Clinical Neuroscience of ECT (CNECT)

Out on PubMed, from noted ECT scholar, C. Andrade, is this commentary: Active Placebo, the Parachute Meta-Analysis, the Nobel Prize, and the Efficacy of Electroconvulsive Therapy. Andrade C. J Clin Psychiatry. 2021 Mar 30;82(2):21f13992. doi: 10.4088/JCP.21f13992. PMID:  34000105 The abstract is copied below: The efficacy of electroconvulsive therapy (ECT) has been recently questioned on the grounds that placebo-controlled (sham ECT) trials are all old and of poor quality; statements have been made that the prescription of ECT should immediately be suspended because its continued use cannot be scientifically justified. These criticisms have come from academicians and have been presented in scientific and news forums with wide readership. A rebuttal is therefore necessary, if only to counter the formation of negative attitudes among patients, health care professionals, and the general public. The quality of sham ECT randomized controlled trials (RCTs) is undoubtedly poor; however, t...

 Out on Pubmed is this article from clinicians in Utah: Outcomes of Youth Treated With Electroconvulsive Therapy: A Retrospective Cohort Study. Pierson MD, Mickey BJ, Gilley LB, Weeks HR. J Clin Psychiatry. 2021 Feb 23;82(2):19m13164. doi: 10.4088/JCP.19m13164. PMID:  33988931 The abstract is copied below: Background: The use of electroconvulsive therapy (ECT) in children and adolescents is based on a limited evidence base in the medical literature. We report outcomes of a cohort of youth treated with ECT at a single US academic medical center. Methods: We conducted a retrospective chart review and analysis of all patients aged 18 years and younger who received ECT at the University of Utah from 1985 through 2016. For each patient record, 3 short-term clinical outcomes were assessed: response on the Clinical Global Impressions-Improvement scale, number of treatments administered, and reported side effects. Baseline characteristics were tested as predictors of clinical outcomes...

"Classics in ECT" brings you this study from 1963: Reactive and endogenous depressions--response to E.C.T. ROSE JT. Br J Psychiatry. 1963 Mar;109:213-7. doi: 10.1192/bjp.109.459.213. PMID:  13974791   The pdf is here . And from the text: Summary Twenty men and thirty women with severe depression were investigated with regard to the type of depression and response to a course of E.C.T. The patients were classified into endogenous, doubtful endogenous, doubtful reactive and reactive depressions, and were assessed on an appropriate rating scale before and twice after receiving E.C.T. The results indicated that all types of depression were of equal severity, and provided evidence that reactive and endogenous depressions respond differently to E.C.T., the latter group having a more favourable outcome. These findings are taken to support the hypothesis that these two types of depression are qualitatively different, and not to support the hypothesis that they differ only in a quanti...

"Classics in ECT" brings you this review article: The therapeutic efficacy of ECT: a review of the literature. RIDDELL SA. Arch Gen Psychiatry. 1963 Jun;8:546-56. doi: 10.1001/archpsyc.1963.01720120020004. PMID:  13982224 The pdf is here . With apologies to blog readers, this is a nasty piece of work, and it does not really have "classic" status. I bring it you, so you know it is out there. When I found it on PubMed, I looked forward to an authoritative, albeit outdated, literature review. Unfortunately, it reads like anti-ECT propaganda. The author is a "graduate in psychology" from Surrey, England.  Poor vetting by the Archives, it seems...Apparently, this is in the ongoing tradition of British psychology dissing ECT, abetted by American psychiatry. Please don't read it (~20 minutes) or pass it on...

Out on Pubmed is this paper: Effects of the COVID-19 pandemic on provision of  electroconvulsive  therapy. Braithwaite R, Chaplin R, Sivasanker V. BJPsych Bull. 2021 May 12:1-4. doi: 10.1192/bjb.2021.43. Online ahead of print. PMID:  33977894 The abstract is copied below: Aims and method: COVID-19 has had a heavy impact on healthcare provision worldwide, including delivery of electroconvulsive therapy (ECT). A survey was completed in the UK and Republic of Ireland in April and July 2020 by 95 and 89 ECT clinics respectively. Results: In April 2020, 53% of the clinics provided only emergency treatment and 24% had closed. Reasons included unavailability of anaesthetists, infection control measures and staff sickness. Restrictions persisted in July, with disruption to an estimated 437 individuals' treatment and poor outcomes, including clinical deterioration and readmission. Clinical implications: Risk stratification, longer clinic sessions, improvements in ventilation, regu...

