ECT for Melancholia: Case Report and Symptom Time Course Analysis
Out on PubMed is this case report from clinicians in Portugal:
Bottom-up neuroanatomical pattern of symptom remission in melancholic depression after electroconvulsive therapy: a case report and literature review.
Psychogeriatrics. 2021 Jan 12. doi: 10.1111/psyg.12654. PMID: 33438326
...we hypothesize that
the amelioration of symptoms occurs, preferentially,
from the reptilian to the mammalian and finally to
the neomammalian brain (Topic S9), according to a
phylogenetic viewpoint
This is straightforward, typical case presentation of psychotic depression, but the analysis of the time course of resolution of different symptoms is particularly interesting. The above graphic (Figure 1) shows this extremely clearly.
The idea that certain symptoms resolve quickly with ECT, while others lag, is, of course nothing new. This clinical wisdom is reflected in the saying, "the patient is the last to know" (that they are getting better). Vegetative symptoms often resolve after one or two treatments, and family members see this, but subjective mood may take considerably longer.
I have never before heard this described as "a bottom-up neuroanatomical pattern of symptom remission...from the reptilian to the mammalian and finally to the neomammalian brain." I give these authors kudos for this highly innovative and vivid description.
This report also has some interesting reflections on the diagnosis of melancholia. (With only 5 references, it is certainly not, however, a "literature review.")
I encourage a full read of this article (~8 minutes).
(note:Psychogeriatrics is the official journal of the Japanese Psychogeriatric Society)
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