Clinical Neuroscience of ECT (CNECT)

 Out on PubMed, from researchers in The Netherlands and Belgium, is this study: Influence of adjuvant nortriptyline on the efficacy of electroconvulsive therapy: a randomized controlled trial and one-year follow-up. Pluijms EM, Kamperman AM, Hoogendijk WJ, van den Broek WW, Birkenhäger TK. Acta Psychiatr Scand. 2022 Feb 12. doi: 10.1111/acps.13408. Online a head of print. PMID:  35152416 The abstract is copied below: Objective:  There is limited evidence that adding an antidepressant to electroconvulsive therapy (ECT), compared with ECT monotherapy, improves outcomes. We aimed to determine whether the addition of nortriptyline to ECT enhances its efficacy and prevents post-ECT relapse. Methods:  We conducted a randomized, double-blind, placebo-controlled trial (RCT). Patients with major depressive disorder and an indication for ECT received either nortriptyline or placebo during a bilateral ECT course. Outcome measures were mean decrease in Hamilton Rating Scale for ...

Out on PubMed, from researchers in Australia, is this editorial: Further Evidence Supporting the Utility of  ECT  for People With Cognitive Impairment. Martin DM, Loo CK. Am J Geriatr Psychiatry. 2022 Jan 14:S1064-7481(22)00004-5. doi: 10.1016/j.jagp.2022.01.004. Online ahead of print. PMID:  35140046   This is a helpful, short editorial that accompanies the Luccarelli article in the same issue of the AJGP (please see also blog posts of January 12 and 20). The editorial reinforces the main finding of the article,namely that baseline cognitive impairment should not deter the prescription of ECT, and that cognitive impairment at baseline will likely improve with ECT. The whole editorial is right there (above) and I recommend a full read to all,~ 8 minutes.

 Out on PubMed, from clinicians in Iran, is this study: Comparison of hemodynamic changes and serum potassium levels in the use of succinylcholine and cisatracurium in electroconvulsive therapy. Nazemroaya B, Ghosouri A, Honarmand A, Hashemi ST. J Res Med Sci. 2021 Nov 29;26:106. doi: 10.4103/jrms.JRMS_951_19. eCollection 2021.  PMID:  35126569   Background:  Electroconvulsive therapy (ECT) is nowadays used commonly as one the most effective treatment methods in psychiatric disorders. In patients undergoing ECT, succinylcholine is usually used. In addition, cisatracurium is occasionally used on a case report basis globally. In this study, we compared the hemodynamic changes and serum potassium levels in the use of succinylcholine and cisatracurium in ECT. Materials and methods:  The current crossover clinical trial was performed on 45 patients who were candidates for ECT between 2017 and 2018. The patients were given succinylcholine or cisatracurium randoml...

Recipients' experience with information provision for electroconvulsive therapy ( ECT ). Coman A. BMC Psychiatry. 2022 Feb 4;22(1):86. doi: 10.1186/s12888-022-03720-w. PMID:  35120485 The abstract is copied below: Background: Despite improvements, studies continue to report unsatisfactory provision of information before, during and after electroconvulsive treatment (ECT). Aims: The study explores participants' experiences with information provision about ECT. Methods: In-depth interviews with 21 participants (21- 65 year-old) were conducted. Thematic analysis resulted in identification of four themes: pre-treatment knowledge, experience of informed consent, the need for information depth and life after ECT. The study includes user involvement. Results: Although some participants were satisfied with information provision, the majority experienced an education deficit throughout the treatment period. Their consent was based mostly on oral information, insufficient and unvaried in...

 Out on PubMed, in the New England Journal of Medicine, is this review: Electroconvulsive   Therapy. Espinoza RT, Kellner CH. N Engl J Med. 2022 Feb 17;386(7):667-672. doi: 10.1056/NEJMra2034954. PMID:   35172057   Review.   The pdf is here . Dr. Espinoza and I are very pleased to have had the opportunity to publish this review in the NEJM, issue of Feb. 17, 2022. Our hope is that having an evidence-based summary of ECT in such an influential general medical journal will be part of the needed corrective to misleading attacks on ECT. A full read will be ~ 15 minutes, thanks.