Out on PubMed is this review from Spain: Electroconvulsive Therapy and Movement Disorders. New Perspectives on A Time-Tested Therapy. Garcia Ruiz PJ. Mov Disord Clin Pract. 2021 Mar 9;8(4):521-524. doi: 10.1002/mdc3.13180. eCollection 2021 May. PMID:  3398178 The abstract is copied below: Electroconvulsive therapy (ECT) has been a very well known therapy in Psychiatry for over 80 years. ECT is considered useful in treating acute mania, severe depression and other psychiatric conditions. Over time, this therapy has also been used in several movement disorders including Parkinson disease (PD) and Huntington disease (HD). In this brief review, I summarize the recent History and evolution of ECT, its proven and potential applications in movement disorders as well as its potential mechanisms. And from the text: ECT is, at present, a well-established treatment for psychiatric disorders and has been increasingly used for some movement disorders including PD.21,35–41 However, the level of ...

Out on PubMed, in Acta Psychiatrica Scandinavica, from clinicians in Germany, is this paper: Effectiveness of maintenance  Electroconvulsive  Therapy - Evidence from modifications due to the COVID-19 Pandemic. Methfessel I, Besse M, Belz M, Zilles-Wegner D. Acta Psychiatr Scand. 2021 May 7. doi: 10.1111/acps.13314. Online ahead of print. PMID:  33960406 The abstract is copied below: Objective: Continuation and maintenance ECT (c-/m-ECT) are effective in the prevention of relapse and recurrence of both affective and psychotic disorders. However, data are scarce concerning the trajectories of severe mental disorders after the end of c-/m-ECT. This prospective study investigates the clinical outcome of patients with versus without modifications of their c-/m-ECT schedules. Methods: In the context of the COVID-19 pandemic, ECT capacities were restricted at many clinics in early 2020. All patients receiving c-/m-ECT in March and April 2020 at our department (n = 53, unipolar d...

Out on PubMed, in the American Journal of Psychiatry, is this commentary: Electroconvulsive Therapy Is an Essential Procedure. Maixner DF, Weiner R, Reti IM, Hermida AP, Husain MM, Larsen D, McDonald WM. Am J Psychiatry. 2021 May 1;178(5):381-382. doi: 10.1176/appi.ajp.2020.20111647. PMID:  33979536   And from the text: To better understand the actual extent of the COVID-19 impact on patients and ECT practice in the United States, the ECT Task Group of the National Network of Depression Centers, a consortium of 27 U.S. academic institutions, surveyed members about the effects of COVID-19 on 20 ECT programs. During April and May of 2020, 80% (16 of 20) of ECT programs in the National Network of Depression Centers reported operating at less than 50% of regular clinical volume, and some reported substantially greater declines. ECT teams of psychiatrists and nurses scrambled to postpone or cancel appointments for many patients who were in acute or maintenance ECT courses. In addit...

 Out on PubMed, from Sam Wilkinson and colleagues, in Psychiatric Services, is this article: Barriers to the Implementation of  Electroconvulsive  Therapy (ECT): Results From a Nationwide Survey of ECT Practitioners. Wilkinson ST, Kitay BM, Harper A, Rhee TG, Sint K, Ghosh A, Lopez MO, Saenz S, Tsai J. Psychiatr Serv. 2021 May 11:appips202000387. doi: 10.1176/appi.ps.202000387. Online ahead of print. PMID:  33971727 The abstract is copied below: Objective: Electroconvulsive therapy (ECT) is an effective treatment for major depressive disorder; yet, its use is confined to <1% of individuals with this disorder. The authors aimed to examine barriers to ECT from the perspective of the provider. Methods: Qualitative interviews were conducted with U.S.-based ECT providers to identify potential barriers. A quantitative survey was created asking providers to rank-order barriers to starting a new ECT service or expanding existing services. Results: Survey responses were re...

Out on PubMed from investigators in China, is this study: The efficacy and acceptability of hybrid  electroconvulsive  therapy compared with standard  electroconvulsive  therapy for schizophrenia patients: A parallel-group, double-blind, randomized, controlled trial. Li J, Deng WF, Xu SX, Jiang ZY, Rong H, Kong XM, Xie XH. Brain Stimul. 2021 May 4;14(3):737-739. doi: 10.1016/j.brs.2021.04.017. Online ahead of print. PMID:  33962078 The pdf is here . And from the text: Previous studies have demonstrated that electroconvulsive therapy (ECT) augmentation of antipsychotics is highly effective for treatment-resistant schizophrenia patients or those who require a rapid response [1]. Despite the effectiveness of ECT, its use is limited primarily due to adverse events (AEs) [2,3], which may be related to ECT dosing, seizures or electrode placement [3,4]. Notably, a study demonstrated that nonconvulsive electrotherapy (NET) or low-charge electrotherapy (LCE) may have sim...

