Clinical Neuroscience of ECT (CNECT)

Out on PubMed, in JECT, from Dr. Max Fink, is this paper: Random Controlled Trial of Sham Electroconvulsive Therapy and Other Novel Therapies: Historical Notes. Fink M. J ECT. 2021 Mar 4. doi: 10.1097/YCT.0000000000000759. Online ahead of print. PMID:  33661180 The abstract is copied below: Critics of electroconvulsive therapy argue that the treatment's efficacy is unproven by random controlled trial comparisons with sham treatments. Their reviews fail to consider sham and random controlled trial studies completed in 1950s, the data republished here. and a table and the Discussion: In this historical review, Dr. Fink responds to the recent attack on the ECT evidence base by well-known anti-ECT agitator, British psychologist, John Read. Dr. Fink describes in detail the research and clinical operation at Hillside Hospital in New York in the 1950s. The data from a 54-patient study, overlooked in recent reviews of the sham-controlled ECT literature, are republished here, summarized in ...

https://news.wttw.com/2021/02/24/hell-and-back-chicago-musician-recovers-severe-depression https://news.wttw.com/2021/02/24/hell-and-back-chicago-musician-recovers-severe-depression   This is a very positive ECT story, sent to me by a friend. The video is 6.5 minutes long. It tells a typical ECT story of recovery from severe late-life depression. The only slightly negative "notes" are the intimation that Mr. Helfer can't play the piano anymore because of ECT (dispelled nicely when he sits down at the keyboard and plays fluidly) and the anchor's asking viewers at the end for ECT experiences, "good, or bad". That journalistic "balance" thing, again. Other musicians who recovered from melancholia with ECT were the New York Philharmonic timpanist, Roland Kohloff, and the renowned pianist, Vladimir Horowitz. (Please see blog post of August 15, 2020) Some practitioners might consider this video useful as part of their patient information library. Definit...

Out on PubMed, from investigators in Singapore and Australia, is this study: Association of Anaesthesia- ECT  time interval with  ECT  clinical outcomes: A retrospective cohort study. Tan XW, Tor PC, Martin D, Loo C. J Affect Disord. 2021 Feb 19;285:58-62. doi: 10.1016/j.jad.2021.02.038. Online ahead of print. PMID:  33636671 The abstract is copied below: Aim: To examine the association of the anaesthesia to ECT stimulus TI (anaesthesia-ECT TI) with efficacy and cognitive outcomes after ECT treatment. Methods: Retrospective cohort study of 690 patients who received ECT from July 2017 till December 2019. Generalized linear regression was utilized to analyse the association of mean anaesthesia-ECT TI (from session 2 to session 6 ECT treatment) with Clinical Global Impression-Severity scale (CGI-S) scores and Montreal Cognitive Assessment (MoCA) score after 6 ECT treatments, and with EEG quality during the treatments (post ictal suppression scores). Results: The average...

Out on PubMed, from researchers in Lund, Sweden, is this animal study: The effect of electroconvulsive therapy on neuroinflammation, behavior and amyloid plaques in the 5xFAD mouse model of Alzheimer's disease. Svensson M, Olsson G, Yang Y, Bachiller S, Ekemohn M, Ekstrand J, Deierborg T. Sci Rep. 2021 Mar 1;11(1):4910. doi: 10.1038/s41598-021-83998-0. PMID:  33649346   The abstract is copied below: Microglial cells are affected in Alzheimer's disease (AD) and interact with amyloid-beta (Aβ) plaques. Apart from memory loss, depression is common in patients with AD. Electroconvulsive therapy (ECT) is an anti-depressive treatment that may stimulate microglia, induce neuroinflammation and alter the levels of soluble Aβ, but the effects of ECT on microglia and Aβ aggregation in AD are not known. We investigated the short- and long-term effects of ECT on neuroinflammation and Aβ accumulation. 5xFAD mice received either electroconvulsive stimulation (ECS n = 26) or sham treatment (n...

