Clinical Neuroscience of ECT (CNECT)

"Classics in ECT" brings you this study from the Green Journal in 1961: A comparative study of selected antidepressant medications and EST. GREENBLATT M , GROSSER GH, WECHSLER H. Am J Psychiatry. 1962 Aug;119:144-53. doi: 10.1176/ajp.119.2.144. PMID:   13901499   The pdf is here . And from the text: This study, by noted psychiatrist, Milton Greenblatt (1914-1994), is a fine classic read. In some ways it is the literary equivalent of easy-listening jazz: well written, easy to read, no surprises, satisfying results. Only the diagnostic categories used in the study are dated and a bit hard to translate to modern cohorts. It is from the time when antidepressant medications were new and amazing. "EST" became ECT and these early drugs have largely (but not totally) been superseded.  (Please see also blog post of October 7, 2020 for some later work by Dr. Greenblatt.)

Out on PubMed, from clinicians in Japan, is this case report: Effectiveness of  Electroconvulsive  Therapy for Apathy accompanied by Psychosis in Early-onset Parkinson's Disease - Case Report. Yamaoka K, Masuda Y, Wada K. Psychiatry Clin Neurosci. 2022 Apr 15. doi: 10.1111/pcn.13365. Online ahead of print. PMID:  35426204 The report is here . And from the text: (before ECT, no post-ECT scan shown) This is a simple case report demonstrating the expected good response of PD to ECT, with a focus on the decrese in apathy. The results were sustained for several months, repeat courses were administered, but no maintenance treatment regimen was prescribed, for unclear reasons. This  case is mainly helpful as a reminder of the benefits of ECT in PD, still mostly overlooked and prescribed only rarely and reluctantly...

Out on PubMed, from researchers in new England, is this study: Electroconvulsive   Therapy and Death by Suicide. Watts BV, Peltzman T, Shiner B. J Clin Psychiatry. 2022 Apr 13;83(3):21m13886. doi: 10.4088/JCP.21m13886. PMID:  35421285 The abstract is copied below: Background:  It is currently unclear if a course of electroconvulsive therapy (ECT) is associated with a decreased risk of death by suicide. The limited literature based on evidence either does not reflect contemporary practice or else includes patients receiving as few as one treatment. We sought to examine the association of an adequate exposure to ECT treatment with risk of death by suicide in a present-day sample. Methods:  We conducted a study using electronic medical record data from the Department of Veterans Affairs health system from between 2000 and 2017. We compared all-cause and suicide mortality among patients who received an index course of ECT with a comparison group created through propensit...

Out on PubMed, from Finnish investigators, is this study: Courses of treatment and risk factors for treatment-resistant depression in Finnish primary and special healthcare: A nationwide cohort study. Lähteenvuo M, Taipale H, Tanskanen A, Rannanpää S, Tiihonen J. J Affect Disord. 2022 Apr 6:S0165-0327(22)00343-3. doi: 10.1016/j.jad.2022.04.010. Online ahead of print. PMID:  35398108 The abstract is copied below: Objective: Investigate incidence, risk factors and courses of treatment for treatment-resistant depression (TRD) in primary and special healthcare. Methods: All patients identified from nationwide registers, aged 16-65 years, diagnosed with depression in Finland during 2004-2016 were included. New antidepressant users were identified with six-month washout period and followed-up for two years to observe for presence of TRD, which was defined as initiation of a third trial after having failed two pharmacological treatment trials with adequate duration. Results: During follow...

 Out on PubMed, from clinicians at the Massachusetts General Hospital, in JECT, is this case report: Rapid Resolution of Prolonged Benzodiazepine-Refractory Catatonia With Electroconvulsive Therapy in an Adolescent Patient: A Case Report. Luccarelli J, Fernandez-Robles C, Wininger B, Becker JE, Hazen EP, Henry ME. J ECT. 2022 Apr 4. doi: 10.1097/YCT.0000000000000841. Online ahead of print. PMID:  35389960 The full letter is here: This is an excellent case report with many teachable moments; the need for more timely prescription of ECT in urgent catatonia cases is probably the most important. The dance of giving/withholding neuroleptics is also interesting and unresolved.  It would be informative to have more details of any residual non-catatonic psychiatric symptoms in this patient; the lack of any prior personal or family psychiatric history is noteworthy. All catatonia scholars/students will want to read this LTE.

