Clinical Neuroscience of ECT (CNECT)

Out on PubMed, from authors in the USA , is this review: Efficacy of Electroconvulsive Therapy for the Treatment of Movement Disorders: A Literature Review. Muhammad N, Brooks Iii N, Chatham L, Chatham A, Muthukanagaraj P. Cureus. 2023 Mar 24;15(3):e36634. doi: 10.7759/cureus.36634. eCollection 2023 Mar. PMID:  36968685    Review. The abstract is copied below: Electroconvulsive therapy (ECT) is a safe and effective treatment modality for various psychiatric disorders. However, evidence suggests a putative role of ECT in treating movement disorders that are refractory to less invasive modalities. ECT is primarily used in treatment-resistant psychiatric disorders. However, growing evidence exists for its use in movement disorders with and without psychiatric comorbidity. The primary objective of this systematic review was to examine the efficacy of ECT as a primary treatment modality for movement disorders. Relevant, peer-reviewed publications were retrieved from PubMed, SC...

Out on PubMed from ECT experts Pascal Sienaert and Declan McLoughlin, is this editorial: Changing tactics: Does switching improve electroconvulsive therapy outcomes? Sienaert P, McLoughlin DM. Acta Psychiatr Scand. 2023 Apr;147(4):319-321. doi: 10.1111/acps.13540. PMID:  36945826 The editorial is here . And here: This is a thoughtful and important editorial. Like many such pieces, it asks more questions than it answers. We certainly are eager to have the results of the RUL-to-BL switching trial that is described in reference #13, to answer some of them. But let's back up a bit and ask 30,000 ft questions. Do we really believe that RUL ECT is as "strong," "effective," "powerful," "non-inferior," "as good as" BL ECT? One interpretation of some of the evidence base suggests so, but this is discordant with decades of clinical experience and the widespread practice of switching to BL electrode placement for non-, or slow, response. And w...

Out on Pubmed, from investigators in the Netherlands and Belgium, is this study: Clinical characteristics associated with relapse two years after electroconvulsive therapy for major depression. Pluijms EM, Vinther PT, Kamperman AM, Birkenhäger TK. Acta Psychiatr Scand. 2023 Mar 20. doi: 10.1111/acps.13542. Online ahead of print. PMID:  36938869 The abstract is copied below: Objective: High relapse rates are observed after electroconvulsive therapy (ECT) for major depression. Identifying patients who are at increased risk for relapse to intensify their treatment regimen post-ECT might reduce relapse rates. We aimed to determine clinical characteristics that are associated with relapse within two years after successful ECT. Methods: Patients who remitted to ECT in a randomised controlled trial comparing adjuvant nortriptyline and placebo during a course of bilateral ECT were followed-up prospectively for one year with open-label nortriptyline (Dutch Trial Register NTR5579). Second-ye...

Out on PubMed, from authors in Hungary and Italy, is this review: How to  save  a life: From neurobiological underpinnings to psychopharmacotherapies in the prevention of suicide. Gonda X, Dome P, Serafini G, Pompili M. Pharmacol Ther. 2023 Mar 18:108390. doi: 10.1016/j.pharmthera.2023.108390. Online ahead of print. PMID:  36940791   Review The abstract is copied below: The impact of suicide on our societies, mental healthcare, and public health is beyond questionable. Every year approximately 700 000 lives are lost due to suicide around the world (WHO, 2021); more people die by suicide than by homicide and war. Although suicide is a key issue and reducing suicide mortality is a global imperative, suicide is a highly complex biopsychosocial phenomenon, and in spite of several suicidal models developed in recent years and a high number of suicide risk factors identified, we still have neither a sufficient understanding of underpinnings of suicide nor adequate manageme...

Here's a link to a 3-minute video about ECT: https://www.youtube.com/watch?v=w66YtVHYZwg The video is from Northwell Health system and features Dr. George Petrides.

