Clinical Neuroscience of ECT (CNECT)

Out on PubMed, from Swedish investigators, is this study: Association of Treatment-Resistant Depression With Patient Outcomes and Health Care Resource Utilization in a Population-Wide Study. Lundberg J, Cars T, Lööv SÅ, Söderling J, Sundström J, Tiihonen J, Leval A, Gannedahl A, Björkholm C, Själin M, Hellner C. JAMA Psychiatry. 2022 Dec 14. doi: 10.1001/jamapsychiatry.2022.3860. Online ahead of print. PMID:  36515938 The abstract is copied below: Importance: The totality of the societal and individual impact of treatment-resistant depression (TRD) is unknown, as is the potential to prognosticate TRD. The generalizability of many observational studies on TRD is limited. Objective: To estimate the burden of TRD in a large population-wide cohort in an area with universal health care by including data from both health care types (psychiatric and nonpsychiatric) and, further, to develop a prognostic model for clinical use. Design, setting, and participants: This cohort study, a populat...

 Out on PubMed, from international authors, is this study: Sex-specifics of  ECT   outcome. Blanken MAJT, Oudega ML, Hoogendoorn AW, Sonnenberg CS, Rhebergen D, Klumpers UMH, Van Diermen L, Birkenhager T, Schrijvers D, Redlich R, Dannlowski U, Heindel W, Coenjaerts M, Nordanskog P, Oltedal L, Kessler U, Frid LM, Takamiya A, Kishimoto T, Jørgensen MB, Jørgensen A, Bolwig T, Emsell L, Sienaert P, Bouckaert F, Abbott CC, Péran P, Arbus C, Yrondi A, Kiebs M, Philipsen A, van Waarde JA, Prinsen E, van Verseveld M, Van Wingen G, Funes CC, Kritzer M, Barbour T, Ten Doesschate F, van Eijndhoven P, Tendolkar I, Dols A. J Affect Disord. 2023 Jan 9:S0165-0327(22)01507-5. doi: 10.1016/j.jad.2022.12.144. Online ahead of print. PMID:  36632848 The abstract is copied below: Objective: Electroconvulsive therapy (ECT) is the most effective treatment for patients with severe major depressive disorder (MDD). Given the known sex differences in MDD, improved knowledge may provide more se...

 Out on PubMed, from US investigators, is this paper: Ethics Considerations in Laws Restricting Incapacitated Patients' Access to  ECT . Iltis AS, Fortier R, Ontjes N, McCall WV. J Am Acad Psychiatry Law. 2023 Jan 16:JAAPL.220029-21. doi: 10.29158/JAAPL.220029-21. Online ahead of print. PMID:  36646453 The abstract is copied below: Electroconvulsive therapy (ECT) is a safe and effective treatment used for numerous psychiatric conditions. While many patients for whom ECT is indicated are able to give voluntary informed consent, some lack decision-making capacity (DMC), at least temporarily. Case reports from numerous countries involving ECT for patients who lack DMC indicate overall positive outcomes and high patient satisfaction with results comparable with those of consenting patients; some patients regain DMC with ECT. Laws and regulations pertaining to ECT vary widely around the world and across the United States. Many United States jurisdictions over-regulate ECT rela...

"Classics in ECT" brings you this article from 1954:   Indications and contra indications for E.C.T. PARTRIDGE M. Postgrad Med J. 1954 Apr;30(342):176-84. doi: 10.1136/pgmj.30.342.176. PMID:  13155259 The pdf is here . And from the text: ======= ====== ====== There is a lot of clinical wisdom here, along with some things that have not withstood the test of time. The differential diagnostic discussion of depression is particularly interesting. The sudden appearance of clinical data from St. George's Hospital (in south London), in what starts out as a review paper, is a bit jarring. A full read, ~10 minutes, is well worth the time.  Dr. Partridge (1910-1984) was known for a follow up study of 300 patients with prefrontal leucotomy. Here is a remembrance: https://history.rcplondon.ac.uk/inspiring-physicians/maurice-aubrey-partridge

"Classics in ECT" brings you this article, part of Review of Psychiatric Progress 1954 : Review of psychiatric progress 1954; physiological treatment. WORTIS J. Am J Psychiatry. 1955 Jan;111(7):515-8. doi: 10.1176/ajp.111.7.515. PMID:  13228695 The pdf is here . The ECT part from the text is here: Here's a Joe Wortis classic from the early days of ECT; there is some older history of convulsive therapy, as well as the note about newly-introduced anesthesia and muscle relaxant techniques. The combinations of ECT and other treatments are of purely historical interest. Here is the Wikipedia entry for Dr. Wortis, founding and longtime Editor of Biological Psychiatry :

Out on PubMed, from investigators in Switzerland, is this study: Distinct and shared patterns of brain plasticity during electroconvulsive therapy and treatment as usual in depression: an observational multimodal MRI-study. Bracht T, Walther S, Breit S, Mertse N, Federspiel A, Meyer A, Soravia LM, Wiest R, Denier N. Transl Psychiatry. 2023 Jan 10;13(1):6. doi: 10.1038/s41398-022-02304-2. PMID:  36627288 The abstract is copied below: Electroconvulsive therapy (ECT) is a highly effective treatment for depression. Previous studies point to ECT-induced volume increase in the hippocampi and amygdalae, and to increase in cortical thickness. However, it is unclear if these neuroplastic changes are associated with treatment response. This observational study aimed to address this research question by comparing neuroplasticity between patients with depression receiving ECT and patients with depression that respond to treatment as usual (TAU-responders). Twenty ECT-patients (16 major depress...

