Clinical Neuroscience of ECT (CNECT)

Out on PubMed, from the team in Augusta, Georgia, is this study: Double-Blinded Randomized Pilot Clinical Trial Comparing Cognitive Side Effects of Standard Ultra-Brief Right Unilateral ECT to 0.5 A Low Amplitude Seizure Therapy (LAP-ST). Youssef NA, McCall WV, Ravilla D, McCloud L, Rosenquist PB. Brain Sci. 2020 Dec 13;10(12):E979. doi: 10.3390/brainsci10120979. PMID:  33322138 The pdf is here . And from the Introduction : In theory, LAP-ST can be helpful because of the direct effect of lower electric current, but the principal reason is that LAP-ST has a more focal electric field (EF) [ 34 , 35 ]. The current amplitude is the primary factor that drives the EF into brain regions located deeper in the brain and is responsible for cognition and memory such as the hippocampus and temporal lobe [ 33 , 35 ]. This extra focality of the EF can minimize or avoid high EF stimulation to the deeper hippocampal and temporal lobe regions [ 33 , 35 ]. Minimization of deeper stimulation by using...

Out on Pubmed, from researchers in Belgium and The Netherlands, is this study: Toward Targeted  ECT : The Interdependence of Predictors of Treatment Response in Depression Further Explained. van Diermen L, Poljac E, Van der Mast R, Plasmans K, Van den Ameele S, Heijnen W, Birkenhäger T, Schrijvers D, Kamperman A. J Clin Psychiatry. 2020 Dec 15;82(1):20m13287. doi: 10.4088/JCP.20m13287. PMID:  33326710 The abstract is copied below: Objective: Several clinical variables assumed to be predictive of electroconvulsive therapy (ECT) outcome in major depressive disorder show substantial interrelations. The current study tries to disentangle this interdependence to distill the most important predictors of treatment success to help improve patient-treatment matching. Methods: We constructed a conceptual framework of interdependence capturing age, episode duration, and treatment resistance, all variables associated with ECT outcome, and the clinical symptoms of what we coin core depress...

Out on PubMed, from investigators in Korea, is this review: Recent Updates on Electro-Convulsive Therapy ( ECT ) in Patients with Depression. Park MJ, Kim H, Kim EJ, Yook V, Chung IW, Lee SM, Jeon HJ. Psychiatry Investig. 2020 Dec 16. doi: 10.30773/pi.2020.0350. Online ahead of print. PMID:  33321557 The abstract is copied below: The pdf is here . This is a very standard literature review. Hopefully, it will reach a new audience, because of where it originates and where it is published. Despite some inaccuracies in reporting study results, it is generally helpful as an overview of selected aspects of the recent ECT literature. Worth a quick review (~5 minutes).

Out on PubMed are these guidelines for depression treatment from Australia and New Zealand: The 2020 Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines for Mood Disorders: Major Depression Summary. Malhi GS, Bell E, Singh A, Bassett D, Berk M, Boyce P, Bryant R, Gitlin M, Hamilton A, Hazell P, Hopwood M, Lyndon B, McIntyre RS, Morris G, Mulder R, Porter R, Yatham LN, Young A, Murray G. Bipolar Disord. 2020 Dec 15. doi: 10.1111/bdi.13035. Online ahead of print. PMID:  33320412 The abstract is copied below: Objectives:  To provide a succinct, clinically useful summary of the management of major depression, based on the 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (MDcpg 2020  ). Methods:  To develop the MDcpg 2020  , the mood disorders committee conducted an extensive review of the available literature to develop evidence-based recommendations (EBR) based on Natio...

 Out on Pubmed, from researchers in Warsaw, Poland, is this study: Efficacy, safety and tolerability of formula-based unilateral vs bilateral electroconvulsive therapy in the treatment of major depression: A randomized open label controlled trial. Dominiak M, Antosik-Wójcińska AZ, Goetz Z, Sikorska O, Stefanowski B, Gorostiza D, Święcicki Ł. J Psychiatr Res. 2020 Dec 4;133:52-59. doi: 10.1016/j.jpsychires.2020.12.002. Online ahead of print. PMID:  33310500 The abstract is copied below: Electroconvulsive therapy (ECT) remains the most effective treatment of depression, though it is still unclear which of its type is the most beneficial. The aim of this study was to compare the formula-based right unilateral ECT (RUL) with the fronto-temporal bilateral ECT (BT), in terms of their efficacy, safety and tolerability in patients with bipolar or unipolar depression. Ninety-one patients were randomly assigned to either BT (n = 45) or RUL (n = 46) ECT. Brief pulse width (0.5 ms) and a ...