Here's a podcast about ECT: Here is the link: https://podcasts.apple.com/us/podcast/the-healing-power-of-ect/id1528414053?i=1000603304720 This is an interview with Dr. Sohag Sanghani of the Zucker Hillside Hospital. It is the first of two parts. Sohag does a great job of describing the benefits of ECT. I particularly like the nuanced way he handles the questions about mechanism of action and memory effects. I recommend a full listen to all blog readers. Kudos to Dr. Sanghani!

 Out on PubMed, from investigators in the USA, is this paper: Electric Field, Ictal Theta Power, and Clinical Outcomes in Electroconvulsive Therapy. Miller J, Jones T, Upston J, Deng ZD, McClintock SM, Erhardt E, Farrar D, Abbott CC. Biol Psychiatry Cogn Neurosci Neuroimaging. 2023 Mar 14:S2451-9022(23)00062-9. doi: 10.1016/j.bpsc.2023.03.001. Online ahead of print. PMID:  36925066 The abstract is copied below: Background: Electroconvulsive therapy (ECT) is efficacious for treatment resistant depression. Treatment-induced cognitive impairment can adversely impact functional outcomes. Our pilot study linked the electric field to ictal theta power from a single suprathreshold treatment and ictal theta power to changes in phonemic fluency. In this study, we set out to replicate our findings and expand upon the utility of ictal theta power as a potential cognitive biomarker. Methods: Twenty-seven subjects (nine male and eighteen female) received right unilateral ECT for treatment ...

 Out on PubMed, from clinicians in Nantes, France, is this case report: [Ketamine and lorazepam combination as an alternative to  electroconvulsive   therapy for catatonia in late-life depression: A case report]. Laurin A, Capelle N, Bukowski N, Le Page A, Gendre I, Sauvaget A, Bulteau S. Encephale. 2023 Mar 10:S0013-7006(23)00014-3. doi: 10.1016/j.encep.2023.01.003. Online ahead of print. PMID:  36907667   French.   No abstract available. The full report is not yet available to me, but we see that a psychotically depressed, suicidal geriatric patient with food and liquid refusal, described as "catatonic," was successfully treated with a combination of IV ketamine and lorazepam instead of ECT.  We do need to know if the diagnosis was accurate, how severe the catatonia was, and other aspects of the management. If true, this is noteworthy, but one case does not an algorithm make, and just as it may be inappropriate to treat urgently ill catatonic pa...

In this week's New Yorker , March 20th, is this article: https://www.newyorker.com/science/annals-of-medicine/what-we-still-dont-understand-about-postpartum-psychosis She spent around eight weeks in the lockdown ward, moving between psychotic and catatonic episodes, and eventually recovered with the help of electroconvulsive therapy. After about three months in the hospital, van den Eijnden received nine months of outpatient treatment. She received home visits from a social worker to help her reacclimate to running a household—assistance with to-do lists, laundry, and the like. She also tapered off lithium, under a doctor’s supervision. I read this article because of interest in the topic, but also suspecting that ECT would would be overlooked. But I was wrong: after many tales of inadequate treatment and tragic  outcomes, here was the story of a Dutch woman who got successful ECT.  I will leave to blog readers how to interpret the following final paragraphs of this vignette....

Out on PubMed, from clinicians in Spain, is this case report: RECURRENT SELF-LIMITED HYPERTHERMIA FOLLOWING  ELECTROCONVULSIVE  THERAPY. Sánchez-Morla EM, Gómez de Las Heras V. Actas Esp Psiquiatr. 2023 Jan;51(1):41-43. Epub 2023 Jan 1. PMID:  36912393 The "Abstract " is copied below: Electroconvulsive therapy (ECT) is an effective and safe treatment for severe mental disorders, when it is implemented under an adequate surveillance. Its most frequently described side effects are anterograde amnesia, mania, post- ictal confusion, nausea, headache, myalgia, oral lacerations and dental injuries. The article is here . And from the text: Here's a case of a patient treated for mania who developed transient fever after each of two ECT. Infectious workup (including lumbar puncture, brain MRI) was negative  and a (non-infectious) central nervous system (hypothalamic) etiology is postulated.  The two treatments were very effective, so this case history is quite positive o...