 Out on PubMed, from clinicians in Texas, is this case report: Electroconvulsive Therapy-Induced Paroxysmal Atrial Fibrillation in Healthy Young Male. Olsen B, Trent JS, Inman BL. Cureus. 2022 Nov 28;14(11):e31989. doi: 10.7759/cureus.31989. eCollection 2022 Nov. PMID:  36589202 The abstract is copied below: Electroconvulsive therapy (ECT) is a widely used and highly effective treatment for psychiatric disorders. This is an overall safe option for the management of antidepressant-resistant depression; however, there are known possibilities of cardiac complications. The majority of documented cardiac-related complications due to ECT are found in patients who are middle-aged or older and generally have comorbidities, including prior myocardial infarction, known arrhythmias, hypertension, obesity, diabetes mellitus, family history of cardiac disease, alcohol abuse, and smoking. We present a case of an overall healthy, 21-year-old male with no prior cardiac disease who developed p...

 Out on PubMed, from clinicians in Florida, is this case report: Maintenance Electroconvulsive Therapy, Developmental Regression, Depression and Catatonia in an Adolescent With Down Syndrome: A Case Report. Anthonio G, Malik F, Ghomeshi A, Lopez O, Gralnik L. Cureus. 2022 Nov 26;14(11):e31905. doi: 10.7759/cureus.31905. eCollection 2022 Nov. PMID:  36579295 The abstract is copied below: This is a case report involving a 22-year-old male with a past medical history of Down syndrome and major depressive disorder who, at age 16, became preoccupied with returning to an infant-like state. He experienced a gradual deterioration in his mood over a year and began to show symptoms consistent with catatonia. These symptoms included waxy flexibility, hypokinesis, decreased appetite, mutism, and altered sleep habits. Pharmacologic therapy was initiated, and the patient experienced a waxing and waning pattern of improvement and regression. Over several years, various combinations of antide...

Out on PubMed, from a group of international investigators, is this paper: Comparative efficacy, cognitive effects and acceptability of electroconvulsive therapies for the treatment of depression: protocol for a systematic review and network meta-analysis. Nikolin S, Owens K, Francis-Taylor R, Chaimani A, Martin DM, Bull M, Sackeim HA, McLoughlin DM, Sienaert P, Kellner CH, Loo C. BMJ Open. 2022 Dec 22;12(12):e068313. doi: 10.1136/bmjopen-2022-068313. PMID:  36549738   The abstract is copied below: Introduction: There have been important advances in the use of electroconvulsive therapy (ECT) to treat major depressive episodes. These include variations to the type of stimulus the brain regions stimulated, and the stimulus parameters (eg, stimulus duration/pulse width). Our aim is to investigate ECT types using a network meta-analysis (NMA) approach and report on comparative treatment efficacy, cognitive side effects and acceptability. Method: We will conduct a systematic review...

Out on PubMed, from investigators at UCLA, is this study: Structural brain plasticity and inflammation are independently related to changes in depressive symptoms six months after an index  ECT  course. Brooks JO 3rd, Kruse JL, Kubicki A, Hellemann G, Espinoza RT, Irwin MR, Narr KL. Psychol Med. 2023 Jan 5:1-9. doi: 10.1017/S0033291722003555. Online ahead of print. PMID:  36600668 The abstract is copied below: Background: Electroconvulsive therapy (ECT) is effective for treatment-resistant depression and leads to short-term structural brain changes and decreases in the inflammatory response. However, little is known about how brain structure and inflammation relate to the heterogeneity of treatment response in the months following an index ECT course. Methods: A naturalistic six-month study following an index ECT course included 20 subjects with treatment-resistant depression. Upon conclusion of the index ECT course and again after six months, structural magnetic resonanc...

Out on PubMed, from authors in Spain, is this paper: Assessment of Beliefs and Attitudes About Electroconvulsive Therapy Posted on Twitter: an Observational Study. de Anta L, Alvarez-Mon MA, Donat-Vargas C, Lara-Abelanda FJ, Pereira-Sanchez V, Gonzalez-Rodriguez C, Mora F, Ortega MA, Quintero J, Alvarez-Mon M. Eur Psychiatry. 2023 Jan 9:1-21. doi: 10.1192/j.eurpsy.2022.2359. Online ahead of print.  PMID:   36620994 The abstract is copied below: The article is here . And from the text: Not surprisingly, this paper documents that there is a lot of negativity about ECT on social media. Since some of that comes from within the profession, the take home message is that we need to do a better job of educating our colleagues about ECT.