 Out on PubMed, from researchers at Northwestern University and UCLA, is this review: Parsing the Network Mechanisms of  Electroconvulsive  Therapy. Leaver AM, Espinoza R, Wade B, Narr KL. Biol Psychiatry. 2021 Nov 26:S0006-3223(21)01796-0. doi: 10.1016/j.biopsych.2021.11.016. Online ahead of print. PMID:  35120710   Review. The abstract is copied below: Electroconvulsive therapy (ECT) is one of the oldest and most effective forms of neurostimulation, wherein electrical current is used to elicit brief, generalized seizures under general anesthesia. When electrodes are positioned to target frontotemporal cortex, ECT is arguably the most effective treatment for severe major depression, with response rates and times superior to other available antidepressant therapies. Neuroimaging research has been pivotal in improving the field's mechanistic understanding of ECT, with a growing number of magnetic resonance imaging studies demonstrating hippocampal plasticity afte...

 Out on PubMed, from researchers in China, is this review: Current progress in neuroimaging research for the treatment of major depression with electroconvulsive therapy. Li XK, Qiu HT. World J Psychiatry. 2022 Jan 19;12(1):128-139. doi: 10.5498/wjp.v12.i1.128. eCollection 2022 Jan 19. PMID:  35111584   The abstract is copied below: Electroconvulsive therapy (ECT) uses a certain amount of electric current to pass through the head of the patient, causing convulsions throughout the body, to relieve the symptoms of the disease and achieve the purpose of treatment. ECT can effectively improve the clinical symptoms of patients with major depression, but its therapeutic mechanism is still unclear. With the rapid development of neuroimaging technology, it is necessary to explore the neurobiological mechanism of major depression from the aspects of brain structure, brain function and brain metabolism, and to find that ECT can improve the brain function, metabolism and even brain ...

 Out on PubMed, in Psychological Medicine , is this article: Depression: why drugs and electricity are not the answer. Read J, Moncrieff J. Psychol Med. 2022 Feb 1:1-10. doi: 10.1017/S0033291721005031. Online ahead of print. PMID:  35100527 The abstract is copied below: The dominant view within mental health services and research suggests that feeling depressed is a kind of medical illness, partially caused by various biological deficits which are somehow corrected by physical interventions. This article critically appraises evidence for the effectiveness and value of antidepressant drugs and electroconvulsive therapy (ECT), the two principle physical treatments recommended for depression. It also describes the negative effects of these interventions and raises concerns about how they impact the brain. We propose an alternative understanding that recognises depression as an emotional and meaningful response to unwanted life events and circumstances. This perspective demands th...

Out on PubMed, from investigators in Australia, is this literature review: Tardive Seizures After Electroconvulsive Therapy. Warren N, Eyre-Watt B, Pearson E, O'Gorman C, Watson E, Lie D, Siskind D. J ECT. 2022 Jan 28. doi: 10.1097/YCT.0000000000000821. Online ahead of print. PMID:  35093969 The abstract is copied below: Objectives: Seizures that occur spontaneously after termination of an electroconvulsive therapy (ECT) seizure are termed tardive seizures. They are thought to be a rare complication of ECT, influenced by risk factors that affect seizure threshold. However, there has been limited review of tardive seizures with modified ECT. We aimed to review the literature to provide clinical guidance for the use of ECT after tardive seizures. Methods: PubMed, EMBASE, PsycInfo, and CINAHL databases were searched from inception to May 2021 to identify cases of modified ECT, with evidence of a seizure occurring within 7 days of a terminated ECT seizure. Data for demographic, medical...

