Clinical Neuroscience of ECT (CNECT)

Out on PubMed, from researchers in Australia, is this review: Effectiveness of Non-Pharmacological Interventions for Agitation during Post-Traumatic Amnesia following Traumatic Brain Injury: A Systematic Review. Carrier SL, Ponsford J, Phyland RK, Hicks AJ, McKay A. Neuropsychol Rev. 2022 Jun 10. doi: 10.1007/s11065-022-09544-5. Online ahead of print.  PMID:  35687261   Review. The abstract is copied below: Agitation is common in the early recovery period following traumatic brain injury (TBI), known as post-traumatic amnesia (PTA). Non-pharmacological interventions are frequently used to manage agitation, yet their efficacy is largely unknown. This systematic review aims to synthesize current evidence on the effectiveness of non-pharmacological interventions for agitation during PTA in adults with TBI. Key databases searched included MEDLINE Ovid SP interface, PubMed, CINAHL, Excerpta Medica Database, PsycINFO and CENTRAL, with additional online reviewing of key journals...

 Out on PubMed, from investigators in China, is this study: Electroconvulsive  Therapy-Induced Changes in Functional Brain Network of Major Depressive Disorder Patients: A Longitudinal Resting-State Electroencephalography Study. Sun S, Yang P, Chen H, Shao X, Ji S, Li X, Li G, Hu B. Front Hum Neurosci. 2022 May 18;16:852657. doi: 10.3389/fnhum.2022.852657. eCollection 2022.  PMID:  35664348   The abstract is copied below: Objectives:  Several studies have shown abnormal network topology in patients with major depressive disorder (MDD). However, changes in functional brain networks associated with electroconvulsive therapy (ECT) remission based on electroencephalography (EEG) signals have yet to be investigated. Methods:  Nineteen-channel resting-state eyes-closed EEG signals were collected from 24 MDD patients pre- and post-ECT treatment . Functional brain networks were constructed by using various coupling methods and binarization techniques. Changes ...

 Out on PubMed, from researchers in China, is this study: Changes in the amplitude of low-frequency fluctuations in specific frequency bands in major depressive disorder after  electroconvulsive  therapy. Li XK, Qiu HT, Hu J, Luo QH. World J Psychiatry. 2022 May 19;12(5):708-721. doi: 10.5498/wjp.v12.i5.708. eCollection 2022 May 19. PMID:  35663299   The abstract is copied below: Background: Major depressive disorder (MDD) tends to have a high incidence and high suicide risk. Electroconvulsive therapy (ECT) is currently a relatively effective treatment for MDD. However, the mechanism of efficacy of ECT is still unclear. Aim: To investigate the changes in the amplitude of low-frequency fluctuations in specific frequency bands in patients with MDD after ECT. Methods: Twenty-two MDD patients and fifteen healthy controls (HCs) were recruited to this study. MDD patients received 8 ECT sessions with bitemporal placement. Resting-state functional magnetic resonance ima...

 Out on PubMed, from investigators in Iran, is this paper: The effect of risperidone and electroconvulsive therapy on corrected QT interval in electrocardiogram of psychiatric patients. Rezaei B, Javdani H, Soleimannejad M, Dodangeh S. ARYA Atheroscler. 2021 Jul;17(4):1-6. doi: 10.22122/arya.v17i0.2235. PMID:  35685233   The abstract is copied below: Background: Some types of antidepressants and antipsychotic medications have cardiovascular side effects that can be life-threatening. Electroconvulsive therapy (ECT) is capable of generating physiological stress and may lead to increased QT interval followed by arrhythmias. Risperidone can also increase the risk of arrhythmia by increasing the corrected QT (QTc) interval. Since many patients require co-administration of risperidone and ECT, this study aimed to investigate the concurrent effect of ECT and risperidone administration on the QTc interval. Methods: For this cross-sectional study, 60 patients (18-65 years) admitte...

Out on PubMed, from investigators in China, is this study: Improved Safety of Hybrid Electroconvulsive Therapy Compared With Standard Electroconvulsive Therapy in Patients With Major Depressive Disorder: A Randomized, Double-Blind, Parallel-Group Pilot Trial. Zhang JY, Xu SX, Zeng L, Chen LC, Li J, Jiang ZY, Tan BJ, Gu CL, Lai WT, Kong XM, Wang J, Rong H, Xie XH. Front Psychiatry. 2022 May 23;13:896018. doi: 10.3389/fpsyt.2022.896018. eCollection 2022.  PMID:   35677877 The abstract is copied below: Objectives: ECT is a rapid and effective treatment for depression. While efficacy is often remarkable over the initial 3-4 sessions, the efficacy of later sessions is less rapid, and the side-effects, especially cognitive impairment limit its use. To preliminarily compare the efficacy and acceptability of a novel hybrid-ECT (HECT) protocol for patients with major depressive disorder (MDD) with standard ECT, we conducted this pilot trial. Methods: Thirty patients were randomly assi...

