Clinical Neuroscience of ECT (CNECT)

Out on PubMed, from international investigators, is this study: Multimodal multi-center analysis of electroconvulsive therapy effects in depression: Brainwide gray matter increase without functional changes. van de Mortel LA, Bruin WB, Thomas RM, Abbott C, Argyelan M, van Eijndhoven P, Mulders P, Narr KL, Tendolkar I, Verdijk JPAJ, van Waarde JA, Bartsch H, Oltedal L, van Wingen GA. Brain Stimul. 2022 Aug 6:S1935-861X(22)00171-1. doi: 10.1016/j.brs.2022.07.053. Online ahead of print. PMID:  35944604 The abstract is here: Background: Electroconvulsive therapy (ECT) is an effective treatment for severe depression and induces gray matter (GM) increases in the brain. Small-scale studies suggest that ECT also leads to changes in brain functioning, but findings are inconsistent. In this study, we investigated the influence of ECT on changes in both brain structure and function and their relation to clinical improvement using multicenter neuroimaging data from the Global ECT-MRI Research ...

 Out on PubMed, in JECT, from a clinician in Philadelphia, is this LTE: Two Cases of Limbic Encephalitis Successfully Treated With Electroconvulsive Therapy After Standard Immunomodulating Therapy Was Unsuccessful. Schardt M. J ECT. 2022 Jul 19. doi: 10.1097/YCT.0000000000000874. Online ahead of print. PMID:  35900110 The LTE is here: Here are two more interesting cases of limbic encephalitis, unresponsive to immunotherapy, but responsive to ECT. I conclude that ECT is an effective immunotherapy for this neurologic disease. I say that only slightly tongue-in-cheek, and of course, if there is an underlying pathology (e.g.teratoma) it must be addressed, but...there are now many such cases in the literature and they make more urgent the question of sequencing of treatments. Analogous to how many failed AD trials must a severely depressed patient be subjected to, how many failed immunotherapy trials must a LE patient be subjected to before ECT is recommended? I know you have opini...

 Out on Pubmed, in JECT, from clinicians at Washington University School of Medicine in St. Louis, is this case report: Electroconvulsive Therapy in an Adolescent With Major Depressive Disorder and Preexisting Arrhythmogenic Right Ventricular Cardiomyopathy. Subramanian S, Patrick C, Avari Silva JN, Charlot C, Cristancho P, Wenzinger M. J ECT. 2022 Jul 19. doi: 10.1097/YCT.0000000000000875. Online ahead of print. PMID:  35900087 The full LTE is here: This is a very well-presented and instructive case report. It is helpful to learn of this type of genetic cardiac disease and its management. While not surprising that this patient was able to be treated safely and effectively with ECT, it is important to have such cases added to the evidence base in the literature of ECT in children and adolescents. All ECT practitioners and students/scholars of ECT anesthesia management should read this LTE, ~ 5 minutes.

 "Classics in ECT" brings you this paper from Aust NZ Psychiatry in 1994: Electroconvulsive   therapy  in a psychiatric intensive care unit. Hafner RJ, Holme G. Aust N Z J Psychiatry. 1994 Jun;28(2):269-73. doi: 10.1080/00048679409075638. PMID:  7993281 The abstract is copied below: This study reviewed all patients (N = 37) treated with ECT in a psychiatric intensive care unit during 1989-91. Diagnoses were: psychotic depression (8); bipolar disorder, manic phase (13); schizoaffective disorder (14); and schizophrenia (2). All patients were very severely disturbed and had failed to respond to medication given at highest levels judged to be safe, usually over 3-4 weeks. Response to ECT was generally rapid and marked, allowing substantial reductions in medication. To achieve the same clinical outcome for each course of ECT, 50% more unilateral than bilateral treatments were required, suggesting that bilateral ECT has a more rapid effect in this highly disturbed popula...

 "Classics in ECT" brings you this case report from The American Journal of Psychiatry, from 1950: Electroconvulsive  therapy following multiple fractures. COHEN LA. Am J Psychiatry. 1950 Nov;107(5):381. doi: 10.1176/ajp.107.5.381. PMID:  14783216 The pdf is here . And the case report is here: This a wonderful, short case report: the clinical story is compelling (including a near-lethal suicide attempt by jumping), the misdiagnosis followed by correct diagnosis is instructive, the early use of curare (Intocostrin was "a biologically standardized form of curare") is an unexpected bonus, and the outcome is gratifying. But wait, there's more! Look what followed Dr. Cohen's letter in that November issue of the Green Journal: But it is not about ECT, so it won't get "Classics in ECT" status...