 Out on PubMed, from the Harvard group, in JECT, is this study: The Duration in Treatment With Electroconvulsive Therapy Among Patients Screening Positive or Negative for Borderline Personality Disorder Traits: A Retrospective Cohort Study. Luccarelli J, McCoy TH Jr, Yip AG, Seiner SJ, Henry ME. J ECT. 2022 Apr 4. doi: 10.1097/YCT.0000000000000847. Online ahead of print. PMID:   35389952 The abstract is copied below: And from the text: This is another interesting dataset from the Harvard group, dazzling mostly because of the large "n". The finding that patients who screen positive for BPD are more likely to receive at least 10 ECT, without lots of additional information, is hard to interpret, as the authors do point out. They choose to interpret it to mean good tolerability, and downplay the possibility that it signals more equivocal/slower response. In any case, the data are the data, and we are again indebted to Dr. Luccarelli for mining them. I suspect most ECT practitione...

Out on PubMed, from investigators in Turkey and the Netherlands, is this study: The superiority of ketofol and etomidate against propofol or thiopental anesthesia for  ECT . Gurel SC, Ozden HC, Karahan S, Ayhan Y. Asian J Psychiatr. 2022 Apr 1;72:103090. doi: 10.1016/j.ajp.2022.103090. Online ahead of print.  PMID:   35390580 The abstract is copied below: Objectives:  Most anesthetic drugs used for electroconvulsive therapy (ECT) have dose-dependent anticonvulsive effects, counter-acting seizure induction, lowering seizure quality. However, a consummate drug for ECT anesthesia has not yet been established. Therefore, in this study, we aimed to investigate the effects of etomidate, thiopental, propofol and co-administration of ketamine-propofol (ketofol) on seizure quality and hemodynamic safety. Methods:  Registries of 121 patients (1077 sessions) were retrospectively evaluated. The effects of anesthetics on ECT-related parameters (stimulation charge, central se...

Out on PubMed, from investigators in France, is this paper:  The anticholinergic burden is not associated with cognitive impairments in patients treated by electroconvulsive therapy for treatment-resistant depression. Laurin A, Bonjour M, Galvao F, Dubien Berbey C, Sauvaget A, Bulteau S. J Psychiatr Res. 2022 Mar 24;150:87-95. doi: 10.1016/j.jpsychires.2022.03.038. Online ahead of print.  PMID:  35366599 The abstract is copied below: Background: Electroconvulsive therapy (ECT) is the most effective non-pharmacological treatment for treatment-resistant depression (TRD) but can expose to transient cognitive impairments. Understanding factors underlying these cognitive side effects is important. This study investigated the impact of anticholinergic treatments on cognitive performances after ECT courses for TRD in naturalistic condition. Methods: Impact of anticholinergic burden (Anticholinergic Impregnation Scale, AIS) on cognitive changes (Montreal Cognitive Assessment, MoC...

"Classics in ECT" brings you these "clinical notes"  from the December, 1961 issue of the American Journal of Psychiatry: A brief "clinical note" about the decreased use of ECT in a Chicago hospital in 1960 compared to 1958 appeared immediately after a note about thalidomide as an hypnotic agent.  The two are actually thematically related in that they both are part of the early 1960s phenomenon of unbridled optimism for pharmaceutical agents; the ECT note suggesting that antidepressant medications would nearly obviate the need for ECT, the thalidomide note praising the drug as a replacement for barbiturates, with no hint of safety concerns. We all know what happened soon after that: thalidomide was taken off the market after it was found to be teratogenic, ECT soldiered on. Both of these notes make very good "classics" reading, the ECT one as a period piece, the thalidomide one as an "oh no"-fill-you-with-dread read...

