Clinical Neuroscience of ECT (CNECT)

Out on PubMed, from clinicians in Florida, is this case report:  Electroconvulsive therapy use for refractory status epilepticus in an implantable vagus nerve stimulation patient: A case report. Katzell L, Beydler EM, Holbert R, Rodriguez-Roman L, Carr BR. Front Psychiatry. 2023 Feb 3;14:1126956. doi: 10.3389/fpsyt.2023.1126956. eCollection 2023. PMID:  36816412   The abstract is copied below: Introduction: Status epilepticus (SE) has a mortality rate of 20 to 50%, with acute symptomatic SE having a higher risk compared to chronic SE. Electroconvulsive therapy (ECT) has been utilized for the treatment of refractory SE with a success rate estimate of 57.9%. There are no known reported cases of concomitant use of vagus nerve stimulation (VNS) and ECT for the treatment of super refractory SE (SRSE) available in the literature. Case description: We present a 44-year-old female with a history of developmental delay, epilepsy, an implantable VNS for 6 years, and traumatic brain...

Out on PubMed, from researchers in Germany, is this paper: Neurological soft signs are increased in major depressive disorder irrespective of treatment. Schülke R, Liepach K, Brömstrup AL, Folsche T, Deest M, Bleich S, Neyazi A, Frieling H, Maier HB. J Neural Transm (Vienna). 2023 Feb 20. doi: 10.1007/s00702-023-02602-z. Online ahead of print. PMID:  36801977 The pdf is here . And from the text: Here's a very interesting study that adds to our knowledge of the neurological safety of ECT. The concept of neurological soft signs is fascinating and the measurement in this study seems very careful. So, more evidence that psychiatric disorders affect the brain (surprise!) and that ECT is not bad for the brain (a real surprise to many critics!)

Here is a 28-minute podcast about ECT from the BBC: This is the link:  https://www.bbc.co.uk/programmes/m001jc56 Thanks to George Kirov for alerting me to this. It is the story of Dr. Tania Gergel, PhD, Wellcome Trust Senior Research Fellow, medical ethicist and ECT recipient.  It features interviews with Drs. Max Fink and George Kirov, as well as ECT nurses from Dr. Kirov's ECT service. The title notwithstanding, it is very well done and positive about ECT. I highly recommend a full listen.

 "Classics in ECT" brings you this editorial from the British Medical Journal, 1977: Treatment of depression. [No authors listed] Br Med J. 1977 Oct 29;2(6095):1105. PMID:  589012 The pdf is here . The editorial is here: Here's a tidbit   that is interesting because it conveys the ambivalence of British attitudes towards ECT in the late 1970s. This is a recounting of papers presented at a meeting in Glasgow; most interesting is the then-new study from C.P. Freeman with two sham ECTs at the start of the treatment in one group.

Out on Pubmed, from investigators in the Netherlands, is this paper: Seizure duration predicts postictal electroencephalographic recovery after  electroconvulsive  therapy-induced seizures. C M Pottkämper J, P A J Verdijk J, Stuiver S, Aalbregt E, Schmettow M, Hofmeijer J, van Waarde JA, J A M van Putten M. Clin Neurophysiol. 2023 Jan 26;148:1-8. doi: 10.1016/j.clinph.2023.01.008. Online ahead of print. PMID:  36773503 The abstract is copied below: Objective: We aim to provide a quantitative description of the relation between seizure duration and the postictal state using features extracted from the postictal electroencephalogram (EEG). Methods: Thirty patients with major depressive disorder treated with electroconvulsive therapy (ECT) were studied with continuous EEG before, during, and after ECT-induced seizures. EEG recovery was quantified as the spectral difference between postictal and baseline EEG using the temporal brain symmetry index (BSI). The postictal tempor...

"Classics in ECT" brings you this editorial from Dr. Max Fink, 1984: ECT : for whom is its use justified? Fink M. J Clin Psychopharmacol. 1984 Dec;4(6):303-4. PMID:  6511995   The pdf is here . The editorial is here: Here is a Max Fink classic, with his perspective on clinical indications as well as the sad state of ECT practice and training in the USA in the early 1980s. I'm sure you will enjoy reading it, and reflecting on how things have changed for the better in the intervening decades, in no small part thanks to his efforts.

"Classics in ECT" brings you this Max Fink editorial from JECT in 2011: Transcranial  magnetic stimulation is not a replacement for electroconvulsive therapy in depressive mood disorders. Fink M. J ECT. 2011 Mar;27(1):3-4. doi: 10.1097/YCT.0b013e3181f18076. PMID:  21336049   The pdf is here . The editorial is here: Here's a fairly recent Max Fink classic. I agree with him completely, and wonder how many followers would also...Has the intervening decade changed anything? I particularly like his description of ECT as having "optic dissonance."