"Classics in ECT" brings you this review from JAMA in 1964: THE PRACTICAL MANAGEMENT OF DEPRESSION. KLINE NS. JAMA. 1964 Nov 23;190:732-40. doi: 10.1001/jama.1964.03070210038007. PMID:  14201588   The pdf is here . And here are the ECT bits: And about the author: I hesitated to make this a "Classic in ECT," but then thought it had enough of the characteristics to qualify. Given who wrote it, and the early 1960s euphoria surrounding antidepressant medications, the somewhat dismissive attitude towards ECT is understandable. Of course, Nathan Kline became very famous and "electroshock" became ECT and did not go away. Some of the drug development history in this article is interesting, and students/scholars of the history of psychiatry may want to read it in full, ~ 15 minutes. Note that this paper was presented in relation to Dr. Kline's receiving the Lasker Award.

Out on Pubmed, from researchers in Ireland, is this study:  Peripheral blood inflammatory markers in depression: Response to electroconvulsive therapy and relationship with cognitive performance. Ryan KM, McLoughlin DM. Psychiatry Res. 2022 Jul 16;315:114725. doi: 10.1016/j.psychres.2022.114725. Online ahead of print. PMID:  35870295 The abstract is copied below: The inflammatory response may play a role in depression and the response to antidepressants. Electroconvulsive therapy (ECT), the most acutely powerful antidepressant treatment, can also affect the innate immune system. Here, we determined circulating blood concentrations of the inflammatory mediators C-reactive protein (CRP), IL-1β, IL-6, IL-10, and TNF-α in depressed patients compared to healthy controls and assessed the effect of ECT on their concentrations. Relationships between inflammatory mediator concentrations and mood/cognition scores were also explored. Plasma CRP, IL-1β, IL-6, IL-10, and TNF-α concentratio...

 "Classics in ECT" brings you this series of LTEs in the Green Journal, 1994: Cardiovascular complications of ECT. Stoudemire A. Am J Psychiatry. 1994 May;151(5):790; author reply 791. PMID:  8166341   The letters are here: Here are three LTEs in response to the classic Zielinski et al. cardiac ECT article from 1993. Myself/Mark Beale, Stoudemire et al. and Figiel et al. argue for more use of cardioprotective agents in selected patients; the Devanand et al. reply is somewhat more conservative/cautious, but generally in polite agreement. The ensuing decades I believe have brought cardiac management more in line with the opinions of the three responsive letter writers, with the exception of the demise of nitroglycerine paste/spray/pills in most ECT practices. I am glad to be reminded that the Zielinski classic is from the Sackeim Columbia group and of the active dialog facilitated by the American Journal of Psychiatry.

 Ot on PubMed, from authors in Japan, is this study: Impact of Sevoflurane and Thiopental Used Over the Course of Electroconvulsive Therapy: Propensity Score Matching Analysis. Yatomi T, Uchida T, Takamiya A, Wada M, Kudo S, Nakajima K, Nishida H, Yamagata B, Mimura M, Hirano J. Front Hum Neurosci. 2022 Jul 8;16:933622. doi: 10.3389/fnhum.2022.933622. eCollection 2022. PMID:  35880104 The abstract is copied below: Objective: Although anesthetics play an important role in electroconvulsive therapy (ECT), the clinical efficacy and seizure adequacy of sevoflurane in the course of ECT remain unclear. The purpose of this study was to examine the clinical efficacy and seizure adequacy of sevoflurane, compared with those of thiopental, in the course of ECT in patients with mood disorders. Methods: We conducted a retrospective chart review. Patients who underwent a course of ECT and received sevoflurane (n = 26) or thiopental (n = 26) were included. Factors associated with ECT and tre...

Out on PubMed, from North American investigators, is this review: Prazosin for the management of behavioural and psychological symptoms of dementia. Tampi RR, Tampi DJ, Farheen SA, Adnan M, Dasarathy D. Drugs Context. 2022 Jul 1;11:2022-3-3. doi: 10.7573/dic.2022-3-3. eCollection 2022. PMID:  35864999 The abstract is copied below: Prazosin, a centrally acting α1 adrenoceptor antagonist, has been included in two published algorithms amongst the list of medications that may be used in the management of behavioural and psychological symptoms of dementia (BPSD). However, a review of PubMed, Ovid and Cochrane Collaboration found that there was only one small published randomized controlled trial (RCT) that evaluated the use of prazosin amongst individuals with BPSD. Evidence from this good quality RCT indicates that prazosin appears to benefit individuals with agitation and aggression amongst individuals with BPSD and this medication is well tolerated. When compared to other treatments ...

