Clinical Neuroscience of ECT (CNECT)

 Out on PubMed, from investigators in Iran, is this study: Efficacy of electroconvulsive therapy in Parkinson's disease: a clinical trial. Afshari D, Shakeri J, Khodamoradi M, Nejad Shahrokh Abadi R, Rahkan J, Afshar Hezarkhani L. Neurosci Lett. 2022 Jan 10:136449. doi: 10.1016/j.neulet.2022.136449. Online ahead of print. PMID:  35026333 The abstract is copied below: Motor and psychiatric symptoms in patients with Parkinson's disease (PD) constitute some of the most problematic issues for both the patients and their caregivers. This study evaluated the short- and long-term efficacy of electroconvulsive therapy (ECT) in PD patients whose psychiatric symptoms had been exacerbated due to drug therapy. Fifteen PD patients were treated using an electroshock device at a range of 25-100 Joules over a period of 6 weeks, during 12 sessions. Motor and psychiatric symptoms of all patients were evaluated before conducting ECT as baseline, after 12 sessions of ECT at the 6th week, and one ...

Out on PubMed, from clinicians in India, is this report: Concurrent catatonia and COVID-19 infection - An experiential account of challenges and management of cases from a tertiary care psychiatric hospital in India. Sakhardande KA, Pathak H, Mahadevan J, Muliyala KP, Moirangthem S, Reddi VSK. Asian J Psychiatr. 2022 Jan 4;69:103004. doi: 10.1016/j.ajp.2022.103004. Online ahead of print.  PMID:  35016069     The abstract is copied below: Catatonia has been reported as one among many neuropsychiatric manifestations associated with COVID-19 infection. Catatonia and COVID-19 co-occurrence remain clinical concerns, often posing challenges pertaining to diagnosis, and especially management. Limited information is available regarding the appropriate approaches to the management of catatonia in COVID-19 infection, particularly with reference to the safety and efficacy of benzodiazepines and Electro-convulsive therapy (ECT). We present our experience of five patients with ca...

"Classics in ECT" brings you this early Abrams comparison of RUL and BL ECT from 1972: The pdf is here . The article is copied below: This early Abrams/Fink et al. paper in the Archives is a naturalistic comparison of RUL and BL ECT done at Gracie Square Hospital in New York City in the early 1970s. It has some quaint quirks, including the Lancaster position for the RUL, and multiple seizures/session (attending's discretion) in the RUL arm. The findings are: slightly better efficacy with BL, slightly fewer cognitive effects with RUL, and different EEG patterns from the two techniques. Later studies from these authors, in the 1980s and 90s, with more methodological rigor, largely confirm these findings.  This paper is written in the clear style that is an Abrams/Fink hallmark; I recommend a full read, ~15 minutes, to all those interested in the history of the electrode placement discussion in ECT.

Out on PubMed, from researchers in the Netherlands, is this paper: Rapid speed of response to  ECT  treatment in bipolar depression: A chart review. Scheepstra KWF, van Doorn JB, Scheepens DS, de Haan A, Schukking N, Zantvoord JB, Lok A. J Psychiatr Res. 2022 Jan 5;147:34-38. doi: 10.1016/j.jpsychires.2022.01.008. Online ahead of print. PMID:  35007809 The abstract is copied below: Objective: To validate a faster speed of response to electroconvulsive therapy (ECT) for bipolar depression (BPD) compared to major depressive disorder (MDD) METHOD: Retrospective chart review on an ECT cohort in an academic hospital setting. Speed of response was defined by the number of ECT treatments needed for response or remission. Results: Sixty-four depressed patients were included, of whom 53 (MDD: 40, BPD: 13) could be analyzed. The bipolar group responded faster with a mean difference of 3.3 fewer ECT treatments to meet response criteria (MDD 10.4 vs. BPD 7.1, p = 0.054). When using ...

 Out on PubMed, from researchers in Brazil and Houston, is this basic science article: Combination of  electroconvulsive  stimulation with ketamine or escitalopram protects the brain against inflammation and oxidative stress induced by maternal deprivation and is critical for associated behaviors in male and female rats. Abelaira HM, Rosa T, de Moura AB, Andrade NM, Martinello NS, Maciel LR, Botelho MEM, Borba LA, Chede BC, Arent CO, Joaquim L, Bonfante S, Danielski LG, Tuon T, Petronilho F, Quevedo J, Réus GZ. Mol Neurobiol. 2022 Jan 7. doi: 10.1007/s12035-021-02718-x. Online ahead of print. PMID:  34994953 The abstract is copied below: This study aimed at evaluating the treatment effects with ketamine, electroconvulsive stimulation (ECS), escitalopram, alone or in combination in adult rats of both sexes, subjected to the animal model of maternal deprivation (MD) . All groups were subjected to the forced swimming test (FST), splash and open field tests. The prefront...

