Clinical Neuroscience of ECT (CNECT)

 Out on PubMed, from authors in Atlanta, is this review: The Use of   ECT   in the Elderly-Looking Beyond Depression. Chatham AN, Shafi H, Hermida AP. Curr Psychiatry Rep. 2022 Jul 13. doi: 10.1007/s11920-022-01353-0. Online ahead of print.  PMID:  35829850   Review. The abstract is copied below: Purpose of review: We reviewed recent evidence on the use of electroconvulsive therapy (ECT) in the geriatric population. This review looked at the literature on depression, for which there is a breadth of data, as well as other conditions that have historically not been as well studied, as well as attempting to provide practical recommendations for ECT practitioners. This review also examined the impact of the COVID-19 pandemic on ECT in the elderly. Recent findings: ECT shows robust efficacy across many psychiatric diseases, from depression and bipolar disorder to psychosis and catatonia. It has also shown positive results at improving behavioral symptoms of deme...

"Classics in ECT" brings you this meta-analysis from 1992:  Psychotic (delusional) depression: a meta-analysis of  physical   treatments . Parker G , Roy K, Hadzi-Pavlovic D, Pedic F. J Affect Disord. 1992 Jan;24(1):17-24. doi: 10.1016/0165-0327(92)90056-c. PMID:  1347545 The pdf is here . The abstract is copied below: Literature reviews have suggested that combination antidepressant/antipsychotic drug therapy and electroconvulsive therapy (ECT) are of comparable efficacy in treating psychotic depression, and distinctly superior to antidepressant alone or antipsychotic alone. We undertook a meta-analysis of 44 studies, and focussed on those three principal treatment options. There was a trend for ECT to be superior to combination drug therapy, with bilateral ECT being suggested as distinctly more effective than unilateral, and ECT was demonstrated to be significantly superior to tricyclic drug alone. Combination drug therapy ranked as more effective than antipsychoti...

Out on PubMed, from clinicians in Japan, is this LTE: Successful treatment using combined monthly maintenance  electroconvulsive  therapy and monthly long-acting injection paliperidone for treatment-resistant schizophrenia with vulnerability to clozapine: a case report. Hirakawa H, Terao T, Muronaga M. Psychiatry Clin Neurosci. 2022 Jul 13. doi: 10.1111/pcn.13450. Online ahead of print. PMID:  35822460 The LTE is here . And here: While some of the ECT details are wonky, this is a worthwhile case report that adds to the ECT literature on the management of patients with TRS. 

 Out on PubMed, from investigators in Japan, is this study: Early electroconvulsive therapy in patients with bipolar depression: A propensity score-matched analysis using a nationwide inpatient database. Yamazaki R, Ohbe H, Matsuda Y, Kito S, Shigeta M, Morita K, Matsui H, Fushimi K, Yasunaga H. J Affect Disord. 2022 Jun 24:S0165-0327(22)00720-0. doi: 10.1016/j.jad.2022.06.060. Online ahead of print. PMID:  35760194 The abstract is copied below: Objectives: Electroconvulsive therapy (ECT) is a widely used treatment for bipolar depression; however, evidence of its effectiveness is not sufficient. This study therefore aimed to evaluate whether early ECT is associated with reduced length of hospital stay. Methods: In this retrospective cohort study using the Japanese Diagnosis Procedure Combination database, we identified patients admitted for bipolar depression between April 2010 and March 2018. The primary outcome was length of hospital stay, and the secondary outcome was clini...

Out on PubMed, from authors in China, is this LTE: Electroconvulsive   therapy plays an irreplaceable role in treatment of major depressive disorder. Ma ML, He LP. World J Clin Cases. 2022 Jun 6;10(16):5515-5517. doi: 10.12998/wjcc.v10.i16.5515. PMID:  35812666   The abstract is copied below: Major depressive disorder is a serious and common neuropsychiatric disorder that affects more than 350 million people worldwide. Electroconvulsive therapy is the oldest and most effective treatment available for the treatment of severe major depressive disorder. Electroconvulsive therapy modifies structural network changes in patients with major depressive disorder and schizophrenia. And it can also affect neuroinflammatory responses and may have neuroprotective effects. Electroconvulsive therapy plays an irreplaceable role in the treatment of major depressive disorder. Keywords: Depression; Electroconvulsive therapy; Major depressive disorder; Somatic cell therapy. The letter is he...

