Clinical Neuroscience of ECT (CNECT)

 Out on PubMed, from clinicians in Georgia, is this case report: Electroconvulsive therapy for super refractory status epilepticus in pregnancy: case report and review of literature. Singla L, Shah M, Moore-Hill D, Rosenquist P, Alfredo Garcia K. Int J Neurosci. 2022 Mar 14:1-11. doi: 10.1080/00207454.2022.2050371. Online ahead of print.  PMID:   35287528 The abstract is copied below: Objective: We aim to describe use of electroconvulsive therapy (ECT) to treat super refractory status epilepticus (SRSE) in pregnancy and review the literature regarding utility and safety of ECT in refractory status epilepticus. Background: Status epilepticus (SE) is a commonly encountered emergency in neuro-critical care world. Pharmacotherapy of status epilepticus in pregnancy is very challenging given the effect of the majority of antiepileptic drugs (AEDs) on fetal development. Although there has been growing evidence for use of ECT in status epilepticus, data about its utility in pregn...

Out on PubMed, from authors in Japan, is this paper: The abstract is copied below: The paper is here . And from the text, the sections on ECT: In these guidelines, ECT is given reasonable consideration. I do, however, dislike the above yellow-highlighted sentence in which ECT and TMS are mentioned together indiscriminately. Treatment guidelines in general are very important for maintaining the recognition of ECT as a standard treatment; whenever a guideline recognizes ECT appropriately, we move away from the inappropriate categorization of ECT as a "last resort." This document is a fairly good primer on geriatric depression; the fact that the the non-ECT parts (the majority) are so boring, makes me realize how privileged we are to be able to offer such a dramatically effective treatment to the segment of the depressed patient population who needs relief most. A full read is only recommended for those who wish to brush up on pharmacotherapy/psychotherapy in geriatric depressio...

Out on PubMed, from researchers in France, is this study: A Retrospective Study of Postictal Suppression during Electroconvulsive Therapy. Moulier V, Guehl J, Evêque-Mourroux E, Quesada P, Rothärmel M. J Clin Med. 2022 Mar 5;11(5):1440. doi: 10.3390/jcm11051440. PMID:  35268529 The abstract is copied below: Background: electroconvulsive therapy (ECT) is the most effective treatment in treatment-resistant depression (TRD), but its response remains partial. Identifying useful indicators to guide decision making for treatment and improve clinical response remains a major issue. The objective of the present retrospective study was to determine if clinical response-early (after 5 ECT sessions) or longer-term (after 12 ECT sessions)-was associated with postictal suppression during the first ECT course and/or with postictal suppression frequency during the whole ECT course. Methods: in a retrospective study, the data of 42 patients suffering from treatment-resistant depression and receivi...

Out on PubMed, from Alexander Sartorius, in Germany, is this LTE: The pdf is here . This is a very important and thoughtful letter; the technical details may be slightly beyond the full grasp of those of us with less background in physics, but the main points are clearly presented, so all can understand them. However, the greatest significance of this correspondence is challenging the published findings that many of us would feel inadequately prepared to question. A single lab, or one non-clinical investigator at the NIMH should not monopolize the literature discourse, particularly when clinical decisions in humans are suggested by the findings. I am reminded of the "bench-to-bedside" process, in which fast is usually applauded, but in which, sometimes, too fast, without adequate replication and testing, is problematic.  I recommend that all students/scholars of the mechanism of action of ECT literature read this letter.

 Out on PubMed, from researchers in China and the US, is this study: Adjuvant  electroconvulsive  therapy with antipsychotics is associated with improvement in auditory mismatch negativity in schizophrenia. Liu Y, Jia LN, Wu H, Jiang W, Wang Q, Wang D, Xiong YB, Ren YP, Ma X, Tang YL. Psychiatry Res. 2022 Feb 25;311:114484. doi: 10.1016/j.psychres.2022.114484. Online ahead of print. PMID:  35245745   The article is here . And from the text: The paper is well written and the methods seem quite solid; if auditory mismatch negativity is a real thing, then this is a real article. But the jargon meter is certainly off the scale... So let's suspend disbelief for a moment and accept all the underlying premises; in that case, this is a very interesting study that shows ECT improves deficient baseline sensory (in this case, auditory) processing in schizophrenia, and improves cognition and psychopathology, with some correlations therein.  Could MMN be used as a bioma...