 Out on PubMed, from researchers in California, Missouri, and Michigan, is this study: Postictal generalized electroencephalographic suppression following electroconvulsive therapy: Temporal characteristics and impact of anesthetic regimen. Hickman LB, Kafashan M, Labonte AK, Chan CW, Huels ER, Guay CS, Guan MJ, Ching S, Lenze EJ, Farber NB, Avidan MS, Hogan RE, Palanca BJA. Clin Neurophysiol. 2021 Jan 28;132(4):977-983. doi: 10.1016/j.clinph.2020.12.018. Online ahead of print. PMID:  33652270 The abstract is copied below: Objective: Postictal generalized electroencephalographic suppression (PGES) has been defined as electroencephalographic (EEG) activity of less than 10 microvolts following a generalized seizure. PGES is associated with an increased risk of sudden unexplained death in epilepsy, as well as treatment efficacy of electroconvulsive therapy (ECT). We investigated the impact of anesthetic on PGES expression and temporal characteristics. Methods: We recorded postict...

Out on PubMed,, from colleagues in Poland and Hungary, is this paper: Changes in the Practice of  Electroconvulsive  Therapy in Poland: A Nationwide Survey Comparing Data Between 2005 and 2020. Antosik-Wójcińska AZ, Dominiak M, Mierzejewski P, Jażdżyk P, Gazdag G, Takacs R, Wichniak A. Neuropsychiatr Dis Treat. 2021 Feb 22;17:605-612. doi: 10.2147/NDT.S296210. eCollection 2021. PMID:  33654402 The abstract is copied below: Background: The use and the characteristics of the practice of electroconvulsive therapy (ECT) in Poland have not been evaluated since 2005, when a nationwide survey revealed its rare utilization (0.11 patients/10,000 inhabitants/year). The aims of this study were to determine the current use of ECT and to compare the findings with those of the previous survey. Methods: Two questionnaires were sent to all 48 inpatient psychiatric centers in Poland. The first one - to units providing ECT to explore its practice, and the second - to units not performing E...

Out on PubMed, from clinicians at UNC, Chapel Hill, NC, is this case report: Transient Febrile Episodes After  Electroconvulsive  Therapy (ECT). Belson C, Register S, Bedford J. J ECT. 2021 Feb 19. doi: 10.1097/YCT.0000000000000751. Online ahead of print. PMID:  33625178 And from the text: Although previous cases have noted febrile episodes with associated laboratory changes secondary to ECT treatment, this appears to be the only one for which ECT treatments were not discontinued. It should be noted that the patient did miss 1 scheduled ECT treatment because of a pending COVID-19 test result, per hospital policy at that time. This report supports previous evidence that ECT can be a possible etiology of fevers and indicates that pausing ECT may not be necessary in a patient with a negative infectious workup. Other possible etiologies for the fevers in this case should be considered, such as propofol, used for sedation. One episode of fever did occur on a day without ECT, w...

Out on PubMed, from investigators in Vancouver, Canada, is this study: Psychiatric, Motor, and Autonomic Effects of Bifrontal ECT in Depressed Parkinson'sDisease Patients. Rodin I, Sung JH, Appel-Cresswell S, Chauhan H, Smith K, Vila-Rodriguez F, Ainsworth NJ. J Neuropsychiatry Clin Neurosci. 2021 Feb 25:appineuropsych20050133. doi: 10.1176/appi.neuropsych.20050133. Online ahead of print. PMID:  33626885 The abstract is copied below: Objective: Depressive symptoms are a source of significant morbidity in Parkinson's disease (PD). Electroconvulsive therapy (ECT) is a promising treatment for depression in PD (dPD); however, data remain limited, including data on optimal electrode placement. In this retrospective study, the investigators aimed to characterize the effects of bifrontal ECT for dPD on psychiatric and motor symptoms, as well as autonomic response. Methods: Clinical data were retrieved from a university-affiliated ECT service in Vancouver, British Columbia, for patient...