 Out on PubMed, from researchers in Japan, is this paper: An Online Survey About Electroconvulsive Therapy in Japan During the COVID-19 Pandemic: Comparison of Early and Recent Stages. Hirata R, Kawashima H, Tsuboi T, Wada K, Takebayashi M, Suwa T. Neuropsychiatr Dis Treat. 2022 Jun 28;18:1277-1285. doi: 10.2147/NDT.S365417. eCollection 2022. PMID:  35789588   The abstract is copied below: Purpose: To provide an overview of how electroconvulsive therapy (ECT) practice in Japan has changed as the coronavirus disease 2019 (COVID-19) pandemic continues. Patients and methods: We surveyed healthcare institutions, primarily university and general hospitals, regarding changes in the number of patients undergoing ECT and infection control measures in the early (August 2020) and recent (August 2021) stages of the COVID-19 pandemic. Data for the early and recent stages were also compared between urban and non-urban areas. Results: Among 32 facilities, the number of patients undergo...

This book review appears in The Atlantic: https://www.theatlantic.com/books/archive/2022/07/-desperate-remedies-book-review-mental-illness-cure/670480/ Here is what the review says about ECT: Thank goodness it's only a book and a book review. And I certainly don't plan to buy the book to find out what else it says about ECT.  Scull and Merkin seem to be disgruntled pseudo-experts, hell-bent on smearing Psychiatry and psychiatrists. Tar and feather the whole lot, failing to distinguish between colectomy, lobotomy, and ECT. Thanks to George Petrides for alerting me to this book review in The Atlantic . The only reason to blog about it is to let you know it is out there.

 Out on PubMed, from authors in South America, is this review: Electroconvulsive Therapy in Psychiatric Disorders: A Narrative Review Exploring Neuroendocrine-Immune Therapeutic Mechanisms and Clinical Implications. Rojas M, Ariza D, Ortega Á, Riaño-Garzón ME, Chávez-Castillo M, Pérez JL, Cudris-Torres L, Bautista MJ, Medina-Ortiz O, Rojas-Quintero J, Bermúdez V. Int J Mol Sci. 2022 Jun 22;23(13):6918. doi: 10.3390/ijms23136918. PMID:  35805923   Review. The abstract is copied below: Electroconvulsive therapy (ECT) is based on conducting an electrical current through the brain to stimulate it and trigger generalized convulsion activity with therapeutic ends. Due to the efficient use of ECT during the last years, interest in the molecular bases involved in its mechanism of action has increased. Therefore, different hypotheses have emerged. In this context, the goal of this review is to describe the neurobiological, endocrine, and immune mechanisms involved in ECT and to de...

 "Classics in ECT" brings you this review by William Karliner  from 1978: ECT for patients with CNS disease. Karliner W. Psychosomatics. 1978 Dec;19(12):781-3. doi: 10.1016/S0033-3182(78)70896-0. PMID:  734033   The pdf is here . Written by the great trailblazing ECT practitioner, William Karliner, this review appeared in Psychosomatics in 1978. The overall message, that safe ECT may be possible despite the presence of neurologic disease, is well taken. The cases are mostly from a time before brain imaging (except pneumo encephalograms) and are not necessarily examples of how current practice would assess these situations; also, the promotion of the "drip method" of ECT anesthesia, without full details of the technique, seems a bit strange. The recommendation of liberal oxygen use is a good one. A full read, ~10 minutes, makes the reader appreciate the efficacy and safety of ECT, and the fact that modern practitioners have much better tools to diagnose neurolog...

"Classics in ECT" brings you this article from The British Journal of Psychiatry, from 1966: Dental care in electroplexy. Durrant BW. Br J Psychiatry. 1966 Nov;112(492):1173-6. PMID:  5971539 The pdf is here . The article is here: This review is a bit obsessional and slightly misguided in some of its assertions and recommendations. I blog about it not as a primer for dental care in ECT, but as an historical document, showing that this aspect of ECT care was worthy of consideration by the British Journal of Psychiatry in the 1960s. I also like the quaintness of calling ECT, "electroplexy."

Out on PubMed, from researchers in Sweden, is this study: Association of Clinical and Demographic Characteristics With Response to Electroconvulsive Therapy in Mania. Popiolek K, Bejerot S, Landén M, Nordenskjöld A. JAMA Netw Open. 2022 Jun 1;5(6):e2218330. doi: 10.1001/jamanetworkopen.2022.18330. PMID:  35737387 The abstract is copied below: Importance: Knowledge of the effectiveness of electroconvulsive therapy (ECT) in the treatment of manic episodes is based on clinical experience, but empirical evidence is scarce. Moreover, prognostic factors associated with response to ECT in patients with mania are poorly understood. Objective: To investigate the response to ECT in patients with manic episodes. Design, setting, and participants: This nationwide, register-based observational cohort study was conducted using data from patients admitted to psychiatric departments in Sweden that reported data to the Swedish National Quality Registry for ECT (Q-ECT). Patients admitted to any hosp...