"Classics in ECT" brings you this paper from researchers at the University of Michigan: Effect of   hyperventilation   on seizure length during electroconvulsive therapy. Pande AC, Shea J, Shettar S, Grunhaus LJ, Haskett RF. Biol Psychiatry. 1990 Apr 1;27(7):799-801. doi: 10.1016/0006-3223(90)90597-u. PMID:   2109642   The pdf is here . And from the text: Comparison of seizure length showed that the lowest pCO2 group had the longest first seizure among the 3 groups. Within the series of 5 treatments in each group the first seizure was the longest as well. Seizure length declined precipitously by the second treatment, and subsequent treatments were indistinguishable for seizure length either among or within groups. ...There are major methodological differences between this study and Bergsholm et al. (1984), thus making a comparison of results difficult. These authors intubated all patients, used etomidate as the anesthetic agent, and crossed patients from hyper- to n...

"Classics in ECT" brings you this Acta paper from Norwegian investigators: Seizure duration in unilateral electroconvulsive therapy. The effect of hypocapnia induced by hyperventilation and the effect of ventilation with oxygen. Bergsholm P, Gran L, Bleie H. Acta Psychiatr Scand. 1984 Feb;69(2):121-8. doi: 10.1111/j.1600-0447.1984.tb02475.x. PMID:  6422704 The abstract is copied below: Seizure duration in unilateral electroconvulsive therapy (ECT) was recorded by means of EEG in an intraindividual comparison under different alveolar O2- and CO2-concentrations. Hypocapnia induced by hyperventilation to an alveolar CO2-concentration of 2% (2 kPa) resulted in a highly significant increase in seizure duration compared to a normal CO2 of 5%, when the alveolar O2-concentration was constant at 92%. Oxygen ventilation to an alveolar O2-concentration of 92% gave no significant increase in seizure duration compared to 15%, obtained by ventilation with air, when the CO2-concentration wa...

 "Classics in ECT" brings you this study from Creedmore State Hospital in 1949: Nonconvulsive biochemotherapy with histamine and electric convulsive therapy; a comparative study on hospitalized psychotics with a control  ECT  series. SACKLER AM, SACKLER MD, SACKLER RR. J Nerv Ment Dis. 1949 Sep;110(3):185-97. doi: 10.1097/00005053-194911030-00001. PMID:  18138865 The pdf is here . I originally choose this article as the earliest in PubMed to use the name, "ECT," although it also uses "electric [sic] convulsive therapy."  The very first PubMed "ECT" citation is from 1947, but it is written "E.C.T." and also reports a complication, so we prefer this one. Nomenclature aside, this turns out to be an interesting read, with what would now be considered a somewhat bizarre study comparing histamine therapy with ECT. Among the interesting details are the inclusion of a couple of patients with postpartum psychosis and the observation that longer ...

Out on PubMed, from researchers in  Chongqing, China, is this study: Subanesthetic dose of ketamine for the antidepressant effects and the associated cognitive impairments of electroconvulsive therapy in elderly patients-A randomized, double-blind, controlled clinical study. Zou L, Min S, Chen Q, Li X, Ren L. Brain Behav. 2020 Dec 11:e01775. doi: 10.1002/brb3.1775. Online ahead of print. PMID:  33305900 The abstract is copied below: Objectives: We previously confirmed that low-dose ketamine, as an adjunctive anesthetic for electroconvulsive therapy (ECT) in adult patients with depression, accelerates the effects of ECT and reduces the ECT-induced learning and memory deficits. This study explored the efficacy and safety of low-dose ketamine in elderly patients with depression. Methods: Elderly patients with depression (N = 157) were randomly divided into two groups: propofol anesthesia group (group P) and propofol combined with ketamine anesthesia group (group KP). Patients in ...

"Classics in ECT" brings you this remarkably insightful essay on the origins of prejudice against ECT by Dr. Max Fink in 1997. The pdf is here . And from the text: And this conclusion: In this essay, Dr. Fink carefully traces the origins of the stigma and prejudice surrounding ECT, by reviewing the history of American psychiatry since World War II. He describes the impact of the "Group for the Advancement of Psychiatry" and the competing struggles between psychodynamics, psychopharmacology and somatic treatments. This may be the best explanation ever written of all the factors that have gone into the needlessly tarnished reputation and "controversy" that follow ECT to the present day.  This is a must-read in its entirety (about 20 minutes).

