Clinical Neuroscience of ECT (CNECT)

"Classics in ECT" brings you this from Medical World News , 1983: Med World News . 1983 Oct 10;24(19):8. PMID:  11649486   No abstract available. Thanks to Dr. W. Vaughn McCall for providing the original text of this document. Please see blog post of October 24, 2022 for additional information about this important historical event in American ECT.  The scientific description of "modern ECT" in the above piece is a bit jarring in juxtaposition with the newsy legal account... This article makes it clear how organized Psychiatry in the USA came together to protect patients' rights and access to ECT.

 Out on PubMed, from Swedish investigators, is this study: Risk factors for mortality of medical causes within 30 days of electroconvulsive therapy. Lindblad L, Nordenskjöld A, Otterbeck A, Nordenskjöld AM. J Affect Disord. 2022 Oct 6:S0165-0327(22)01191-0. doi: 10.1016/j.jad.2022.10.008. Online ahead of print. PMID:  36209782 The abstract is copied below: Background: Electroconvulsive therapy (ECT) is used to treat severe psychiatric disorders and is associated with reduced risk of suicide and all-cause mortality in patients with severe depression. We investigated the causes of death occurring shortly after ECT and identified potential risk factors for medical causes of death. Methods: Patients treated with ECT between 2012 and 2018 were included in this Swedish register-based study. Multivariate binary logistic regression was used to calculate odds ratios for covariates to determine potential predictors of 30-day mortality. Results: Of the 20,225 included patients, 93 (0.46...

Improvement of catatonia-induced rapid respiratory failure with electroconvulsive therapy: A case report. Nakamura T, Shimizu-Ichikawa M, Takahashi K, Shimizu S, Ichiyama T, Todoroki K, Konno M, Amada D, Sasayama D, Washizuka S. Asian J Psychiatr. 2022 Oct 6;78:103280. doi: 10.1016/j.ajp.2022.103280. Online ahead of print. PMID:  36228426 The abstract is copied below: We encountered a case of sudden respiratory failure during treatment of catatonia that required intensive care. Electroconvulsive therapy (ECT) was administered in the intensive care unit while the patient was under systemic control. The catatonia symptom was relieved, and respiratory failure improved. Although a proximal venous thrombus was observed, anticoagulation therapy was continued during ECT, and the patient was successfully treated without causing a pulmonary embolism. It is crucial to monitor the patient's physical and psychological symptoms because respiratory status may deteriorate rapidly in a catatonic ...

"Classics in ECT" brings you this study from the American Journal of Psychiatry, from 1966: A controlled comparison of amitriptyline and electroconvulsive  therapy  in the treatment of depression. McDonald IM, Perkins M, Marjerrison G, Podilsky M. Am J Psychiatry. 1966 Jun;122(12):1427-31. doi: 10.1176/ajp.122.12.1427. PMID:  5326021 The pdf is here . And from the text: Here's a small Canadian study from the early days of antidepressant medications. ECT and amitriptyline are suggested to be equal, but note that the study was funded by the drug manufacturer. I bet the four patients who got simulated ECT in this study are never counted in tallies of patients who got sham ECT.

 Out on PubMed, from an author in Virginia, is this case report: Self-administration of Psilocybin in the Setting of Treatment-resistant Depression. Lyons A. Innov Clin Neurosci. 2022 Jul-Sep;19(7-9):44-47. PMID:  36204170   The abstract is copied below: Background:  Patients diagnosed with major depressive disorder (MDD) who fail to respond to two or more antidepressants are often considered to have treatment-resistant depression (TRD). Many of the current options for TRD have significant side effect profiles, are expensive, and are difficult to access. There has been a revival of psychedelic research in recent years that shows promising results in the treatment of TRD. Case presentation:  Here, the case of a 43-year-old man with TRD is presented. TRD symptoms were greatly interfering with his life. He underwent psychological testing, lab work, adequate trials of numerous medications, transcranial magnetic stimulation (TMS), and electroconvulsive therapy, all ...

Out on PubMed, from researchers in Canada, is this review: Brain-Derived Neurotrophic Factor (BDNF) as a biomarker of treatment response in patients with Treatment Resistant Depression (TRD): A systematic review & meta-analysis. Meshkat S, Alnefeesi Y, Jawad MY, D Di Vincenzo J, B Rodrigues N, Ceban F, Mw Lui L, McIntyre RS, Rosenblat JD. Psychiatry Res. 2022 Sep 21;317:114857. doi: 10.1016/j.psychres.2022.114857. Online ahead of print. PMID:  36194941   Review The abstract is copied below: Multiple lines of evidence have implicated brain-derived neurotrophic factor (BDNF) in treatment-resistant depression (TRD). The aim of this synthesis was to determine the impact of TRD treatments on peripheral BDNF levels, and ascertain whether these changes are associated with antidepressant effects. Thirty-six articles involving 1198 patients with TRD were included herein. Electroconvulsive therapy (ECT) , ketamine, and repetitive transcranial magnetic stimulation (rTMS) were the mos...