Senior Residents' Perceived Competence in Evidence-Based Treatments for Major Depressive Disorder. Ng E, Teshima J, Tan A, Steinberg R, Zhu A, Giacobbe P. Acad Psychiatry. 2022 Mar 4. doi: 10.1007/s40596-022-01605-4. Online ahead of print.  PMID:   35246813 The abstract is copied below: Objective: The current study aims to assess the self-reported competence of graduating psychiatry residents in Canada to provide pharmacotherapy and psychotherapy for major depressive disorder as recommended in national practice guidelines. Methods: Canadian psychiatry residents who participated in an optional national review course to prepare for licensing were anonymously surveyed regarding their experience and competence in providing treatments recommended by the 2016 Canadian Network for Mood and Anxiety Treatments guidelines. Results: The majority (89%, 130/146) reported competence in ≥ 5 medication monotherapies (e.g., selective serotonin/norepinephrine reuptake inhibitors, bupropion, mir...

 "Classics in ECT' brings you this LTE from the BJP in 1992: Continuation  ECT. Benbow SM . Br J Psychiatry. 1992 Apr;160:572-3. doi: 10.1192/bjp.160.4.572. PMID:  1571774   The letter pdf is here . The complete letter is copied below: This is an excellent LTE about continuation/maintenance ECT, following up on the article by Alan Scott in the BJP in December 1991 (see blog post of March 19,2022). The main point of blogging about it is to remind us of the early 90s zeitgeist that maintenance ECT was practiced but not much discussed or researched, just beginning to come into its own. Please see blog post of March 5, 2022 for more about Professor Susan Benbow.

Out on PubMed, from US authors in Pharma, is this study: I ncremental burden of relapse in patients with major depressive disorder: a real-world, retrospective cohort study using claims data. Touya M, Lawrence DF, Kangethe A, Chrones L, Evangelatos T, Polson M. BMC Psychiatry. 2022 Mar 1;22(1):152. doi: 10.1186/s12888-022-03793-7. PMID:  35232411 The abstract is copied below: Background: Relapse is common in major depressive disorder (MDD). In this study, we evaluated the incremental health care burden of relapse in patients with MDD. Methods: This real-world retrospective cohort study used administrative medical and pharmacy claims data to identify commercially insured adult patients in the United States diagnosed with MDD who initiated a new antidepressant between January 1, 2012, and September 30, 2017. All-cause health care resource utilization, total costs, and medication adherence were evaluated in two cohorts: patients with and patients without relapse. Relapse was defined a...

Out on PubMed, from investigators in China, is this study: Regional cerebral blood flow in major depression treated with electroconvulsive therapy: an arterial spin labeling magnetic resonance study. Shi Y, Li J, Tong P, Yang J, Zhang H, Dong L. Neurocase. 2022 Feb 27:1-5. doi: 10.1080/13554794.2022.2044861. Online ahead of print.  PMID:   35225161 The abstract is copied below: Until recently, regional cerebral blood flow (rCBF) in major depressive disorder (MDD) patients treated with electroconvulsive therapy (ECT) using arterial spin labeling (ASL) magnetic resonance imaging (MRI) have seldom been studied. We report here 10 patients with MDD treated by bilateral frontotemporal ECT. rCBF was assessed with ASL MRI pre- and post-ECT, and compared with patients treated by antidepressants. Compared to pre-ECT, rCBF significantly decreased in the bilateral frontal gyrus. Compared to medication, in patients treated with ECT, rCBF showed a significant decrease in the left amygdala, ...

Out on PubMed, from researchers in Denmark, is this study: Serum S100B protein after electroconvulsive therapy in patients with depression. Gbyl K, Jørgensen NR, Videbech P. Acta Neuropsychiatr. 2022 Mar 7:1-23. doi: 10.1017/neu.2022.8. Online ahead of print. PMID:  35249591 The abstract is copied below: Objective: S100B is a glial cell protein with bimodal function. In low concentrations, it exerts neurotrophic effects, but higher levels reflect neuronal distress. Recent research suggests that this molecule may be a biomarker of response to electroconvulsive therapy (ECT). We examined the effect of ECT on serum S100B and its utility as 1) a biomarker of a depressive state and 2) a predictor of ECT response. We also wanted to ensure that ECT does not cause a marked serum S100B-elevation, indicating neural distress. Methods: We measured serum S100B in 22 in-patients treated with ECT due to depression. Depression severity was assessed using 17-item Hamilton Rating Scale for Depressio...