Out on PubMed, from investigators in The Netherlands, is this study: Is ketamine an appropriate alternative to  ECT  for patients with treatment resistant depression? A systematic review. Veraart JKE, Smith-Apeldoorn SY, Spaans HP, Kamphuis J, Schoevers RA. J Affect Disord. 2020 Nov 30;281:82-89. doi: 10.1016/j.jad.2020.11.123. Online ahead of print. PMID:  33307338   The abstract is copied below: Objective: Ketamine has repeatedly shown to have rapid and robust antidepressant effects in patients with treatment resistant depression (TRD). An important question is whether ketamine is as effective and safe as the current gold standard electroconvulsive therapy (ECT). Methods: The literature was searched for trials comparing ketamine treatment with ECT for depression in the Pubmed/MEDLINE database and Cochrane Trials Library. Results: A total of 137 manuscripts were identified, 6 articles were included in this review. Overall quality of the included studies was diverse ...

Out on PubMed, from a group of TRD experts, is this paper: Management of Treatment-Resistant Depression in Real-World Clinical Practice Settings Across Asia. Wang G, Han C, Liu CY, Chan S, Kato T, Tan W, Zhang L, Feng Y, Ng CH. Neuropsychiatr Dis Treat. 2020 Dec 3;16:2943-2959. doi: 10.2147/NDT.S264813. eCollection 2020. PMID:  33299316   The abstract is copied below: Purpose: Consensus is lacking on the management of treatment-resistant depression (TRD), resulting in significant variations on how TRD patients are being managed in real-world practice. A survey explored how clinicians managed TRD across Asia, followed by an expert panel that interpreted the survey results and provided recommendations on how TRD could be managed in real-world clinical settings. Methods: Between March and July 2018, 246 clinicians from Hong Kong, Japan, Mainland China, South Korea, and Taiwan completed a survey related to their treatment approaches for TRD. Results: The survey showed physici...

"Classics in ECT" brings you this paper from the British Journal of Psychiatry in 1992: Audit of  electroconvulsive  treatment in two national health service regions. Pippard J. Br J Psychiatry. 1992 May;160:621-37. doi: 10.1192/bjp.160.5.621. PMID:  1591572 The abstract is copied below: The practice of ECT has been surveyed by visits to all 35 NHS hospitals and five private clinics where it is used in the North East Thames and East Anglian Regions, and observation of ECT administration in 29 NHS and two private clinics. Since 1981 there has been much improvement in the physical conditions in which ECT is given and in anaesthetic practice. Nursing is good or excellent in a majority. About half the clinics have the most effective Ectron constant-current series 5 apparatus; the rest have older models with which 'missed' fits and undertreatment are frequent. Stimulus-dosing is usually by habit rather than rational strategy, and routine instrument settings differ fourfold...

  "Classics in ECT" brings you this 1987 paper from renowned researchers at the NIMH : Differential time course of antidepressant effects after sleep deprivation, ECT, and carbamazepine: clinical and theoretical implications. Post RM,  Uhde TW , Rubinow DR, Huggins T. Psychiatry Res. 1987 Sep;22(1):11-9. doi: 10.1016/0165-1781(87)90045-x. PMID:  3659217 The abstract is copied below: The pattern and time course of antidepressant response to different treatment modalities provide important clinical information and hints about underlying neurobiological mechanisms. Depressed patients who responded to 1 night's sleep deprivation (11 of 33 patients) showed maximal improvement on day 1 and deterioration in mood thereafter. In contrast, slower onset and more sustained effects were observed following carbamazepine (12 of 37) or electroconvulsive therapy (ECT) (8 of 8). Nearly maximal improvement required about 2 weeks for ECT and 3 weeks for carbamazepine. Possible differential o...

  Electroconvulsive  therapy in an adolescent patient with catatonia: a case report. Clermont A, Loubriel D, Li E, Mitera D, Samuels S. Neurocase. 2020 Dec 9:1-4. doi: 10.1080/13554794.2020.1859545. Online ahead of print. PMID:  33297838 The abstract is copied below: Catatonia is characterized by motor and behavioral symptoms and can arise in a wide variety of medical and psychiatric conditions. We describe the case of a 16-year-old female with a history of anxiety and depression who presented with prominent symptoms of negativism, initially diagnosed as conversion disorder. She failed to respond to increasing doses of benzodiazepines; after over six weeks of hospitalization, she received electroconvulsive therapy (ECT), resulting in significant remission of symptoms. This case demonstrates the importance of prompt diagnosis and treatment of catatonia in adolescent patients, as well as the safety and efficacy of ECT in this population. Abbreviations: AACAP: American Acade...