Out on PubMed, from researchers in Sweden, is this study: Response to electroconvulsive therapy in treatment-resistant depression: nationwide observational follow-up study. Nygren A, Reutfors J, Brandt L, Bodén R, Nordenskjöld A, Tiger M. BJPsych Open. 2023 Feb 14;9(2):e35. doi: 10.1192/bjo.2023.5. PMID:  36786152 The abstract is copied below: Background: Previous studies have not investigated response rates after electroconvulsive therapy (ECT) in patients with non-psychotic treatment-resistant depression (TRD). Aims: To assess and compare the response rate of ECT for patients with TRD and non-TRD, in a large and clinically representative patient sample. Method: Patients aged ≥18 years, who were treated for a unipolar, non-psychotic depressive episode with at least one ECT session as part of a first-time, index ECT series between 1 January 2011 and 31 December 2017 were included from the Swedish National Quality Register for ECT. Patients who had initiated a third consecutive tri...

 Dear Blog Followers, Please note that I will not be posting new material on the weekends from now on. For the time being, I plan to continue on a five day/week schedule. As always, thank you for your support and comments. CK

Out on PubMed, in the NEJM, is this review: Transient   Global   Amnesia . Ropper AH. N Engl J Med. 2023 Feb 16;388(7):635-640. doi: 10.1056/NEJMra2213867. PMID:  36791163   Review.   The review is here. And from the text: In an otherwise reasonable review of TGA, Deputy NEJM editor Allan Ropper takes an unnecessary swipe at ECT. If you look at how a typical patient awakens from ECT compared to how a patient with TGA behaves, there is little comparison. The ECT patient awakens calmly and is reoriented in a few minutes, while the TGA patient is frantic, and the amnesia lasts "a mean of 6 hours." Not a big deal, you say? Well the NEJM is the most influential medical journal in the world and this review will be read by a huge audience.  A gratuitous, inaccurate jab at ECT is both uncalled for and damaging to patient welfare. I hope ECT colleagues around the world will consider writing in response, to set the record straight.

  Out on PubMed, from clinicians in South Africa, is this case report: Electroconvulsive therapy ( ECT ) with ketamine induction for catatonia in an HIV positive patient. Nel Y, Bracken CA. S Afr J Psychiatr. 2023 Jan 30;29:1944. doi: 10.4102/sajpsychiatry.v29i0.1944. eCollection 2023. PMID:  36756540   The abstract is copied below: Introduction: The successful use of ECT as treatment for catatonia, in the context of HIV (human immunodeficiency virus) infection, has been described previously. Ketamine has been used as an anaesthetic induction agent for ECT, although not considered the induction agent of choice. There are also case reports suggesting that ketamine may be an alternative treatment specifically for catatonia. Patient presentation: This case report describes the management of a female patient who presented with catatonia, evidenced by stupor, waxy flexibility, mutism, negativism, and stereotypy, as well as stage four HIV infection, with poor response to previo...

 Dear Blog Followers/readers, I will be away from the blog from Feb. 4th through 15th, resuming Feb. 16th. As always, please consider checking PubMed daily, and reviewing past blog post articles. Thanks, CK

 Out on PubMed, from authors in Germany, is this review: Therapy Strategies for Late-life Depression: A Review. Piel C, Quante A. J Psychiatr Pract. 2023 Jan 1;29(1):15-30. doi: 10.1097/PRA.0000000000000678. PMID:  36649548   Review. The abstract is copied below: Background: Depression in the elderly requires different treatment options because therapies that are commonly used for depression in younger patients show different effects later in life. Treatment options for late-life depression (LLD) are summarized in this article. Methods: A literature search in Medline/PubMed performed in June 2020 identified 83 relevant studies. Results: Pharmacotherapy with selective serotonin reuptake inhibitors can be an effective first-line treatment in LLD, but >50% of elderly patients do not adequately respond. Switching to other selective serotonin reuptake inhibitors or augmenting with mood stabilizers or antipsychotics is often effective in achieving a therapeutic benefit. Seve...

Out on PubMed, from authors in India, is this review:   A Comprehensive Review on Postpartum Depression. Suryawanshi O 4th, Pajai S. Cureus. 2022 Dec 20;14(12):e32745. doi: 10.7759/cureus.32745. eCollection 2022 Dec. PMID:   36686097 The abstract is copied below: One of the most common psychological effects following childbirth is postpartum depression. Postpartum depression (PPD) has a significant negative impact on the child's emotional, mental as well as intellectual development if left untreated, which can later have long-term complications. Later in life, it also results in the mother developing obsessive-compulsive disorder and anxiety. Many psychological risk factors are linked with PPD. The pathophysiology of the development of PPD is explained by different models like biological, psychological, integrated, and evolutionary models, which relate the result of the condition with particular conditions and factors. This article also explains the role of methyldopa as a med...