 Out on PubMed, from researchers at the Medical College of Georgia at Augusta University, is this case report: Safe Administration of ECT in a Suicidal Patient With a Space-Occupying Astrocytoma. Youssef NA, Casola B, Rosenquist PB, McCall WV, Spearman V. J ECT. 2021 Feb 19. doi: 10.1097/YCT.0000000000000749. Online ahead of print. PMID:  33625177 The abstract is copied below: Electroconvulsive therapy (ECT) can be lifesaving for patients suffering from treatment-resistant psychiatric conditions, especially acute suicidality or depression. However, space-occupying lesions pose risks associated with ECT use due in part to seizure-induced escalations in blood pressure with corresponding increases in cerebral blood flow and possibly intracranial pressure, subsequently increasing the risk of brain herniation. Here, we present the case of a patient with a left medial temporal lobe astrocytoma, worsening epileptic seizures, and nonepileptic seizures who underwent ECT for major depre...

Out on PubMed, in JECT, is this paper: Trends for  Electroconvulsive  Therapy Utilization in Children and Adolescents in the United States From 2002 to 2017: A Nationwide Inpatient Sample Analysis. Trivedi C, Motiwala F, Mainali P, Mansuri Z, Jain S. J ECT. 2021 Feb 19. doi: 10.1097/YCT.0000000000000750. Online ahead of print. PMID:  33625175 The abstract is copied below: Objectives: Electroconvulsive therapy (ECT) is controversial in children and adolescents (C/A). The primary objective of this study was to evaluate baseline characteristics of C/A in the utilization of ECT compared with the non-ECT group with the same primary indication. The secondary objective was to assess the trends in ECT utilization over 16 years and explore the predictors of length of stay. Methods: Using the Nationwide Inpatient Sample database from the years 2002 to 2017, we identified patients (age ≤18 years) undergoing ECT in the United States using International Classification of Diseases, Nin...

Out on PubMed, from researchers in Japan, is this study: Association of  electroconvulsive  therapy-induced structural plasticity with clinical remission. Takamiya A, Kishimoto T, Hirano J, Kikuchi T, Yamagata B, Mimura M. Prog Neuropsychopharmacol Biol Psychiatry. 2021 Feb 20:110286. doi: 10.1016/j.pnpbp.2021.110286. Online ahead of print. PMID:  33621611 The abstract is copied below: Background: Electroconvulsive therapy (ECT) is the most effective treatment for severe depression. Recent neuroimaging studies have consistently reported that ECT induces volume increases in widely distributed brain regions. However, it still remains unclear about ECT-induced volume changes associated with clinical improvement. Methods: Longitudinal assessments of structural magnetic resonance imaging were conducted in 48 participants. Twenty-seven elderly melancholic depressed individuals (mean 67.5 ± 8.1 years old; 19 female) were scanned before (TP1) and after (TP2) ECT. Twenty-one healt...

"Classics in ECT" brings you this study from the British Journal of Psychiatry in 1973: Prediction  of clinical response to ECT. Abrams R, Fink M, Feldstein S. Br J Psychiatry. 1973 Apr;122(569):457-60. doi: 10.1192/bjp.122.4.457. PMID:  4718282   The pdf is here . This study from the early 1970s was an attempt to replicate  three previously published methods for "calculating an index for prediction of response to ECT" in depressed patients. The results were completely negative. None of those methods has survived, and nothing has really replaced them. The evolution of research in ECT response prediction is fascinating. The fact that we have not achieved perfect accuracy is both frustrating and expected in such a complex clinical situation. Of course, since ECT works so well, it makes the need for precision less urgent; most "seriously ill" depressed patients will get well with ECT, as will almost all patients with catatonia. The clinical profile of likely ...

Classics in ECT brings you this article from the Archives of General psychiatry in 1976: Schizophrenia--a follow-up study of results of treatment. May PR , Tuma AH, Yale C, Potepan P, Dixon WJ. Arch Gen Psychiatry. 1976 Apr;33(4):481-6. doi: 10.1001/archpsyc.1976.01770040047009. PMID: 938185 The pdf is here . and from the text: Patients who had been treated initially with ECT or with drug therapy showed a trend towards spending less time in hospital after their release, a delayed post hospital advantage above and beyond the initial advantages of higher release rate, speedier release, lessened cost of treatment, and better global condition at the time of release as reported earlier. ..These beneficial effects from drug therapy and ECT are less marked if one considers only those patients whose treatment was declared to be a success. There were, however, far more successes among the drug- and ECT treated patients than in the other groups (95% to 96% of the drug alone and drug plus psychot...

