Clinical Neuroscience of ECT (CNECT)

Out on PubMed, from investigators in Thailand, is this study: Prevalence and Predictors of Postictal Confusion After Electroconvulsive Therapy. Ittasakul P, Jarernrat P, Tor PC. Neuropsychiatr Dis Treat. 2021 Feb 2;17:283-289. doi: 10.2147/NDT.S281961. eCollection 2021. PMID:  33564234   The abstract is copied below: Objective: To investigate the prevalence and predictors of postictal confusion (PIC) in patients who received electroconvulsive therapy (ECT). Methods: We conducted chart reviews for 79 patients who were receiving inpatient ECT. Subjects with PIC were identified. PIC was defined by confusion, disorientation, motor restlessness, purposeless movement, and nonresponse to verbal commands following ECT within an hour, intravenous benzodiazepine was necessary to manage disturbed behavior. Multivariable logistic regression analysis was used to examine the association of PIC with demographic and clinical variables. Results: Prevalence of PIC was 36.7%. In 912 ECT sessions...

"Classics in ECT" brings you this study from the British Journal of Psychiatry in 1981: Lithium continuation therapy following electroconvulsive therapy. Coppen A, Abou-Saleh MT, Milln P, Bailey J, Metcalfe M, Burns BH, Armond A. Br J Psychiatry. 1981 Oct;139:284-7. doi: 10.1192/bjp.139.4.284. PMID:  6799032   The abstract is copied below: Thirty-eight depressed patients who were treated with ECT were randomly assigned to receive lithium therapy or identical-looking placebo tablets for one year after clinical recovery in a double-blind trial. The patients who received placebo tablets spent an average of 7.8 weeks with an episode of depression (either as in-patients or day-patients) during the year. In comparison, patients who received lithium spent on average 1.7 weeks with an episode (P less than 0.02). The trial confirms the high rate of relapses after ECT and suggests that lithium considerably reduces this morbidity. It is suggested that ECT without continuation therapy is...

"Classics in ECT" brings you this paper from 1979: Treatment of unipolar depression following electroconvulsive therapy. Relapse rate comparisons between lithium and tricyclics therapies following ECT. Perry P, Tsuang MT. J Affect Disord. 1979 Jun;1(2):123-9. doi: 10.1016/0165-0327(79)90031-4. PMID:  162494 The pdf is here . And from the text: And from the "Discussion": Therefore, one of the expected benefits in treating depression with ECT followed by either tricyclic or lithium prophylaxis may well be the decreased risk of suicide and suicide attempts among such patients. This is a small retrospective study (total n=54, (34 TCA, 20 lithium)) demonstrating good post-ECT relapse prevention with pharmacotherapy, either a tricyclic antidepressant or lithium. This is the earliest such lithium data found by Lambrichts et al. in their recent Acta Psychiatrica Scandinavica meta-analysis of post-ECT lithium prophylaxis. The mention of  citations of maintenance ECT from the...

Out on PubMed, from researchers in Bengaluru, India, is this paper: Resting State Functional Connectivity of Brain With Electroconvulsive Therapy in Depression: Meta-Analysis to Understand Its Mechanisms. Sinha P, Joshi H, Ithal D. Front Hum Neurosci. 2021 Jan 21;14:616054. doi: 10.3389/fnhum.2020.616054. eCollection 2020. PMID:  33551779 The abstract is copied below: Introduction: Electroconvulsive therapy (ECT) is a commonly used brain stimulation treatment for treatment-resistant or severe depression. This study was planned to find the effects of ECT on brain connectivity by conducting a systematic review and coordinate-based meta-analysis of the studies performing resting state fMRI (rsfMRI) in patients with depression receiving ECT. Methods: We systematically searched the databases published up to July 31, 2020, for studies in patients having depression that compared resting-state functional connectivity (rsFC) before and after a course of pulse wave ECT. Meta-analysis was per...

Out on Pubmed, from clinicians in The Netherlands, is this case report:  Successful electroconvulsive therapy for depression in a man with cerebral amyloid angiopathy. Schurgers G, Arts BMG, Postma AA, de Kort A. BMJ Case Rep. 2021 Feb 5;14(2):e238922. doi: 10.1136/bcr-2020-238922. PMID:  33547125 The pdf is here . I approached this case report with ennui and some disdain, but ended up being totally impressed with its high quality and sophistication. The clinical care and medical investigations were state of the art; the teaching points are all well taken. This case adds to the considerable body of evidence that ECT remains safe and effective despite the presence of certain common brain pathologies of aging. The sensible approach used to limit intra-procedural hemodynamic changes in a patient with prior intracerebral hemorrhage is what most practitioners would do. The discussion in the case report is also excellent, including the fascinating theoretical speculation that E...