 "Classics in ECT" brings you this announcement from JAMA in 1954: MEDCRAFT  glissando  type shock therapy unit, model B-24. [No authors listed] J Am Med Assoc. 1954 May 8;155(2):126. PMID:  13151902 Here is an announcement in JAMA in 1954 from the Council on Physical Medicine and Rehabilitation "Apparatus Accepted" section. This early Medcraft had the "glissando" feature, for gradual application of the stimulus. It looks pretty modern, compared to the "Tractolater" (see above).

 "Classics in ECT" brings you this case report from the American Journal of Psychiatry, from 1957: Electroshock therapy and aortic aneurysm. WOLFORD JA. Am J Psychiatry. 1957 Jan;113(7):656. doi: 10.1176/ajp.113.7.656. PMID:  13394736 The pdf is here . Here is an early report of of a large number of ECT administered to a patient with a thoracic aortic aneurysm. Unfortunately, there are no details of the ECT technique or anesthesia, and it is unclear if the patient's demise from aneurysmal rupture was ECT-related. This turns out to be one of the earliest reports of maintenance ECT, and the conclusion is that the patient was given several good years of life by having had the ECT. (Please see also blog post of June 14, 2022)

Out on PubMed, from clinicians in Delaware, is this case report: The Role of Acetylcholinesterase Inhibitors in the Treatment of Prolonged Postelectroconvulsive Therapy Delirium. Gutowski B, Bomasang-Layno E. Case Rep Psychiatry. 2022 May 30;2022:6966882. doi: 10.1155/2022/6966882. eCollection 2022. PMID:  35677728 The abstract is copied below: Electroconvulsive therapy (ECT) is an extremely effective treatment modality for severe depression but is often associated with transient or persistent cognitive impairment. ECT-induced cognitive impairment, however, can serve as a deterrent to completion of treatment. We present a case of a prolonged post-ECT delirium lasting approximately 3 weeks in which donepezil, an acetylcholinesterase inhibitor, was used and was successful in shortening the duration of post-ECT delirium. The case report is here . And from the text: This case report raises some issues about the diagnosis of post-ECT delirium and its management. That the authors did not...

 Out on PubMed, from authors in the UK and Ireland, is this commentary: ECT   is evidence-based - a commentary on depression: why drugs and electricity are not the answer. Meechan CF, Laws KR, Young AH, McLoughlin DM, Jauhar S. Psychol Med. 2022 Jun 8:1-3. doi: 10.1017/S003329172200085X. Online ahead of print.  PMID:  35674232   The pdf is here . And the full commentary is here: Rebutting Read and Moncrieff is a dirty job, but someone's gotta do it, and Meechan and colleagues do it very well. This point-by-point rebuttal is well-crafted and authoritative.  It still defies explanation that reputable medical journals continue to publish Read and colleagues' diatribes. With hope that the back-and-forth ends here, I recommend a full and careful read (small "r") of the above (~8 mins) to all ECT healthcare personnel. Kudos to the authors for setting the record straight.

 Out on PubMed, from investigators in Japan, is this study: Characteristics of the treatments for each severity of major depressive disorder: A real-world multi-site study. Muraoka H, Kodaka F, Hasegawa N, Yasui-Furukori N, Fukumoto K, Kashiwagi H, Tagata H, Hori H, Atake K, Iida H, Ichihashi K, Furihata R, Tsuboi T, Takeshima M, Komatsu H, Kubota C, Ochi S, Takaesu Y, Usami M, Nagasawa T, Makinodan M, Nakamura T, Kido M, Ueda I, Yamagata H, Onitsuka T, Asami T, Hishimoto A, Ogasawara K, Katsumoto E, Miura K, Matsumoto J, Ohi K, Yamada H, Watanabe K, Inada K, Nishimura K, Hashimoto R. Asian J Psychiatr. 2022 May 18;74:103174. doi: 10.1016/j.ajp.2022.103174. Online ahead of print.  PMID:   35661492 The abstract is copied below: Purpose: In the treatment guidelines for major depressive disorder (MDD), the recommended treatment differs based on the severity. However, the type of treatment provided based on the severity of MDD in real-world clinical practice has not been inve...

Out on PubMed, from researchers in the Low Countries, is this paper : Long-term Outcome Following Electroconvulsive Therapy for Late-Life Depression: Five-Year Follow-up Data From the MODECT Study. Lambrichts S, Wagenmakers MJ, Vansteelandt K, Obbels J, Schouws SNTM, Verwijk E, van Exel E, Bouckaert F, Vandenbulcke M, Schrijvers D, Veltman DJ, Beekman ATF, Oudega ML, Sienaert P, Dols A. Am J Geriatr Psychiatry. 2022 May 18:S1064-7481(22)00417-1. doi: 10.1016/j.jagp.2022.05.010. Online ahead of print. PMID:  35667960 The abstract is copied below: Objective: Electroconvulsive therapy (ECT) is the most effective treatment for late-life depression (LLD). Research addressing long-term outcome following an acute course of ECT for LLD is limited. We aimed to describe relapse, cognitive impairment and survival 5 years after a treatment with ECT for severe LLD, and assess the association of clinical characteristics with all three outcome measures. Methods: This cohort study was part of the ...