Out on PubMed, from authors in the US, is this review: Systematic review: Electroconvulsive therapy for treatment-resistant mood disorders in children and adolescents. Castaneda-Ramirez S, Becker TD, Bruges-Boude A, Kellner C, Rice TR. Eur Child Adolesc Psychiatry. 2022 Jan 9. doi: 10.1007/s00787-022-01942-7. Online ahead of print. PMID:  34999973 The article is here . And from  the text: This review (on which I was pleased to be asked to collaborate) is comprehensive. The findings are reassuring, consistent, and not surprising. ECT is underutilized in children and adolescents with severe mood disorders; having this compilation of case studies is very helpful to demonstrate a firm evidence base for efficacy and safety. Child and adolescent psychiatrists in general are still poorly educated about ECT and not very accepting of it as a group. This article, published in a high impact factor journal, is a good step towards educating this segment of our colleagues.  Kudos ...

 Out on PubMed, from a clinician/researcher in Athens, Greece, is this paper: [Electroconvulsive therapy in treatment resistant depression: What is new?]. Kaliora SC. Psychiatriki. 2021 Dec;32(Supplement I):82-89. doi: 10.22365/jpsych.2021.053. PMID:   34990383 The abstract is copied below: Despite major advances in the treatment of mood disorders, major depression, a common mental disorder, remains a serious public health problem. Electroconvulsive therapy (ECT) regardless of the anesthetic agent used, is the most effective form of treatment in major depression and the gold standard therapy in treatment resistant depression. Ketamine is one of the anesthetic drugs approved by the Αmerican Psychiatric Association Task Force Report for use in ECT. However, it has been used infrequently as an anesthetic in ECT. The initial reports suggested that ketamine has antidepressant properties resulting in rapid antidepressant response when administered in subanesthetic dose (0.5 mg/kg) ...

Out on PubMed, From investigators in Canada and the US, is this paper: The Effects of Ketamine on Cognition in Unipolar and Bipolar Depression: A Systematic Review. Vaccarino SR, Adamsahib F, Milev RV, Parikh SV, Lam RW, Blier P, Kennedy SH, Ladha KS, Bhat V.J Clin Psychiatry. 2022 Jan 4;83(1):21r13870. doi: 10.4088/JCP.21r13870.PMID: 34985832 Just what we needed, another systematic review involving ketamine and ECT , confirming equivocal ("no negative") results on cognition. Since J Clin Psych makes it difficult to get the full article, we only have the above abstract, but I am quite confident that, even with the full text, the conclusion would be, "nothing to see here, move along..." My summary of the literature of ECT and ketamine: it is a fine alternate anesthetic agent, either alone or combined with another agent; it may enhance seizure elicitation, may slightly speed up response time, and has "no negative" effect on cognition.

 Out on PubMed, in JECT, is this personal account: Electroconvulsive Therapy: What's Love Got To Do With It? Richardson M. J ECT. 2021 Nov 10. doi: 10.1097/YCT.0000000000000808. Online ahead of print. PMID:   34779424   This is a moving and compelling patient story of the good that ECT can do. Perhaps the most remarkable part is the fortunate correction of the misdiagnosis of dementia; it is frightening to think of how often that mistake is made and not corrected. Kudos to the author and to the editor of JECT, Dr. Vaughn McCall, for adding this to the ECT literature. I recommend a full read for all ECT healthcare providers, ~10 minutes.

Out on PubMed, in JECT, from clinicians in New York, is this LTE: Role of Electroconvulsive Therapy in Managing Major Depressive Episodes in Patients With Dementia With Lewy Bodies. Fruitman K, Francois D. J ECT. 2021 Dec 28. doi: 10.1097/YCT.0000000000000817. Online ahead of print. PMID:  34966041 The letter is here: This LTE is a useful reminder of the utility   of ECT in severe psychiatric symptoms in the context of Parkinson's syndromes, including LBD. ECT is definitely underutilized in this population, so any additions to the case report/series literature are welcome. The first author is a medical student at Cornell; kudos to her for this contribution to the ECT literature.

 Out on PubMed, from clinicians in California, is this case report: Adjunct Ketamine in  Electroconvulsive  Therapy. Yang C, Klein CA, Frazier A. Innov Clin Neurosci. 2021 Jul-Sep;18(7-9):10. PMID:  34980987 The full letter is here: This is a well-intended case report that describes a known anesthesia modification to enhance seizure induction. Unfortunately, not enough details are provided to tell if the patient actually had a high seizure threshold; furthermore it is unclear why the authors did not try to lower the methohexital dose when they added the ketamine. But Monday morning critiques aside, it is good to hear that ECT is being done in the state hospital system in California. And, whoever are the readers of Innovations in Clinical Neuroscience , this case introduces ECT to them, so kudos to these clinician authors for putting this in the literature.