 Out on PubMed, from Turkish investigators, is this paper: Turkish Validity and Reliability Study of the ECT Perception and Knowledge Scale. Yıldırım YE, Aydın PÇ, Öztürk N. Noro Psikiyatr Ars. 2023 Feb 26;60(1):55-61. doi: 10.29399/npa.28144. eCollection 2023. PMID:  36911565 The abstract is copied below: Introduction: Electroconvulsive Therapy (ECT) is an effective and safe treatment method used in the treatment of various psychiatric diseases. However, negative attitudes associated with ECT are common. This causes many negative consequences, from the treatment preference to treatment response and stigma. I n this study, we aimed to carry out a validity-reliability analysis of the ECT Perception and Knowledge Scale (ECT-PK), which was developed to determine the perception and knowledge levels related to ECT, and adapt it to Turkish. Method: The Turkish adaptation of the ECT-PK was made using the translation-retranslation method. Our study included 50 patients with schizophre...

 Out on PubMed, from authors in Brazil and Texas, is this review: Efficacy and adverse effects of ketamine versus electroconvulsive therapy for major depressive disorder: A systematic review and meta-analysis. de A Simoes Moreira D, Gauer LE, Teixeira G, da Silva AC, Cavalcanti S, Quevedo J. J Affect Disord. 2023 Mar 10:S0165-0327(23)00324-5. doi: 10.1016/j.jad.2023.02.152. Online ahead of print. PMID:  36907464   Review. The abstract is copied below: Background: ECT is considered the fastest and most effective treatment for TRD. Ketamine seems to be an attractive alternative due to its rapid-onset antidepressant effects and impact on suicidal thoughts. This study aimed to compare efficacy and tolerability of ECT and ketamine for different depression outcomes (PROSPERO/CRD42022349220). Methods: We searched MEDLINE, Web of Science, Embase, PsycINFO, Google Scholar, Cochrane Library and trial registries, which were the ClinicalTrials.gov and the World Health Organization's ...

 Out on PubMed, from clinicians in Taiwan, is this case report: Management for A Depressive Patient with Femoral Neck Fracture by Electroconvulsive Therapy during COVID-19 Pandemic: A Case Report and Literature Review. Chiu NM, Tseng EY. Int J Environ Res Public Health. 2023 Feb 23;20(5):4004. doi: 10.3390/ijerph20054004. PMID:  36901014 The abstract is copied below: Electroconvulsive therapy (ECT) is an effective treatment for refractory major depressive disorder with suicidal ideation. The most common adverse medical events are transient retrograde amnesia, falls and pneumonia. Hip fractures, associated with high-energy trauma by convulsions, were occasionally reported in western countries, in the period before the COVID-19 pandemic. Strict COVID-19 regulations influenced the course and further investigation of the treatment of post-ECT complications. A 33-year-old man, previously diagnosed with major depressive disorder, had a history of nine successful sessions of ECT trea...

Out on PubMed, from investigators in India and the USA (Yale), is this study: Influence of chronic   electroconvulsive   seizures on plasticity-associated gene expression and perineuronal nets within the hippocampi of young adult and middle-aged Sprague-Dawley rats. Jaggar M, Ghosh S, Janakiraman B, Chatterjee A, Maheshwari M, Dewan V, Hare B, Deb S, Figueiredo D, Duman RS, Vaidya VA. Int J Neuropsychopharmacol. 2023 Mar 4:pyad008. doi: 10.1093/ijnp/pyad008. Online ahead of print. PMID:  36879414 The abstract is copied below: Background: Electroconvulsive seizure therapy is often used in both treatment-resistant and geriatric depression. However, preclinical studies identifying targets of chronic electroconvulsive seizure (ECS) are predominantly focused on animal models in young adulthood. Given that putative transcriptional, neurogenic and neuroplastic mechanisms implicated in the behavioral effects of chronic ECS themselves exhibit age-dependent modulation, it remains u...

