-6736(88)90374-1. PMID:  2893104 The pdf is here . According to PubMed, this LTE is the earliest (out of a total of 317 citations to  "propofol electroconvulsive") published report of the use of propofol for ECT anesthesia. Rampton and colleagues report a comparison of seizure length in 10 patients between methohexitone (average, 32 seconds) and propofol (average,18 seconds). Their publication was one month earlier than that of EC Rouse (in Anaesthesia, 20 patients , reported on recovery times, blood pressure, pain on injection, as well as seizure duration ).  Rampton et al. do refer to a 1987 paper by KH Simpson, but I cannot find that reference.  So began the ongoing debate about whether the anticonvulsant property of propofol is a detriment to ...

Use of  ECT  in the United States. Fink M. Am J Psychiatry. 1988 Jan;145(1):133-4. PMID:  3276227 The pdf is here . This is a classic LTE from Dr. Max Fink, most definitely deserving of a careful read. His letter is responsive to an article in the American Journal in 1987 ( Thompson JW, Blaine JD, Use of ECT in the United States in 1975 and 1980, Am J Psychiatry, 1987, May;144(5):557-62 ) which reported declining use of ECT. He counters that the authors' survey was a "lagging indicator" and subject to "sampling error" and that, in fact, ECT use, and interest in ECT, was increasing. He cites the growing number of scientific articles on ECT, the birth of the journal, Convulsive Therapy , and development of the ECT device industry. To this day, we do not know exactly how much ECT is actually performed in the United States. As I have said before, we in the USA are at a great disadvantage compared to many European countries, where systems of socialized medicine allow...

"Classics in ECT" brings you this review by Holly Lisanby in The NEJM from 2007: Electroconvulsive therapy for depression Lisanby SH. N Engl J Med. 2007 Nov 8;357(19):1939-45. doi: 10.1056/NEJMct075234. PMID:  17989386 The pdf is here . This is one of the most-cited reviews of ECT. It appeared in the "Clinical Therapeutics" feature of the NEJM in November, 2007. This feature uses a clinical vignette as the starting point for a review of the therapy in question, and ends with a recommendation. Dr. Lisanby skillfully described the seriousness of depression ("The Clinical Problem"), reviewed the evidence base for ECT in depression and gave a very clear precis of modern ECT technique. She ended with specific recommendations about the use of ECT for the elderly woman of the vignette with psychotic depression and suicidality. As I have noted previously, it is the responsibility of leaders in the field to keep ECT front and center in the general medical literatur...

Out on PubMed, from researchers in the UK, Ireland, and Israel is this study: Augmentation of clozapine with ECT: a retrospective case analysis. Lally J, Breese E, Osman M, Hua Sim C, Shetty H, Krivoy A, MacCabe JH. Acta Neuropsychiatr. 2020 Sep 24:1-22. doi: 10.1017/neu.2020.32. Online ahead of print. PMID:  32967745 The abstract is copied below: Objective:  We sought to assess the effectiveness of clozapine augmentation with ECT (C+ECT) in patients with clozapine-resistant schizophrenia. Methods:  We conducted a retrospective review of electronic health records to identify patients treated with C+ECT. We determined the response to C+ECT and the rate of rehospitalisation over the year following treatment with C+ECT. Results:  Forty-two patients were treated with C+ECT over a ten year period. The mean age of the patients at initiation of ECT was 46.3 (SD=8.2) years (range 27-62 years). The mean number of ECTs given was 10.6(SD = 5.3)(Range 3-25) with the majority rec...

Out on PubMed, from researchers in Brescia and Novedrate, Italy, is this review article: Blues in the Brain and Beyond: Molecular Bases of Major Depressive Disorder and Relative Pharmacological and Non-Pharmacological Treatments. Maffioletti E, Minelli A, Tardito D, Gennarelli M. Genes (Basel). 2020 Sep 18;11(9):E1089. doi: 10.3390/genes11091089. PMID:  32961910 The abstract is copied below: Despite the extensive research conducted in recent decades, the molecular mechanisms underlying major depressive disorder (MDD) and relative evidence-based treatments remain unclear. Various hypotheses have been successively proposed, involving different biological systems. This narrative review aims to critically illustrate the main pathogenic hypotheses of MDD, ranging from the historical ones based on the monoaminergic and neurotrophic theories, through the subsequent neurodevelopmental, glutamatergic, GABAergic, inflammatory/immune and endocrine explanations, until the most recent evidence ...

Out on PubMed, from clinicians at Penn State University College of Medicine, is this case report: Recurrent Mania in an Adolescent with Velocardiofacial Syndrome and Treatment Challenges. Hasoglu T, Waxmonsky JG, Baweja R. Bipolar Disord. 2020 Sep 22. doi: 10.1111/bdi.12992. Online ahead of print. PMID:  32960492 The abstract is copied below: Patients with Velocardiofacial syndrome can present with recurrent mania in adolescence, and may have poor response and tolerability with conventional treatments. Complex and variable clinical manifestation and comorbidities can complicate the management and require multidisciplinary approach. Clinicians should consider ECT in the early stages of treatment along with mood stabilizers. This is a well-presented case report that deserves to be read in its entirety.  It describes a 16 y.o. male with Velocardiofacial Syndrome (DiGeorge Syndrome) and autism spectrum disorder who developed classic mania that was either quickly recurrent, or not ...