Out on PubMed, from authors in England, in JECT, is this LTE: Benzodiazepine Reduction and a Generalized Tonic-Clonic Seizure With Therapeutic Benefit in Catatonia Associated With Autism Spectrum Disorder. Parry S, Raheem A, Williams E, Rogers JP. J ECT. 2022 Feb 25. doi: 10.1097/YCT.0000000000000835. Online ahead of print. PMID:   35220360 The letter is here: This is a very clearly presented case report of the beneficial effects a spontaneous seizure can sometimes have. It reminds us of one of the possible original observations that led to the development of convulsive therapy. Of course, most spontaneous (unintended) seizures are not good, and the fact that an entire course of therapeutic seizures is usually needed to treat psychiatric illness (including catatonia) means the analogy is imperfect; we have much yet to understand. This is an instructive LTE; I recommend a full read for all ECT practitioners, ~ 5 minutes.

 Out on PubMed, in JECT, is this commentary: Appreciating Ladislas Meduna: Visionary Creator of Convulsive Therapy. Fink M, Gazdag G, Shorter E. J ECT. 2022 Feb 25. doi: 10.1097/YCT.0000000000000834. Online ahead of print. PMID:   35220362 This is a very instructive historical note, paying homage to the inventor/discoverer of convulsive therapy. Please see blog post of December 10, 2021 for the links to Meduna's autobiography (reference #1 in the above). Many thanks to Max, Gabor and Ned for this excellent commentary.

 "Classics in ECT" brings you this paper from the British Journal of Psychiatry from 1991: Continuation  electroconvulsive therapy: preliminary guidelines and an illustrative case report. Scott AI , Weeks DJ, McDonald CF. Br J Psychiatry. 1991 Dec;159:867-70. doi: 10.1192/bjp.159.6.867. PMID:  1790461 The abstract is copied below: Despite renewed interest in ECT as a continuation treatment after an episode of depressive illness, few guidelines for its use are available. Meaningful research findings are few, although the potential benefits and risks of modern continuation ECT merit study. We suggest preliminary guidelines and provide an illustrative clinical example. The article is here . This is an excellent short article from the early days of the explosion of reports on maintenance ECT three decades ago. The case report of recurrent psychotic depression with failure to respond to (presumably) low-dose RUL ECT, but good response to BL ECT, is instructive. The reference t...

Out on Pubmed, from US investigators, is this review: A comparison of the safety, feasibility, and tolerability of  ECT  and ketamine for treatment-resistant depression. Tamman A, Anand A, Mathew SJ. Expert Opin Drug Saf. 2022 Mar 14:1-15. doi: 10.1080/14740338.2022.2049754. Online ahead of print. PMID:  35253555   The abstract is copied below: Treatment-resistant depression (TRD) is a problematic and prevalent public health and societal concern. Although electroconvulsive therapy (ECT) is the gold standard TRD intervention, the treatment evokes apprehension due to public perceptions, feasibility, and tolerability. Despite significant medical advancements, few medications have been approved by the U.S. Food and Drug Administration for TRD. In 2019, intranasal esketamine, the S-isomer of racemic ketamine, was approved for TRD, garnering significant excitement about the potential for the drug to act as an alternative treatment to ECT. The goal of this narrative review...

 Out on PubMed, from researchers in India, in JECT, is this study: Effect of Modified Bifrontotemporal Electroconvulsive Therapy on Executive Function in Patients With Psychiatric Illness: A Longitudinal Observational Study. Garg A, Pj P, Shirahatti B. J ECT. 2022 Feb 25. doi: 10.1097/YCT.0000000000000837. Online ahead of print. PMID:  35220364 The abstract is copied below: Objective: The study was conducted to compare the pre-electroconvulsive therapy (ECT) and post-ECT status of the executive functions of patients and report any deficits found at long-term follow-up. The secondary objective of the study was to compare the performance at executive function tests after ECT with patient characteristics and ECT parameters. Methodology: In a prospective longitudinal observational study, 50 patients in the age group of 18 to 65 years who were receiving modified bifrontotemporal ECT for the first time and admitted in psychiatry ward of a tertiary care hospital from July 2015 to Jun...

Out on PubMed, from clinicians in Nantes, France, in JECT, is this case report: Electroconvulsive  Therapy-Induced Takotsubo Cardiomyopathy: A Successful Retrial of ECT With 1-Year Follow-Up in a 69-Year-Old Woman. Guine JB, Rooze P, Bukowski N, Nicolet L, Martin-Grellier M, Laurin A, Bulteau S, Sauvaget A. J ECT. 2022 Feb 25. doi: 10.1097/YCT.0000000000000827. Online ahead of print. PMID:  35220363   While the main message of this case report is clear (safe resumption of ECT one month after TTCM), the details are quite confusing.  One hopes to get specific management advice from such a report, and there is some here, but it is pretty hard to extract and incomplete, given the way the data are presented. Careful reading, and re-reading, are needed to get the most from this LTE, ~15 minutes.