Out on PubMed,in Psychiatric Clinics of North America, are these two related reviews: Catatonia in Patients with Autism Spectrum Disorder.      Ghaziuddin N, Andersen L, Ghaziuddin M.      Psychiatr Clin North Am. 2021 Mar;44(1):11-22. doi: 10.1016/j.psc.2020.11.002.      PMID:  33526232   Review. Use of Electroconvulsive Therapy in Autism. Park SE, Grados M, Wachtel L, Kaji S. Psychiatr Clin North Am. 2021 Mar;44(1):23-33. doi: 10.1016/j.psc.2020.11.003. PMID:  33526235 These are both scholarly reviews with obviously overlapping content. They are comprehensive and well-referenced. Neera Ghaziuddin and Lee Wachtel are preeminent child psychiatrists, who have championed the use of ECT in children and adolescents, particularly for catatonia in autism. In the Park et al. paper, the use of ECT in autism is discussed as exclusively for catatonia (self-injurious behaviors are conceptualized as a form of catatonia), but not targe...

Out on PubMed is this editorial: Electroconvulsive  Therapy: Still The Gold Standard for Highly Treatment-Resistant Mood Disorders. Goldberg JF. CNS Spectr. 2021 Feb 1:1-7. doi: 10.1017/S1092852921000110. Online ahead of print. PMID:  33517939 The pdf is here . And from the text: As the progenitor of newer modalities of brain stimulation, ECT is neither experimental nor innovative. It has long been regarded as an established gold standard treatment for severe and/or treatment-resistant mood and psychotic disorders. In major depression, ECT exerts a large effect size and superiority to pharmacotherapy (effect size ̴0.80). It is demonstrably more effective than antidepressant pharmacotherapy for reducing suicide attempts or completions. And despite transient retrograde amnestic effects, ECT improves verbal memory and other elements of cognitive dysfunction associated with treatment-resistant depression. ...For practitioners who routinely consult on severe, pan-refractory mood di...

Out on PubMed, from 2 psychiatrists at the University of California,Riverside, is this editorial: Should Electroconvulsive Therapy ( ECT ) be Banned for Schizophrenia? Cummings MA, O'Day JA. CNS Spectr. 2021 Feb 1:1-12. doi: 10.1017/S1092852921000109. Online ahead of print. PMID:  33517952   The pdf is here . and from the text: In conclusion, Read, et al identified methodological flaws in eleven studies of ECT for depression and five related meta-analyses which evaluated 1 to 7 of these studies. Based on their findings, they called for better-designed, more rigorous studies of ECT , as well as immediate suspension of ECT use. While improved research and data are always a worthy goal in medicine and psychiatry, the call for suspension of ECT use ignores decades of data supporting the efficacy of ECT and also ignores a number of different lines of data indicating ECT as effective in a variety of clinical circumstances, including treatment and clozapine- resistant schizoph...

Out on PubMed, from researchers in Belgium, is this paper:  The Leuven late life depression (L3D) study: PET-MRI biomarkers of pathological brain ageing in late-life depression: study protocol. Emsell L, Laroy M, Van Cauwenberge M, Vande Casteele T, Vansteelandt K, Van Laere K, Sunaert S, Van den Stock J, Bouckaert F, Vandenbulcke M. BMC Psychiatry. 2021 Jan 28;21(1):64. doi: 10.1186/s12888-021-03063-y. PMID:  33509135 The abstract is copied below: Background: Major depressive disorders rank in the top ten causes of ill health in all but four countries worldwide and are the leading cause of years lived with disability in Europe (WHO). Recent research suggests that neurodegenerative pathology may contribute to the development of late-life depression (LLD) in a sub-group of patients and represent a target for prevention and early diagnosis. In parallel, electroconvulsive therapy (ECT), which is the most effective treatment for severe LLD, has been associated with significant bra...

"Classics in ECT" brings you this study from 1982 from researchers at Cornell in New York City: Psychotic vs. nonpsychotic depression: comparison of treatment response. Brown RP ,  Frances A , Kocsis JH, Mann JJ. J Nerv Ment Dis. 1982 Oct;170(10):635-7. doi: 10.1097/00005053-198210000-00008. PMID:  6125562   The abstract is copied below: This retrospective study compared the treatment responses of 34 primary, unipolar depressives without psychotic features and 30 with psychotic features. Patients were diagnosed by Research Diagnostic Criteria and received trials of tricyclic antidepressants, antipsychotics, the combination of the two, electroconvulsive therapy, or placebo and psychotherapy. Only three of 18 psychotic patients vs. 17 of 23 nonpsychotic patients responded to antidepressants alone. Electroconvulsive therapy and the combination of antipsychotic and antidepressant medication gave better responses. These data suggest that major depressive disorder with psychoti...

Out on PubMed, from clinicians in Korea, is this case report: Resolution of Persistent Auditory Verbal Hallucinations after Long-term Electroconvulsive Therapy Maintenance: A Case Report of a Patient with Clozapine-resistant Schizophrenia. Chung IW, Kim HS, Kim JH, Jang JH, Kim YS. Clin Psychopharmacol Neurosci. 2021 Feb 28;19(1):170-173. doi: 10.9758/cpn.2021.19.1.170. PMID:  3350880 The abstract is copied below: A 32-year-old woman with schizophrenia and persistent auditory verbal hallucinations (AVHs), which caused continuous suicidal thoughts and depression, was treated with electroconvulsive therapy (ECT) of an acute course followed by maintenance ECT (M-ECT) augmented onto clozapine for 7 years. Although the general psychopathology and AVHs initially reduced slightly with ECT and clozapine, her AVHs and suicidal thoughts did not decrease subjectively. When 3 years of M-ECT, her voices declined sharply, and improvement was maintained for 2 years thereafter. A total 91 ECT sess...