 "Classics in ECT" brings you this editorial from the NEJM in 1993: Electroconvulsive  therapy--a modern medical procedure. Potter WZ, Rudorfer MV. N Engl J Med. 1993 Mar 25;328(12):882-3. doi: 10.1056/NEJM199303253281213. PMID:  8441434   The pdf is here . This editorial in the NEJM accompanied the Sackeim electrode placement study that appeared in this issue and was a follow up to the Crowe review of a decade earlier. This was before the CORE studies, but was a harbinger of the next wave of ECT clinical trial data. Labeling ECT a "modern medical procedure" in the NEJM was a particularly helpful strategy. Bill Potter is an eminent psychopharmacologist with NIMH and industry backgrounds; Matt Rudorfer has been the NIMH ECT point person/expert for decades and a major supporter and collaborator in ECT research, including the CORE studies. Their classic editorial deserves a full read, ~10 minutes.

Out on PubMed, from researchers in Norway and New Mexico, is this review: Magnetic Resonance Spectroscopy in Depressed Subjects Treated With  Electroconvulsive  Therapy-A Systematic Review of Literature. Erchinger VJ, Ersland L, Aukland SM, Abbott CC, Oltedal L. Front Psychiatry. 2021 Mar 25;12:608857. doi: 10.3389/fpsyt.2021.608857. eCollection 2021. PMID:  33841198   The abstract is copied below: Electroconvulsive therapy (ECT) is considered to be the most effective acute treatment for otherwise treatment resistant major depressive episodes, and has been used for over 80 years. Still, the underlying mechanism of action is largely unknown. Several studies suggest that ECT affects the cerebral neurotransmitters, such as gamma-aminobutyric acid (GABA) and glutamate. Magnetic resonance spectroscopy (MRS) allows investigators to study neurotransmitters in vivo, and has been used to study neurochemical changes in the brain of patients treated with ECT. Several investigat...

Out on PubMed, from investigators in Germany, is this paper: Malignant Catatonia: severity, treatment and outcome - a systematic case series analysis. Cronemeyer M, Schönfeldt-Lecuona C, Gahr M, Keller F, Sartorius A. World J Biol Psychiatry. 2021 May 5:1-28. doi: 10.1080/15622975.2021.1925153. Online ahead of print. PMID:  33949287 The abstract is copied below: Malignant catatonia (MC) is a rare, yet potentially life-threatening neuropsychiatric condition. Evidence on its therapy is weak, treatment recommendations are scarce and predominantly unprecise. The aim of this study was to compare the effectiveness of different MC treatment approaches regarding outcome and severity of MC. We conducted systematic searches for MC case reports in biomedical databases and the psychiatric archive of University Hospital Ulm. 117 cases were included. Treatments were compared considering MC severity and temporal aspects. Treatment had a significant influence on outcome: treatment with both benzod...

Out on PubMed is this study from investigators in the Sichuan province of China: Transcriptome Sequencing Reveals the Potential Mechanisms of Modified  Electroconvulsive   Therapy  in Schizophrenia. Peng W, Tan Q, Yu M, Wang P, Wang T, Yuan J, Liu D, Chen D, Huang C, Tan Y, Liu K, Xiang B, Liang X. Psychiatry Investig. 2021 Apr 29. doi: 10.30773/pi.2020.0410. Online ahead of print. PMID:  33910328 The abstract is copied below: Objective: Schizophrenia (SCZ) is one of the most common and severe mental disorders. Modified electroconvulsive therapy (MECT) is the most effective therapy for all kinds of SCZ, and the underlying molecular mechanism remains unclear. This study is aim to detect the molecule mechanism by constructing the transcriptome dataset from SCZ patients treated with MECT and health controls (HCs). Methods: Transcriptome sequencing was performed on blood samples of 8 SCZ (BECT: before MECT; AECT: after MECT) and 8 HCs, weighted gene co-expression network...

Out on PubMed, from clinicians in Georgia, USA, is this case report: Cotard Syndrome in an Adolescent With a First Episode of Psychosis. McGreal AE, Boles MK, Boyanchek I. J Psychiatr Pract. 2021 May 5;27(3):224-227. doi: 10.1097/PRA.0000000000000545. PMID:  33939377 The abstract is copied below: This case report describes a unique presentation of Cotard syndrome in an 18-year-old female patient experiencing first-episode psychosis. Cotard syndrome was first described in 1880 by Jules Cotard as a novel subtype of anxious depression and is presently understood as a rare cluster of mood and psychotic symptoms centered on nihilistic delusions including the absence of organs and a perception of being dead. Although rare, Cotard syndrome has been described in a variety of neurological and psychiatric illnesses, but it is most commonly seen in middle-aged adults with a history of chronic mood disorders. It is rarely reported in childhood or adolescence, and it has not previously been des...