 Out on PubMed, from researchers in the American Southwest, is this editorial:   Five-Year Longitudinal Evidence Supports the Safety and Efficacy of   Electroconvulsive   Therapy for Older Adults With Major Depressive Disorder. McClintock SM, Abbott CC. Am J Geriatr Psychiatry. 2022 Jul 4:S1064-7481(22)00461-4. doi: 10.1016/j.jagp.2022.06.010. Online ahead of print. PMID:  35879214 The editorial is here: This editorial gives a clear message of the benefits of ECT in the geriatric population, based on the long-term data reported recently from the MODECT study. (Please see blog post of June 20, 2022, about the original Lambrichts et al. article.) Drs. McClintock and Abbott also discuss opportunities to refine ECT technique, based on their particular research interests in electric field modeling and stimulus amplitude manipulation. Kudos to Shawn and Chris for this powerful endorsement of ECT for geriatric depression.

 "Classics in ECT" brings you this article from the Green Journal in 1949: The use of electroshock therapy in treating psychiatric patients with associated pulmonary tuberculosis. CLOSE HP. Am J Psychiatry. 1949 Nov;106(5):352-7. doi: 10.1176/ajp.106.5.352. PMID:  18143865   The pdf is here . And from the text: This is a fascinating case series from "back in the day." Unmodified ECT and old therapies for TB, including phreniclasis (crushing of the phrenic nerve). ECT allowed sufficient treatment of severe agitation or catatonia, so that TB treatments, such as they were, could be carried out. One is reminded of the discovery of the antidepressant properties of MAOIs, with iproniazid as a TB drug. History of ECT buffs, or students of the abnormal chest x-ray, will want to read this paper in full, ~15 minutes.

"Classics in ECT" brings you this review from Acta Psychiatrica Scandinavica, in 1991: Lithium and  electroconvulsive   therapy: adversaries, competitors, allies? Schou M. Acta Psychiatr Scand. 1991 Nov;84(5):435-8. doi: 10.1111/j.1600-0447.1991.tb03174.x. PMID:  1776496   Review. The pdf is here . The article is here: This is a fine review of some of the issues of indications/efficacy and interaction between lithium and ECT. We are reminded of the different profile of efficacy of lithium in depression and mania, and the lack of evidence for maintenance ECT 30 years ago. The risk/benefit ratio of concomitant use of lithium and ECT is still debated today. Mogens Schou (1918-2005) was a Danish psychiatrist, who, along with John Cade, pioneered the use of lithium for bipolar disorder. A full read, ~10 minutes, is recommended for all history of ECT buffs.

Out on Pubmed, from researchers in Japan, is this study: Relationship among psychotic features, benzodiazepine receptor agonists, and rehospitalization in patients with  electroconvulsive  therapy-responsive major depressive disorder: A retrospective 2-year observational study. Umakoshi A, Takeshima M, Itoh Y, Yamamoto M, Shibata N, Ogasawara M, Ayabe N, Mishima K. Neuropsychopharmacol Rep. 2022 Jul 22. doi: 10.1002/npr2.12282. Online ahead of print.  PMID:   35866441 The abstract is copied below: Aim:  It is controversial whether psychotic features are a risk factor for relapse in patients with electroconvulsive therapy-responsive major depressive disorder. A recent study reported that benzodiazepine receptor agonists reduce relapse of psychotic depression. As long-term use of these agonists may induce dependence, further research is required. We examined whether psychotic features are associated with rehospitalization in electroconvulsive therapy-responsive ma...

And from an online article about the book: https://nextbigideaclub.com/magazine/cure-darkness-story-depression-treat-bookbite/28445/ Alex Riley's book about depression came out last year and I want to bring it to the attention of blog readers. Alex interviewed me in 2018, along with other ECT practitioners, and came to observe ECT at New York Community Hospital. It is always a gamble to talk to writers about ECT, but Alex was forthright and true to his word. The ECT section in the book is very positive and should be helpful for patients. I am very pleased to recommend this book; kudos to Alex for telling his story and giving an accurate portrayal of modern ECT. I hope his book is widely read.