ECT Update From Greece: Focus on Ketamine

 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) in slow intravenous injection in patients suffering from depression. In recent trials has been reported that ketamine as the only anesthetic or as an adjunctive to another anesthetic agent may enhance the antidepressant effect of ECT either by increasing efficacy or by producing a rapid antidepressant response. ECT with ketamine may also cause less cognitive side effects. The most notable limitations of these studies are the small number of patients enrolled and several methodological differences (patients characteristics, electrode placements, titration method, anesthetic agent used with ketamine). The results of the clinical trials have been summarized in six meta-analysis and suggest that ketamine when used as a sole anesthetic agent or as an adjunctive anesthetic in ECT may accelerates the antidepressant response but does not augment ECT efficacy. It also does not improve the cognitive profile of the treatment. Larger, double-blind randomized controlled trial are needed for a definite conclusion.

Keywords: Electroconvulsive therapy; cognitive functions; depression; ketamine; safety.

As you can see, this article is in Greek, so most of us must make do with the abstract.
The obsession with ketamine aside, I'm sure this is an excellent update.
Dr. Kaliora is a colleague who is a serious ECT clinician and scholar, who spent time studying in the US with Georgios Petrides.
This journal is the quarterly journal of the Hellenic Psychiatric Association.
Kudos (from the Greek word "kydos") to Stela for this nice contribution to the ECT literature for European colleagues. 

Comments

Post a Comment

Popular posts from this blog

ECT vs Ketamine: NEJM Article Sets Up False Equivalency

Image
Out on PubMed, from investigators in the US, is this study: Ketamine versus  ECT   for Nonpsychotic Treatment-Resistant Major Depression. Anand A, Mathew SJ, Sanacora G, Murrough JW, Goes FS, Altinay M, Aloysi AS, Asghar-Ali AA, Barnett BS, Chang LC, Collins KA, Costi S, Iqbal S, Jha MK, Krishnan K, Malone DA, Nikayin S, Nissen SE, Ostroff RB, Reti IM, Wilkinson ST, Wolski K, Hu B. N Engl J Med. 2023 May 24. doi: 10.1056/NEJMoa2302399. Online ahead of print. PMID:  37224232 The abstract is copied below: Background:  Electroconvulsive therapy (ECT) and subanesthetic intravenous ketamine are both currently used for treatment-resistant major depression, but the comparative effectiveness of the two treatments remains uncertain. Methods:  We conducted an open-label, randomized, noninferiority trial involving patients referred to ECT clinics for treatment-resistant major depression . Patients with treatment-resistant major depression without psychosis were recruited and assigned in a 1:1 rat
Read more

RUL ECT vs Low Amplitude Seizure Therapy (LAP-ST)

Image
Out on PubMed, from the team in Augusta, Georgia, is this study: Double-Blinded Randomized Pilot Clinical Trial Comparing Cognitive Side Effects of Standard Ultra-Brief Right Unilateral ECT to 0.5 A Low Amplitude Seizure Therapy (LAP-ST). Youssef NA, McCall WV, Ravilla D, McCloud L, Rosenquist PB. Brain Sci. 2020 Dec 13;10(12):E979. doi: 10.3390/brainsci10120979. PMID:  33322138 The pdf is here . And from the Introduction : In theory, LAP-ST can be helpful because of the direct effect of lower electric current, but the principal reason is that LAP-ST has a more focal electric field (EF) [ 34 , 35 ]. The current amplitude is the primary factor that drives the EF into brain regions located deeper in the brain and is responsible for cognition and memory such as the hippocampus and temporal lobe [ 33 , 35 ]. This extra focality of the EF can minimize or avoid high EF stimulation to the deeper hippocampal and temporal lobe regions [ 33 , 35 ]. Minimization of deeper stimulation by using LAP
Read more

ECT For Children at a University Hospital: New Study in JECT

Image
 Out on PubMed, from authors at Vanderbilt and Mass General,, is this article: Use of   ECT   for Children With and Without Catatonia: A Single-Site Retrospective Analysis. Smith JR, Baldwin I, Termini KA, McGonigle T, Vandekar S, Luccarelli J. J ECT. 2024 Jan 25. doi: 10.1097/YCT.0000000000000993. Online ahead of print. PMID:  38265759 The abstract is copied below: Objectives: The objective study was to investigate the safety and efficacy of electroconvulsive therapy (ECT) in a retrospective cohort of pediatric patients. Methods: A single-site retrospective analysis was conducted of patients aged younger than 18 years who received ECT in a private university hospital from January 28, 2012 to April 8, 2023. Treatment efficacy and adverse events were determined retrospectively through review of the medical record. Results: A total of 36 pediatric patients met the inclusion criteria. Catatonia was the most common presenting indication for ECT, followed by psychosis and suicidal ideation.
Read more