 Out on PubMed, from clinicians in Spain, is this article: Cultural adaptation to Spanish of the “Patient Satisfaction Survey” to assess satisfaction with electroconvulsive therapy ( ECT ). Urretavizcaya M, De Arriba-Arnau A, Caballero M, Bagney A, Bernardo M, Menchón JM, Rodriguez-Jimenez R. Actas Esp Psiquiatr. 2022 Jan;50(1):1-14. Epub 2022 Jan 1. PMID:  35103293 The abstract is copied below: The degree of satisfaction of patients and their relatives with electroconvulsive therapy (ECT) is considered an important treatment goal; however there is no scale in Spanish to quantify it. The aim of the study was to translate and adapt into Spanish the “Patient Satisfaction Survey” (PSS) for its use in patients and their relatives. The article (in Spanish) is here . This article details the translation and modification of the "Patient Satisfaction Survey" for Spanish ECT ("TEC") patients. The conclusion is that the end product is r...

 "Classics in ECT" brings you this paper from Max Fink, from 1961: Inhalant-induced convulsions. Significance for the theory of the convulsive therapy process. FINK M , KAHN RL, KARP E, POLLACK M, GREEN MA, ALAN B, EFKOWITS HJ. Arch Gen Psychiatry. 1961 Mar;4:259-66. doi: 10.1001/archpsyc.1961.01710090045006. PMID:  13699611 The pdf is here . And from the text: This a great classic from Max Fink. The discussion of the centrality of the seizure is compelling reading. I highly recommend a full read of this paper (~20 minutes), in preparation for Dr. Fink's presentation on inhalational convulsive therapy at the ISEN Annual Meeting.

Functional reconfiguration of cerebellum-cerebral neural loop in schizophrenia following electroconvulsive therapy. Hu H, Jiang Y, Xia M, Tang Y, Zhang T, Cui H, Wang J, Xu L, Curtin A, Sheng J, Cao X, Guo Q, Jia Y, Li C, Wang Z, Luo C, Wang J. Psychiatry Res Neuroimaging. 2022 Jan 22;320:111441. doi: 10.1016/j.pscychresns.2022.111441. Online ahead of print. PMID:  35085957 The abstract is copied below: Recent evidence highlights the role of the cerebellum-cerebral loop in the pathophysiology of schizophrenia (SZ). Electroconvulsive therapy (ECT) is clinically applied to augment the effect of antipsychotic drugs. The study aims to address whether the cerebellum-cerebral loop is involved in the mechanisms of ECT's augmentation effect. Forty-two SZ patients and 23 healthy controls (HC) were recruited and scanned using resting-state functional MRI (rs-fMRI). Twenty-one patients received modified ECT plus antipsychotics (MSZ group), and 21 patients took antipsychotics only (DSZ group)....

Out on PubMed, in JECT, from clinicians in North Carolina, is this case report: This is an interesting case report and literature review with imaging, depicting a very rare, transient complication of ECT. The discussion of the likely vasogenic etiology is informative. It would have been even better to know the exact timing of the scan and resolution of symptoms. This is a worthwhile read for all ECT practitioners, ~5 minutes. 

Out on PubMed, from investigators in China, is this study: Changes in brain network properties in major depressive disorder following  electroconvulsive  therapy: a combined static and dynamic functional magnetic resonance imaging study. Liu D, Tang S, Wu Z, Yang J, Liu Z, Wu G, Sariah A, Ouyang X, Long Y. Ann Palliat Med. 2022 Jan 14:apm-21-2723. doi: 10.21037/apm-21-2723. Online ahead of print. PMID:  35073711 The abstract is copied below: Background: Major depressive disorder (MDD) is a common and intractable mood disorder. Electroconvulsive therapy (ECT) is a common means of brain electrical stimulation for the treatment of MDD, but the neurobiological mechanism of its clinical symptom relief effect is still to be explored. This study aims to explore how ECT plays a role in depression remissions by investigating the changes of static and dynamic brain network characteristics in MDD patients before and after ECT. Methods: Resting-state functional magnetic resonance ima...