Out on Pubmed, from researchers in several European countries, is this paper: Temporal trajectory of brain tissue property changes induced by  electroconvulsive  therapy. Gyger L, Ramponi C, Mall JF, Swierkocz-Lenart K, Stoyanov D, Lutti A, von Gunten A, Kherif F, Draganski B. Neuroimage. 2021 Feb 19:117895. doi: 10.1016/j.neuroimage.2021.117895. Online ahead of print. PMID:  33617994 The abstract is copied below: Background: After more than eight decades of electroconvulsive therapy (ECT) for pharmaco-resistant depression, the mechanisms governing its anti-depressant effects remain poorly understood. Computational anatomy studies using longitudinal T1-weighted magnetic resonance imaging (MRI) data have demonstrated ECT effects on hippocampus volume and cortical thickness, but they lack the interpretational specificity about underlying neurobiological processes. Methods: We sought to fill in the gap of knowledge by acquiring quantitative MRI indicative for brain's myelin,...

Out on PubMed, from researchers "on behalf of" the STOP-PD II Study Group in the USA and Canada, is this dataset:   Pharmacotherapy Prescriptions for Relapse Prevention of Psychotic Depression After  Electroconvulsive  Therapy. Patel DA, Flint AJ, Rothschild AJ, Whyte EM, Meyers BS, Mulsant BH, Voineskos AN, Marino P, Alexopoulos GS; STOP-PD II Study Group. J Clin Psychopharmacol. 2021 Feb 11. doi: 10.1097/JCP.0000000000001354. Online ahead of print. PMID:  33587400 The abstract is copied below: Purpose/background: Electroconvulsive therapy (ECT) is effective in the treatment of acute episodes of psychotic depression. However, no adequately powered studies have directly investigated the efficacy of antipsychotic pharmacotherapy in relapse prevention of psychotic depression after ECT. In the absence of such literature, we reviewed the clinical practice of 4 academic medical centers that have made research contributions in the treatment of psychotic depression ove...

Out on PubMed, in JECT, is this report from researchers in Aachen, Germany: Lithium Is Likely to Persist in the Brain: Clinical Implications for Electroconvulsive Therapy. Augustin M, Karakavuz R, Riester L, Grözinger M. J ECT. 2021 Mar 1;37(1):67-70. doi: 10.1097/YCT.0000000000000719. PMID:  33600119 The abstract is copied below: Electroconvulsive therapy and concomitant lithium therapy remain a matter of debate because of increased rates of adverse events. Current recommendations include monitoring lithium levels and reducing lithium to minimally effective dose. We present a report on protracted effects of lithium intoxication as electroconvulsive therapy 8 days after intoxication and under normal lithium serum levels resulted in a prolonged seizure. Electroencephalogram recordings before stimulation showed electroencephalogram correlates of subsiding lithium intoxication most likely due to protracted lithium influx and efflux of the central nervous system. Part of the text is co...

Out on PubMed, from authors at Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Dublin, Ireland, is this editorial: Do we need to revisit our thinking on Electroconvulsive Therapy? Donohue G, Keogh B.J Psychiatr Ment Health Nurs. 2020 Dec 7. doi: 10.1111/jpm.12719. Online ahead of print. PMID: 33617086  The final paragraph is copied below: If mental health service users and their relatives are to be best served in terms of treatment options, then there is an onus on mental health nurses to challenge contemporary discourse and to clarify preconceived myths using scientific evidence. However, consensus is also needed about the scientific evidence to support the use of ECT with its utility and effectiveness often cited in the absence of robust research to support it. Read et al. ( 2020 ), following a systematic review, conclude that the data to support the efficacy of ECT in the treatmen...