"Classics in ECT" brings you this LTE from The Lancet, in 1979: Efficacy of ECT Fink M. Lancet. 1979 Dec 15;2(8155):1303-4. doi: 10.1016/s0140-6736(79)92317-1. PMID:  93218   The pdf is here . And from the text of the letter: Sir, The peremptory question in your Oct. 27 editorial stimulates a different reply from the one you give. ECT has not been "until lately ... almost completely neglected by research workers". Evidence of its efficacy, changes in procedures to ensure greater safety, and many studies of the mechanism of action fill more than 1200 references in a recent review. …Some studies have examined the efficacy of seizure and non-seizure therapies. These have been criticised on methodological grounds, but I would criticise them as redundant andmissing the mark. The principal scientific issue today for ECT research is the mode of action, not the efficacy or the safety of convulsive therapy in depression and catatonia. In this letter (a response to the editor...

 "Classics in ECT" brings you this anonymous editorial from The Lancet in 1979: ECT ,  forty   years  on. [No authors listed] Lancet. 1979 Oct 27;2(8148):888-9. PMID:  90973 The pdf is here . Every contemporary ECT practitioner should read this editorial and be ashamed of the way Lancet editors (British psychiatry in general? (see the NICE reports)) have treated ECT over the years. The tone of this editorial is downright derogatory. No wonder Max Fink felt compelled to respond in the forceful way he did (see his response on tomorrow's blog).

Out on PubMed, from researchers in Belgium and The Netherlands, is this paper: Cognitive remediation following  electroconvulsive  therapy in patients with treatment resistant depression: randomized controlled trial of an intervention for relapse prevention - study protocol. Van de Velde N, Kappen M, Koster EHW, Hoorelbeke K, Tandt H, Verslype P, Baeken C, De Raedt R, Lemmens G, Vanderhasselt MA. BMC Psychiatry. 2020 Sep 16;20(1):453. doi: 10.1186/s12888-020-02856-x. PMID:  32938410 The abstract is copied below: Background:  Major depressive episode (MDE) is worldwide one of the most prevalent and disabling mental health conditions. In cases of persistent non-response to treatment, electroconvulsive therapy (ECT) is a safe and effective treatment strategy with high response rates. Unfortunately, longitudinal data show low sustained response rates with 6-month relapse rates as high as 50% using existing relapse prevention strategies. Cognitive side effects of ECT, eve...

"Classics in ECT" brings you this very early paper about succinylcholine use: Use of succinylcholine in E.C.T., with particular reference to its effect on blood pressure. ADDERLEY DJ,  HAMILTON M. Br Med J. 1953 Jan 24;1(4803):195-7. doi: 10.1136/bmj.1.4803.195. PMID:  13009136 The pdf is here . And from the text: With complete relaxation it is difficult to determine whether an adequate convulsive dose has been given. We have employed two methods for this purpose: (a) By noting the autonomic component of the cerebral discharge which constitutes the fit; the simplest observation is to look for dilatation of the pupils, and, particularly, injection of the conjunctivae. (b) As this method is not always accurate with ganglion-blocking agents we have devised a specific manceuvre to demonstrate the presence of the fit. Immediately before succinylcholine is injected a tourniquet or a sphygmomanometer cuff is fixed round the opposite arm. If this be kept tight enough to compress the ...

Out on PubMed, from researchers in Norway and the USA, is this study: Anterior cingulate gamma-aminobutyric acid concentrations and  electroconvulsive  therapy. Erchinger VJ, Miller J, Jones T, Kessler U, Bustillo J, Haavik J, Petrillo J, Ziomek G, Hammar Å, Oedegaard KJ, Calhoun VD, McClintock SM, Ersland L, Oltedal L, Abbott CC. Brain Behav. 2020 Sep 17:e01833. doi: 10.1002/brb3.1833. Online ahead of print. PMID:  32940003 The abstract is copied below: Objective:  The anticonvulsant hypothesis posits that ECT's mechanism of action is related to enhancement of endogenous anticonvulsant brain mechanisms. Results of prior studies investigating the role of the inhibitory neurotransmitter gamma-aminobutyric acid ("GABA+", GABA and coedited macromolecules) in the pathophysiology and treatment of depression remain inconclusive. The aim of our study was to investigate treatment-responsive changes of GABA+ in subjects with a depressive episode receiving electroconvulsive th...

Out on PubMed, from researchers in Portugal and Brazil, is this review: A medical algorithm for Cotard delusion based on more than 300 literature cases. Couto RAS, Moreira Gonçalves L. Int J Psychiatry Clin Pract. 2020 Sep 16:1-13. doi: 10.1080/13651501.2020.1819335. Online ahead of print. PMID:  32935595 The abstract is copied below: Objective:  Cotard delusion (CD) is a rare psychiatric disorder in which the patient believes to be dead,  i.e. , the patient holds nihilistic delusions concerning his/her own existence. Taking into account its rarity, and possible subdiagnosis due to unawareness, most of the literature consists of case studies, complicating a more systematic approach and leading to difficulties in deciding the best clinical guidance to offer the patient suffering from CD. The objective of this work is to review the literature and propose an algorithm to help the differential diagnosis and the management of this condition. Method:  To do so, an extensiv...