 Out on PubMed, from Indian authors, is this "viewpoint": Electroconvulsive  Therapy: A Closer Look into Legal Provisions in the MHCA, 2017. Narayan CL, Deepanshu M. Indian J Psychol Med. 2022 May;44(3):293-296. doi: 10.1177/02537176221077309. Epub 2022 May 1. PMID:  35656437 The article is here . And from the text: While the specific details of Indian mental health law may not be of great interest to non-Indian psychiatrists, it is worth knowing about the general issues described in this commentary. The authors make very reasonable suggestions about simplifying the Mental Health care Act (MHCA) such that ECT can be provided in emergencies and in appropriate outpatient settings. One important reminder that comes from reading this piece is that the WHO Resource Book on Mental Health, Human Rights, and Legislation  has some very inappropriate  and denigrating comments about ECT. I hope blog readers will take the ~ 10 minutes to read this piece in full and thi...

 "Classics in ECT" brings you this article from the British Journal of Anaesthesia, from 1969: Electroconvulsive   therapy no-relaxant anaesthesia. Delilkan AE. Br J Anaesth. 1969 Oct;41(10):884-9. doi: 10.1093/bja/41.10.884. PMID:  5347162 The pdf is here . The first page of the article is here: Here's an interesting report, of historical interest, written by an anesthesiologist in Malaysia in 1969. It describes an experimental anesthesia and ECT technique that attempted to eliminate the need for muscle relaxation. It involved methohexital anesthesia induction, a gradually ramped up stimulus delivery (also called the "glissando" method) and manual holding of the patient's jaw, to eliminate dental/oral injury. The author reports good results, including better hemodynamics. Of course, this did not catch on, and is of purely historical interest, but it is an example of well-intentioned attempts to optimize overall ECT technique. For history buffs, this is a go...

 "Classics in ECT" brings you this paper from 1987: Electroconvulsive therapy use in  geriatric  depression. Kramer BA. J Nerv Ment Dis. 1987 Apr;175(4):233-5. doi: 10.1097/00005053-198704000-00008. PMID:  3559535 The abstract is copied below: A retrospective review of elderly patients who received electroconvulsive therapy (ECT) over an 18-month period found ECT to be safe and effective. Of the 1159 patients admitted to the psychiatric unit during this time period, 50 patients (4.3%) aged 61 to 88 received between two and 14 ECT treatments. Brief pulse current with bilateral electrode placement and electroencephalogram monitoring were used with each patient. A total of 46 patients (92%) were much improved after ECT. Of the four nonresponders, three terminated treatment prematurely due to increased confusion, and one failed to respond after a course of 12 ECT treatments. There were no medical complications related to the ECT. A mean of 4.93 months from the onset of s...

 Out on PubMed, from researchers in Singapore and Australia, is this study: The Impact of Electroconvulsive Therapy on Negative Symptoms in Schizophrenia and Their Association with Clinical Outcomes. Tan X, Martin D, Lee J, Tor PC. Brain Sci. 2022 Apr 25;12(5):545. doi: 10.3390/brainsci12050545. PMID:  35624932   The abstract is copied below: Objective: The treatment efficacy of electroconvulsive therapy (ECT) for negative symptoms amongst patients with schizophrenia remains unclear. In this study, we aim to examine the effects of ECT on negative symptoms in schizophrenia and their association with other clinical outcomes, including cognition and function. Methods: This is a retrospective data analysis of patients with schizophrenia/schizoaffective disorder treated with ECT at the Institute of Mental Health (IMH), Singapore, between January 2016 and December 2019. Clinical outcomes were assessed by the Brief Psychiatric Rating Scale (BPRS), the Montreal Cognitive Assessme...

 Out on PubMed, from researchers in New Mexico and the NIMH is this paper in JECT: Ictal Theta Power as an Electroconvulsive Therapy Safety Biomarker: A Pilot Study. Miller J, Jones T, Upston J, Deng ZD, McClintock SM, Ryman S, Quinn D, Abbott CC. J ECT. 2022 Jun 1;38(2):88-94. doi: 10.1097/YCT.0000000000000812. PMID:  35613008 The abstract is copied below: Objective: Electroconvulsive therapy (ECT) remains the benchmark for treatment resistant depression, yet its cognitive adverse effects have a negative impact on treatment. A predictive safety biomarker early in ECT treatment is needed to identify patients at cognitive risk to maximize therapeutic outcomes and minimize adverse effects. We used ictal electroencephalography frequency analysis from suprathreshold treatments to assess the relationships between ECT dose, ictal power across different frequency domains, and cognitive outcomes. Methods: Seventeen subjects with treatment resistant depression received right unilateral...