Out on PubMed, is this LTE in Molecular Psychiatry: Electroconvulsive  therapy-a shocking inducer of neuroplasticity? Tartt AN, Mariani M, Hen R, Mann JJ, Boldrini M. Mol Psychiatry. 2023 Mar 3. doi: 10.1038/s41380-023-02015-0. Online ahead of print. PMID:  36869226 The letter is here . And here: This is a comprehensive response to the prior LTE from Sartorius and colleagues in which they called out the authors of the original review of neuroplasticity in antidepressant treatment for omitting ECT. So here they speculate about neuronal mechanisms underlying both the rapid and more long-term effects of ECT. Kudos to both sets of authors for recognizing the omission, and then correcting it with this thoughtful response. One still wonders about the rare patient who has a switch from profound depression to euthymia or hypomania immediately after a single treatment... (Please see also blog post of September 18, 2022.)

 "Classics in ECT" brings you this tribute to Ugo Cerletti from the American Journal of Psychiatry, 1963: UGO CERLETTI, M.D. (1877-1963). MORA G. Am J Psychiatry. 1963 Dec;120:620-2. doi: 10.1176/ajp.120.6.620. PMID:  14090328   The pdf is here .  The text is here: Here's a nice tribute to the co-inventor of ECT, with interesting historical details, as well as the iconic portrait. The references are also worth reviewing.

 Out on PubMed, from researchers in Austria, is this study: Comparison of etomidate and methohexital as anesthetic agents for continuation and maintenance electroconvulsive therapy: A retrospective analysis of seizure quality and safety. Millischer V, Pramhas S, Wiedermann I, Eder V, Kress HG, Michalek-Sauberer A, Rujescu D, Frey R, Baldinger-Melich P. J Affect Disord. 2023 Feb 28:S0165-0327(23)00250-1. doi: 10.1016/j.jad.2023.02.085. Online ahead of print. PMID:  36863475 The abstract is copied below: Background: The ideal hypnotic agent for electroconvulsive therapy (ECT) is still under debate and previous studies comparing etomidate and methohexital have produced conflicting results. This retrospective study compares etomidate and methohexital as anesthetic agents in continuation and maintenance (m)ECT with regard to seizure quality and anesthetic outcomes. Methods: All subjects undergoing mECT at our department between October 1st, 2014 and February 28th, 2022 were include...

NBC's Chicago Med Season 8, Episode 15 had a subplot involving ECT:   Here we have a new portrayal of ECT on TV. A young man with ? schizoaffective disorder presents with auditory hallucinations and the delusion that he is dead. The ECT scene itself is okay, what I would call semi-realistic.  The post-ECT scene is good, as he is now less agitated, denies hearing voices and seems to think he is again living. The red burn marks on his temples are an unfortunate dramatic distortion. Having to watch 40 minutes of medical TV drama to see a couple of minutes of ECT was grueling, but ultimately worth it. ECT-in-the-media scholars will certainly want to watch this.

 Out on PubMed, in the NEJM, are these two papers:Antidepressant Augmentation versus Switch in Treatment-Resistant Geriatric Depression. Lenze EJ , Mulsant BH, Roose SP, Lavretsky H, Reynolds CF 3rd, Blumberger DM, Brown PJ, Cristancho P, Flint AJ, Gebara MA, Gettinger TR, Lenard E, Miller JP, Nicol GE, Oughli HA, Pham VT, Rollman BL, Yang L, Karp JF. N Engl J Med . 2023 Mar 3. doi: 10.1056/NEJMoa2204462. Online ahead of print. PMID:  36867173   Aripiprazole   Augmentation in Older Persons with Treatment-Resistant Depression. Lewis G,  Lewis G. N Engl J Med. 2023 Mar 3. doi: 10.1056/NEJMe2301045. Online ahead of print. PMID:  36867178 A major treatment trial for geriatric depression (actually geriatric TRD) with poor remission rates, published this week in the NEJM, and an accompanying editorial fail to even mention ECT. Nothing, crickets... The editorial, written by by two PhDs from University College, London, concludes: The findings from this trial s...