Clinical Neuroscience of ECT (CNECT)

Out on Pubmed, from clinicians in China, is this case report: Case Report:  Effect of Electroconvulsive Therapy on Obsessive-Compulsive Disorder Comorbid With Body Dysmorphic Disorder. Ma X, Li R. Front Psychiatry. 2021 Aug 2;12:706506. doi: 10.3389/fpsyt.2021.706506. eCollection 2021.  PMID:  34408682   The pdf is here . And from the text: An 18-year-old male high school student with an established diagnosis of OCD presented in our department accompanied by his parents after cutting off a small piece of his nose with scissors. A year and a half earlier, he had decided that his nose was ugly and started picking and prodding his nose repeatedly until it was bleeding and painful. Psychiatric treatment had been sought nearly a year before the current presentation. At that time, he was started on fluvoxamine 200mg twice daily for 12 weeks and then in combination with CBT for a further 12 weeks. However, his symptoms worsened and he was spending increasing amounts of time...

Out on PubMed, in Acta Psychiatrica Scandinavica, is this editorial: Electroconvulsive  Therapy: Stayin' Alive, Stayin' Well. Kellner CH. Acta Psychiatr Scand. 2021 Sep;144(3):215-217. doi: 10.1111/acps.13352. PMID:  34397107   The pdf is here . This editorial, written by me, is mainly about maintenance ECT. Of course, I recommend you read in full the three articles in this issue of Acta, from which the editorial derives. Usually, I dislike cutsey titles for serious pieces about ECT, but I could not resist the Bee Gees reference, given the new data about ECT's effectiveness in reducing suicide (reference #6, above, and blog posts of August 4th and 12th). I guess the other relevant point is the call to drop the term, "continuation ECT," and just refer to all ECT after the index course as "maintenance ECT." As I say near the end, the Editors of Acta deserve great praise for their ongoing recognition of the importance of ECT research and clinical papers.

Out on PubMed, from an international group of investigators, is this article: Accounting for symptom heterogeneity can improve neuroimaging models of antidepressant response after  electroconvulsive  therapy. Wade BSC, Hellemann G, Espinoza RT, Woods RP, Joshi SH, Redlich R, Dannlowski U, Jorgensen A, Abbott CC, Oltedal L, Narr KL. Hum Brain Mapp. 2021 Aug 13. doi: 10.1002/hbm.25620. Online ahead of print. PMID:  34390089 The abstract is copied below: Depression symptom heterogeneity limits the identifiability of treatment-response biomarkers. Whether improvement along dimensions of depressive symptoms relates to separable neural networks remains poorly understood. We build on work describing three latent symptom dimensions within the 17-item Hamilton Depression Rating Scale (HDRS) and use data-driven methods to relate multivariate patterns of patient clinical, demographic, and brain structural changes over electroconvulsive therapy (ECT) to dimensional changes in depress...

Out on PubMed, from investigators at Columbia University Medical Center, is this review: Electroconvulsive  Therapy in Elderly Patients With Cerebral Aneurysms: A Systematic Review With Clinical Recommendations. Mehdi SMA, Devanand DP. J Geriatr Psychiatry Neurol. 2021 Aug 17:8919887211039016. doi: 10.1177/08919887211039016. Online ahead of print. PMID:  34402339 The abstract is copied below: Introduction: Electroconvulsive therapy (ECT) is commonly used in the elderly due to its proven efficacy and safety profile. However, presence of cardiovascular comorbidities such as cerebral aneurysms may complicate the course of treatment. Our knowledge about the possible risk factors and precautionary measures remains limited. Methods: We performed a systematic review of published case reports of elderly patients with cerebral aneurysms treated with ECT. Results: A total of 11 cases were included for the review. One patient died because of subarachnoid hemorrhage (SAH) secondary t...

Out on PubMed, from investigators in Australia and Canada, is this review: Therapeutic Neurostimulation in Obsessive-Compulsive and Related Disorders: A Systematic Review. Acevedo N, Bosanac P, Pikoos T, Rossell S, Castle D. Brain Sci. 2021 Jul 19;11(7):948. doi: 10.3390/brainsci11070948. PMID:  34356182 The abstract is copied below: Invasive and noninvasive neurostimulation therapies for obsessive-compulsive and related disorders (OCRD) were systematically reviewed with the aim of assessing clinical characteristics, methodologies, neuroanatomical substrates, and varied stimulation parameters. Previous reviews have focused on a narrow scope, statistical rather than clinical significance, grouped together heterogenous protocols, and proposed inconclusive outcomes and directions. Herein, a comprehensive and transdiagnostic evaluation of all clinically relevant determinants is presented with translational clinical recommendations and novel response rates. Electroconvulsive therapy (EC...

Out on PubMed, from investigators in India, is this report: Use of Electroconvulsive Therapy in Adolescents: A Retrospective Study. Grover S, Raju V, Chakrabarti S, Sharma A, Shah R, Avasthi A. Indian J Psychol Med. 2021 Mar;43(2):119-124. doi: 10.1177/0253717620956730. Epub 2020 Oct 31. PMID:  3437688 The abstract is copied below: Background: This study aimed to evaluate the clinical profile of adolescents aged up to 19 years who had received electroconvulsive therapy (ECT). Methods: A retrospective chart review was carried out to identify adolescents aged up to 19 years who had received ECT during the period 2012-2018. Details regarding their sociodemographic and clinical variables and ECT data were extracted from the records. Results: During the study period, a total of 51 adolescents received ECT, and complete records of 50 patients were available for analysis. 4.04% (51 out of 1260) of the patients who received ECT were aged up to 19 years. There was a decreasing trend of use ...