Out on PubMed is this commentary by Dr. Andrade: Reconsideration of the Benefits of Pharmacological Interventions for the Attenuation of the Cognitive Adverse Effects of Electroconvulsive Therapy. Andrade C. J Clin Psychiatry. 2022 Oct 3;83(5):22f14668. doi: 10.4088/JCP.22f14668. PMID:  36198062 The abstract is copied below: The cognitive adverse effects (AEs) of electroconvulsive therapy (ECT) limit the wider use of the treatment. These AEs can be attenuated by changing the way ECT is administered; however, such changes may reduce the response rate, the speed of response, or both. A recent systematic review and meta-analysis identified more than a dozen pharmacologic interventions in 26 randomized controlled trials (RCTs) that sought to reduce ECT-induced cognitive AEs . Because of large differences across RCTs, only a few outcomes for a few interventions could be pooled in meta-analysis, and most pooled analyses included only 2-3 RCTs. Important findings were that acetylcholines...

"Classics in ECT" brings you some media articles about the Berkeley, CA ban on ECT: This was on PubMed, but I could not access the text: Judge tosses out Berkeley ban on ECT, surprising both sides in controversy. [No authors listed] Med World News . 1983 Oct 10;24(19):8. PMID:  11649486   No abstract available. And from the NY Times : Here is the text, typed out, of the above NY Times article: And from the LA Times in 1986: The Berkeley, California ban on ECT is part of American ECT lore. Although the city voted in 1982 to ban ECT, as noted above, the ban never went into effect due to legal challenges*. The details of all the back and forth are complex and beyond the scope of this blog; the APA was instrumental in the ultimate good outcome. Some of this resonates with what is happening in the USA today regarding abortion. (*Some sources I read implied that the ban might actually been in effect very briefly at the end of 1982, before the January,1983 ruling.)

Out on Pubmed, from clinicians in Connecticut, is this case report: Late to respond, but early to relapse - An abnormal course of electroconvulsive therapy in treatment-resistant schizophrenia during times of COVID-19. Qureshi H, Jain L. Psychiatry Res Case Rep. 2022 Dec;1(2):100052. doi: 10.1016/j.psycr.2022.100052. Epub 2022 Sep 19. PMID:  36188755   The case is here . And here: Here is a well-intended publication that raises important questions about ECT treatment planning for patients with severe schizoaffective disorder or schizophrenia. The patient described is desperately ill and with a tragic life history.  She ultimately got dramatically better, but the healthcare system was unable to provide an environment that could sustain the improvement. The details of patient management here were clearly flawed, despite the good intent and the perseverance of the team to provide ECT. It was a mistake to use ultrabrief-pulse RUL in such an urgently ill patient and ...

 "Classics in ECT" brings you this paper from 1948, in the American Journal of Psychiatry: The effect of electric shock on mental efficiency. HUSTON PE, STROTHER CR. Am J Psychiatry. 1948 May;104(11):707-12. doi: 10.1176/ajp.104.11.707. PMID:  18864979   The full paper is here . And from the text: Here's   a very early report of neuropsychological testing in ECT. The ECT was sine wave, bilateral and unmodified, yet the results showed no evidence of significant long-term cognitive impairment. While the assessment instruments and methods may not be up to modern standards, it is useful to be aware of this 75-year old study. Perhaps neuropsychologist blog followers will want to comment about some of the specifics of the testing and instruments used... The first author, PE Huston, has 33 PubMed citations, from 1946-1973, mostly about schizophrenia, depression and ECT.

 Out on PubMed, from investigators in China, is this paper: Predictors of electroconvulsive therapy outcome in major depressive disorder. Su L, Zhang Y, Jia Y, Sun J, Mellor D, Yuan TF, Xu Y. Int J Neuropsychopharmacol. 2022 Oct 3:pyac070. doi: 10.1093/ijnp/pyac070. Online ahead of print. PMID:  36190694 The abstract is copied below: Background: Electroconvulsive therapy (ECT) is an effective therapy for Major Depressive Disorder (MDD) patients. However, few clinical predictors are available to predict the treatment outcome. This study aimed to characterize the response trajectories of MDD patients undergoing ECT treatment and to identify potential clinical and demographic predictors for clinical improvement. Methods: We performed a secondary analysis on data from a multicenter randomized, blinded, controlled trial with three ECT modalities (bifrontal, bitemporal, unilateral). The sample consisted of 239 patients whose demographic and clinical characteristics were investigated...