Out on Pubmed, from clinicians in Germany, is this case report: Immunological changes following electroconvulsive therapy in multiple sclerosis. Kavakbasi E, Rodner F, Nimalavachchlan L, Schwarte K, Schettler C, Bonnekoh LM, Opel N, Peine AC, Baune BT, Hohoff C. J Psychiatr Res. 2022 Apr 3;150:180-183. doi: 10.1016/j.jpsychires.2022.03.061. Online ahead of print.   PMID:   35390698 The abstract is copied below: Introduction:  Electroconvulsive therapy (ECT) is a well-established treatment option in case of treatment-resistant depression (TRD). Only a few cases of ECT in depressed patients with multiple sclerosis (MS) were reported so far suggesting efficacy for the treatment of severe depression in MS, while data on possible neurological deterioration remained unclear. Methods:  In this case study we report on a case of a middle-aged man with MS. He was on dimethyl fumarate for relapse prevention since 2019 and without signs of active disease in a recent cerebra...

Out on PubMed, from researchers in China, is this study: The correlation between dynamic functional architecture and response to  electroconvulsive  therapy combined with antipsychotics in schizophrenia. Gong J, Cui LB, Zhao YS, Liu ZW, Yang XJ, Xi YB, Liu L, Liu P, Sun JB, Zhao SW, Liu XF, Jia J, Li P, Yin H, Qin W. Eur J Neurosci. 2022 Apr 6. doi: 10.1111/ejn.15664. Online ahead of print. PMID:  35388553 The abstract is copied below:Attempts to determine why some patients respond to electroconvulsive therapy (ECT) are valuable in schizophrenia. Schizophrenia is associated with aberrant dynamic functional architecture, which might impact the efficacy of ECT. We aimed to explore the relationship between pre-treatment temporal variability and ECT acute efficacy . Forty-eight patients with schizophrenia and thirty healthy controls underwent functional magnetic resonance imaging to examine whether patterns of temporary variability of functional architecture differ between hi...

 "Classics in ECT" brings you this LTE from The British Medical Journal in 1977: ECT  and the  media . Anderson JF, MacDonald EJ, Morrison A, Armit KM, MacGregor DM. Br Med J . 1977 Oct 22;2(6094):1081-2. doi: 10.1136/bmj.2.6094.1081. PMID:  922428 The pdf is here . If you only read one thing about ECT this week, I hope it is this (the first letter, not the following two, although they are interesting as well...). This LTE was followed by no less than six (6!) retorts in the BMJ over the next year, some friendly, some decidedly hostile, including one from the "Acting National Chairman, Citizens' Commission on Human Rights, a Mental Health Reform Group sponsored by the Church of Scientology." I do love this letter about the media; without having known about it, we published Electroconvulsive Therapy (ECT) in the News: "Balance" Leads to Bias, JECT 2017; 33(1):1-2. That piece describes the same flawed concept, that presenting half scientific/clinical fac...

 Out on PubMed, from investigators in Denmark and Ireland, is this paper: Subjective cognitive complaints and subjective cognition following  electroconvulsive  therapy for depression: A systematic review and meta-analysis. Semkovska M, Knittle H, Leahy J, Rasmussen JR. Aust N Z J Psychiatry. 2022 Apr 1:48674221089231. doi: 10.1177/00048674221089231. Online ahead of print. PMID:  35362328 The abstract is copied below: Background:  Subjective cognitive complaints represent a leading reason for suboptimal prescription of electroconvulsive therapy, the most acutely effective treatment for depression. However, research findings regarding their presentation are conflicting. Objective:  To describe, quantify and explain the variability in subjective cognitive complaints and subjective cognition following electroconvulsive therapy for depression. Methods:  We searched systematically PubMed, Embase, PsycARTICLES, CINAHL and relevant reviews for research publis...