Here is the link: https://www.washingtonpost.com/health/electroshock-therapy-and-depression/2021/07/30/fb7857d8-d9b7-11eb-9bbb-37c30dcf9363_story.html Here is yet another patient account of successful ECT, this one recently in The Washington Post . It is generally helpful, but dwells on memory loss too much, and has several inaccuracies. The final line, "I've been shocked back to life," while dramatic, does put the favorable benefit-risk calculation of ECT into good perspective.  Unfortunately, many of the online comments that were posted at the end of the article were the typical anti-ECT disinformation. Two steps forward, one step back...

In The New Yorker , August 9th, is this article: The link is here: https://www.newyorker.com/magazine/2021/08/16/finding-a-way-back-from-suicide This personal account will be very helpful for ECT. It is a compelling story of severe illness with prominent suicidality, successfully treated with ECT. No mention of adverse effects. It will be read by a huge audience. Congratulations and thanks to Donald Antrim for having the courage to go public with his personal story.

Out on PubMed, from clinicians in Texas, is this paper; "The Use of Electroconvulsive Therapy in Neuropsychiatric Complications of COVID-19: A systematic literature review and case report". Austgen G, Meyers M, Gordon M, Livingston R. J Acad Consult Liaison Psychiatry. 2021 Aug 3:S2667-2960(21)00127-0. doi: 10.1016/j.jaclp.2021.07.010. Online ahead of print. PMID:  34358726   The abstract is copied below: Objective: This study reports on the use of electroconvulsive therapy (ECT) in neuropsychiatric symptoms (NPS) associated with COVID-19. Methods: A review of the literature pertaining to the use of ECT in COVID-19 patients with NPS was performed through PubMed, PsycINFO, and MEDLINE. Search terms included "Electroconvulsive Therapy" and "ECT," combined with "COVID-19" and "SARS-COV-2." Additionally, we present a case in which ECT was used to achieve complete remission in a patient who developed new onset, treatment-resistant depression...

 Out on PubMed, from authors in Michigan and Beirut, Lebanon,, is this study: Maintenance  Electroconvulsive  Therapy Is an Essential Medical Treatment for Patients With Catatonia: A COVID-19 Related Experience. Ghaziuddin N, Yaqub T, Shamseddeen W, Reddy P, Reynard H, Maixner D. Front Psychiatry. 2021 Jul 15;12:670476. doi: 10.3389/fpsyt.2021.670476. eCollection 2021. PMID:  34335326 The abstract is copied below: Aim: Describe naturalistic clinical course over 14 weeks in a mixed adolescent and a young-adult patient group diagnosed with developmental delays and catatonia, when the frequency of maintenance electroconvulsive therapy (M-ECT) was reduced secondary to 2020 COVID-19 pandemic restrictions. Methods: Participants were diagnosed with catatonia, and were receiving care in a specialized clinic. They (n = 9), F = 5, and M = 4, ranged in age from 16 to 21 years; ECT frequency was reduced at end of March 2020 due to institutional restrictions. Two parents/caregive...

Good title, good text. It is always gratifying to find an accurate positive story about ECT, no matter where it is published. For a healthcare professional and patient to share his story is an act of courage (although it shouldn't have to be, of course) that is laudable. Thanks to my friend from New Jersey for sending this article along.

 Out on PubMed, from clinicians in India, is this paper: Effect of a Video-Assisted Teaching Program About  ECT  on Knowledge and Attitude of Caregivers of Patients with Major Mental Illness. Nagarajan P, Balachandar G, Menon V, Saravanan B. Indian J Psychol Med. 2021 Jan;43(1):45-50. doi: 10.1177/0253717620938038. Epub 2020 Aug 11. PMID:  34349306 The abstract is copied below: Background: Electroconvulsive therapy (ECT) is a widely used treatment modality for mental disorders such as major depression, bipolar affective disorder (BPAD) and catatonia. However, it is considered as one of the most controversial and misunderstood procedures, especially among caregivers. Methods: An experimental pre-test, post-test design was adopted. Forty caregivers of persons with schizophrenia (n = 12), depression (n = 13), BPAD with mania (n = 8), and BPAD with depression (n = 7) were selected using convenience sampling. The caregiver's knowledge and attitude toward ECT were assessed...

Here is Dr. Andrade's  most recent online commentary in J Clin Psych: The link is here: https://doi.org/10.4088/JCP.21f14173 https://www.psychiatrist.com/jcp/depression/anesthesia-electroconvulsive-therapy-niche-role-for-sevoflurane/ The abstract is copied below: Anesthesia for electroconvulsive therapy (ECT) usually involves the intravenous (IV) administration of drugs such as methohexital, thiopental, propofol, etomidate, or ketamine. Sevoflurane is an inhalational anesthetic agent that has been available for the past 3 decades. Although many studies have examined sevoflurane in the context of ECT, treatment guidelines make either no mention or only passing mention of its potential use in the ECT procedure. A recent systematic review and meta-analysis identified 12 randomized clinical trials (pooled N = 377) of sevoflurane vs IV anesthetics in patients receiving ECT. The meta-analysis found that sevoflurane was associated with shorter EEG seizure duration than barbiturate, ketami...