Out on PubMed, from researchers at McLean Hospital, is this paper: First Acute-Course Electroconvulsive Therapy for Moderate-to-Severe Depression Benefits Patients With or Without Accompanying Baseline Cognitive Impairment. Copersino ML, Long MP, Bolton P, Ressler KJ, Seiner SJ, Yip AG. J ECT. 2021 Dec 28. doi: 10.1097/YCT.0000000000000819. Online ahead of print. PMID:  34966040 The abstract is copied below: Background: Researchers are increasingly investigating therapeutic response associated with new patient subgroups as a way to improve electroconvulsive therapy (ECT) treatment outcomes and reduce adverse events. This study is the first to examine baseline cognitive impairment status as a predictor of clinical outcome in first acute-course ECT patients. Methods: Baseline cognitive function at various thresholds and serial depressive symptom severity data from first-time ECT patients were examined using generalized linear mixed-effects models. Results: Of 1345 patients who met th...

Out on PubMed, from authors in Texas, is this article: Current knowledge and attitudes of psychiatric nurses toward electroconvulsive therapy. Ezeobele IE, Ekwemalor CC, Pinjari OF, Boudouin GA, Rode SK, Maree E, Russo AA, Selek S. Perspect Psychiatr Care. 2021 Dec 28. doi: 10.1111/ppc.13016. Online ahead of print. PMID:  34964509 The abstract is copied below: Purpose: This study assessed the current knowledge and attitudes of psychiatric nurses toward electroconvulsive therapy (ECT). Design and methods: A quantitative, nonexperimental study was conducted at a large psychiatric hospital in the United States. The Questionnaire on Attitudes and Knowledge (QuAKE) Scale was used to conduct the assessment among a convenient sample of 158 psychiatric nurses. Findings: Participants' responses to questions that elicited knowledge of ECT ranged from 45% to 99% and positive attitudes ranged from 21% to 96%, revealing increased levels when compared with the low to average knowledge and p...

Out on PubMed, from investigators in China, is this study: Electroconvulsive  therapy modulates critical brain dynamics in major depressive disorder patients. Xin Y, Bai T, Zhang T, Chen Y, Wang K, Yu S, Liu N, Tian Y. Brain Stimul. 2021 Dec 22:S1935-861X(21)00843-3. doi: 10.1016/j.brs.2021.12.008. Online ahead of print. PMID:  34954084 The abstract is copied below: Background: Electroconvulsive therapy (ECT) is widely considered as an effective and fast-acting option for treating patients with major depressive disorder (MDD). However, the neural basis underlying this powerful therapy remains uncertain. Recent studies have suggested that the healthy brain may operate near a critical state, which may reflect a balance between neuronal excitation and inhibition. Objective: In the present study, we investigated whether there are any changes regarding criticality in MDD and, if so, whether ECT can reverse them. Critical dynamics analysis was performed on resting-state functional m...

Out on PubMed, from clinicians in Japan is this paper: Serial case report of high seizure threshold patients that responded to the lengthening of pulse width in  ECT . Katagai H, Yasui-Furukori N, Kawashima H, Suwa T, Tsushima C, Sato Y, Shimoda K, Tasaki H. Neuropsychopharmacol Rep. 2021 Dec 24. doi: 10.1002/npr2.12224. Online ahead of print.  PMID:   34953064 The abstract is copied below: Electroconvulsive therapy (ECT) has been used as an effective treatment modality for psychiatric disorders. In patients with high seizure thresholds, augmentation strategies are considered such as changing anesthetic agents, hyperventilation, and premedication with theophylline. We tried to switch to "long (1.5 ms)" brief pulse ECT in all six patients from October 2020. The successful induction of effective seizures with "long" brief pulse stimulation in five of six patients who could not be treated adequately with standard ECT. In the current situation in cases in which brief pu...

Out on PubMed, from a consortium of international investigators, is this study: Interrogating Associations Between Polygenic Liabilities and  Electroconvulsive  Therapy Effectiveness. Luykx JJ, Loef D, Lin B, van Diermen L, Nuninga JO, van Exel E, Oudega ML, Rhebergen D, Schouws SNTM, van Eijndhoven P, Verwijk E, Schrijvers D, Birkenhager TK, Ryan KM, Arts B, van Bronswijk SC, Kenis G, Schurgers G, Baune BT, Arns M, van Dellen EE, Somers M, Sommer IEC, Boks MP, Gülöksüz S, McLoughlin DM, Dols A, Rutten BPF. Biol Psychiatry. 2021 Oct 24:S0006-3223(21)01707-8. doi: 10.1016/j.biopsych.2021.10.013. Online ahead of print. PMID:  3495516 9 The abstract is copied below: Background: Electroconvulsive therapy (ECT) is the most effective treatment for severe major depressive episodes (MDEs). Nonetheless, firmly established associations between ECT outcomes and biological variables are currently lacking. Polygenic risk scores (PRSs) carry clinical potential, but associations with tr...