 Out on PubMed, from researchers in Belgium and Sweden, is this systematic review and meta-analysis: Does lithium prevent relapse following successful electroconvulsive therapy for major depression? A systematic review and meta-analysis. Lambrichts S, Detraux J, Vansteelandt K, Nordenskjöld A, Obbels J, Schrijvers D, Sienaert P. Acta Psychiatr Scand. 2021 Jan 28. doi: 10.1111/acps.13277. Online ahead of print. PMID:  33506961 The abstract is copied below: Objective: The risk of relapse following successful antidepressant treatment, including electroconvulsive therapy (ECT), is substantial. Lithium has been suggested to effectively prevent relapse, yet data remain limited and inconclusive. We performed a systematic review and meta-analysis to examine the efficacy of continuation treatment with lithium in preventing relapse following a successful acute course of ECT in patients with major depression, in comparison to continuation treatment without lithium. We also assessed the r...

 Out on PubMed, from clinicians in Montana, is this case report: Successful bilateral  electroconvulsive  therapy in a patient with a seizure disorder taking levetiracetam, lorazepam, and zonisamide: A case report. McGrane IR, Tenison RE, Bimler DM, Munjal RC, Molinaro JR. Ment Health Clin. 2021 Jan 8;11(1):23-26. doi: 10.9740/mhc.2021.01.023. eCollection 2021 Jan. PMID:  33505822 The abstract is copied below: Electroconvulsive therapy (ECT) may be considered for treatment of severe, treatment-resistant, and emergent depression associated with MDD or bipolar disorder. Patients with epilepsy usually take medications that raise the seizure threshold, which poses challenges during ECT. We report a 66-year-old male with epilepsy taking levetiracetam extended-release (XR), lorazepam, and zonisamide requiring ECT for severe MDD. After literature review, the XR form of levetiracetam was changed to higher doses of the immediate-release (IR) formulation, and zonisamide was di...

Out on PubMed, from investigators in France, is this review: Cytokines changes associated with electroconvulsive therapy in patients with treatment-resistant depression: a Meta-analysis. Gay F, Romeo B, Martelli C, Benyamina A, Hamdani N. Psychiatry Res. 2021 Jan 16;297:113735. doi: 10.1016/j.psychres.2021.113735. Online ahead of print. PMID:  33497973   Review. The abstract is copied below: One third of depressive patients do not achieve remission after several steps of treatment and are considered as treatment resistant. Electroconvulsive therapy (ECT) improves symptoms in 70 to 90% of such cases. Resistant depression is associated with a dysregulation of the immune system with a dysbalance between the pro- and the anti-inflammatory cytokines. Therefore, we aimed to measure the kinetic of cytokines levels before, during and at the end of ECT. To test this hypothesis, we performed a meta-analysis assessing cytokines plasma levels before, during and after ECT in patients with ...

Out on PubMed, from clinicians in Aarhus, Denmark, is this case report:  [ ECT  in autoimmune encephalitis]. Waaler HO, Harbo T. Ugeskr Laeger. 2021 Jan 18;183(3):V09200703. PMID:  33491641   Danis h. The abstract is copied below: In this case report, a 27-year-old male presented at a department of neurology with postherpetic anti-N-methyl-d-aspartate (NMDA) receptor autoimmune encephalitis. The patient was psychotic and exhibited symptoms of akinetic and excited catatonia. He was mechanical restrained for a total of 46 days due to violent behaviour. He was treated with olanzapine and lorazepam up to 15 mg/day without effect on catatonic and behavioural symptoms. ECT was initiated, and the patient received a total of 16 treatments. He responded well to the treatment, and the violent behaviour resolved completely after the first treatment. ECT should be considered for catatonia in anti-NMDA-receptor autoimmune encephalitis. The pdf is here . (in Danish) This patient ...

"Classics in ECT" brings you this this study from 1964  from California: PREDICTION OF SHORT-TERM OUTCOME OF ELECTROCONVULSIVE THERAPY. GONDA TA. J Nerv Ment Dis. 1964 Jun;138:587-94. PMID:  14165148   The pdf is here . ============================== This paper reports on 50 patients who got ECT in a 4,000-bed (!) state hospital in San Jose, California. It looks at the predictive value of three measures: 1) the "methacholine-epinephrine" (Funkenstein) test 2)  the MMPI Prognosis scale (52-item) 3) clinical prognosis (as judged by the treating MD) "Clinical prognosis" (#3) was the clear winner, and the clinical predictors of ECT response listed above (in the discussion) have, remarkably, stood the test of time; a current list would be largely the same. The Funkenstein test now seems ridiculous, but hindsight is 20/20...Interestingly, it seems that its predictive value may merely have been due to the correlation between blood pressure changes and age. The be...