 Out on PubMed, from clinicians in the US, is this case report: Non-convulsive Status Epilepticus in a Patient With Schizoaffective and Seizure Disorder on Clozapine and Electroconvulsive Therapy: A Case Report. Weiss JR, Baker LP. Cureus. 2022 May 25;14(5):e25337. doi: 10.7759/cureus.25337. eCollection 2022 May. PMID:  35761918     The abstract is copied below: There is limited literature on electroconvulsive therapy (ECT) in patients with a severe schizophrenia spectrum illness and concomitant seizure disorder. In addition, it is unclear whether it is safe to perform ECT in a patient with these comorbidities and a history of status epilepticus. This is the case of a 48-year-old patient with a history of schizoaffective disorder, bipolar type, refractory psychosis on clozapine and ECT, and seizure disorder on carbamazepine. She presented to the emergency department with suspected post-ECT delirium four days after her last ECT treatment, was found to be in non-convul...

Published online in Molecular Psychiatry is this LTE: The pdf is here . This is a brief, well-referenced assessment of ECT's proper role in psychiatric treatment. It is all too easy to let ECT be sidelined in review papers; kudos to my German colleagues for calling this out to Molecular Psychiatry and a big thanks for asking me to collaborate with them. I hope all ECT practitioners will read this; blog readers kindly share it with your colleagues.

 Out on PubMed, in JECT, from researchers in Belgium, is this review: Asystole During Electroconvulsive Therapy: Does Electrode Placement Matter? A Systematic Review. Hartnett S, Rex S, Sienaert P. J ECT. 2022 Jun 11. doi: 10.1097/YCT.0000000000000863. Online ahead of print. PMID:  35700970 The abstract is copied below: Asystole presenting at the start of electrical stimulus application during electroconvulsive therapy (ECT) is a relatively common occurrence. It is most likely caused by vagal nerve stimulation, affecting autonomic cardiac tone. This article reviews the effect of the electrode placement (EP) on the incidence and severity of bradycardia and asystole. A systematic literature review was conducted using the Embase and PubMed databases, up to September 2021, searching for studies evaluating the effect of EP on bradycardia and/or asystole during ECT. Nine case reports describing asystole in patients receiving ECT almost exclusively reported the association with bitem...

Out on PubMed, from researchers in Germany, in JECT, is this report: Electroconvulsive Therapy in Children and Adolescents in Germany-A Case Series From 3 University Hospitals. Karl S, Methfessel I, Weirich S, Rothermel B, Crozier J, Besse M, Reinhardt M, Buchmann J, Dück A, Schulz J, Zilles-Wegner D, Häßler F, Kölch M, Uebel von Sandersleben H, Poustka L, Sartorius A. J ECT. 2022 Jun 11. doi: 10.1097/YCT.0000000000000861. Online ahead of print. PMID:  35700967 The abstract is copied below: Objective: Electroconvulsive therapy (ECT) is a well-established, safe, and efficacious treatment for severe psychiatric disorders. In children and adolescents, it is used much less frequently than in adults, likely because of a lack of knowledge. Methods: We retrospectively analyzed all patients aged 12 to 17 years who completed a course of ECT at 3 psychiatric university hospitals in Germany between 2010 and 2020. Clinical Global Impression Severity (CGI-S) scores were assessed based on electr...

 Out on PubMed, in JECT, is this case report: Electroconvulsive Therapy With Titanium-Based Uveoscleral Stents. Rasheed HA, Cohenmehr J, Chen ST. J ECT. 2022 Jun 11. doi: 10.1097/YCT.0000000000000871. Online ahead of print. PMID:  35700965 The LTE is here: This is an instructive LTE, adding to the literature on the safety of ECT in the presence of cranial metal objects. Without taking anything away from a highly cautious attitude in approaching patient safety, the inescapable conclusion is that theoretical concerns are often not borne out in clinical care. It is instructive for non-ophthalmologists to learn about this new stenting technique as a treatment for glaucoma.  Kudos to these authors for taking the time to add this case report to the ECT literature, particularly the first author medical student.

 "Classics in ECT" brings you this "Special Article" from the Journal of the Canadian Medical Association, in 1959: Why such apprehension over "shock treatment"? PASCOE H. Can Med Assoc J. 1959 Nov 1;81(9):738-40. PMID:  14430684 The pdf is here . The text is here: Here is an interesting early defense of ECT. Dr. Pascoe's candor about the state of knowledge of mechanism of action is refreshing. We get a glimpse of the range of available psychiatric treatments in 1959, just as antidepressants were being introduced and somatic therapies other than ECT were being phased out.