Clinical Neuroscience of ECT (CNECT)

  I'm off to the IPA meeting in Lisbon. I plan to resume posting sometime in mid-July. Please keep an eye on PubMed, and send comments about ECT-related articles, thanks. CK

Out on PubMed, from authors in Iran, is this paper: The Therapeutic Effect of Electroconvulsive Therapy in Patients With Obsessive-compulsive Disorder: A Quasi-experimental Study. Noorazar SG, Emamizad S, Fakhari-Dehkharghani A, Pouya P. Basic Clin Neurosci. 2023 Jan-Feb;14(1):19-30. doi: 10.32598/bcn.2022.3524.1. Epub 2023 Jan 1. PMID:  37346874   The abstract is copied below: Introduction: Electroconvulsive therapy (ECT) is an effective treatment for some psychiatric disorders. It is postulated that ECT should primarily be considered for patients with treatment-resistant obsessive-compulsive disorder (OCD) in the context of major depression. Therefore, we aimed to evaluate the efficacy of ECT in OCD patients without comorbid psychiatric disorders. Methods: This quasi-experimental study was conducted on 12 adult patients with severe OCD (Yale-Brown test score above 25) and no comorbid psychiatric disorders referred to a tertiary care hospital for psychiatric disorders. Treatm...

Effect of Continuation-Maintenance Electroconvulsive Therapy on Hospitalization: A Retrospective Mirror-Image Study. Sombatcharoen-Non N, Yamnim T, Jullagate S, Ittasakul P. Neuropsychiatr Dis Treat. 2023 Jun 15;19:1427-1433. doi: 10.2147/NDT.S415878. eCollection 2023. PMID:  37342756   The abstract is copied below: Objective: To examine the effect of continuation-maintenance electroconvulsive therapy (ECT) on psychiatric hospitalization in Thai patients. Methods: This retrospective mirror-image study reviewed medical records of Thai patients who received continuation-maintenance ECT at Ramathibodi Hospital, Bangkok, between September 2013 and December 2022. The initiation of continuation-maintenance ECT served as the index event, establishing pre-initiation and post-initiation periods. The primary outcome measured the differences in admissions and admission days before and after continuation-maintenance ECT. Results: Forty-seven patients were included in the study, with diagn...

Out on PubMed, from investigators in Michigan and Pennsylvania, is this article: Stakeholders' Ethical Concerns Regarding Psychiatric Electroceutical Interventions: Results from a US Nationwide Survey. Bluhm R, Sipahi ED, Achtyes ED, McCright AM, Cabrera LY. AJOB Empir Bioeth. 2023 Jun 21:1-11. doi: 10.1080/23294515.2023.2224592. Online ahead of print. PMID:  37343219 The abstract is copied below: Background: Psychiatric electroceutical interventions (PEIs) use electrical or magnetic stimulation to treat mental disorders and may raise different ethical concerns than other therapies such as medications or talk therapy. Yet little is known about stakeholders' perceptions of, and ethical concerns related to, these interventions. We aimed to better understand the ethical concerns of a variety of stakeholder groups (patients with depression, caregivers of patients, members of the public, and psychiatrists) regarding four PEIs: electroconvulsive therapy (ECT), repetitive transcranial...

Out on PubMed, from colleagues in Australia and Denmark, in JECT, is this commentary: ChatGPT on  ECT : Can Large Language Models Support Psychoeducation? Lundin RM, Berk M, Østergaard SD. J ECT. 2023 Jun 12. doi: 10.1097/YCT.0000000000000941. Online ahead of print. PMID:  37310145   The paper is here . And from the text: This is a clever commentary that tests AI for ECT information. The hopeful tone is surprising and encouraging, but obviously preliminary and tentative, as the authors carefully note. It is a quick read that all ECT practitioners/referrers should take the time to look at. Kudos to these authors for their creative contribution to the ECT literature.

Out on PubMed, from anesthesiologists in Germany, is this review: Electroconvulsive therapy: recent advances and anesthetic considerations. Ninke T, Groene P. Curr Opin Anaesthesiol. 2023 Jun 9. doi: 10.1097/ACO.0000000000001279. Online ahead of print. PMID:  37314167 The abstract is copied below: Purpose of review: This review summarizes the current indications and principles of ECT. Contemporary anesthetic considerations are described with a focus on the optimal use of hypnotic agents and providing ECT in pregnant patients. Recent findings: ECT is useful in treatment-resistant major depression, bipolar disorders, and treatment-resistant schizophrenia. It is a well tolerated treatment in pregnant patients with treatment-resistant depression. Cognitive side effects may be attenuated by using unilateral placement of scalp electrodes, fewer treatment sessions, and the use of ultrabrief pulse width of the electrical charge. All modern hypnotics can be used for induction of anesthesia ...

Out on PubMed, from researchers in Belgium and The Netherlands, is this review: Reviewing the neurobiology of electroconvulsive therapy on a micro- meso- and macro-level. Belge JB, Mulders P, Van Diermen L, Sienaert P, Sabbe B, Abbott CC, Tendolkar I, Schrijvers D, van Eijndhoven P. Prog Neuropsychopharmacol Biol Psychiatry. 2023 Jun 16:110809. doi: 10.1016/j.pnpbp.2023.110809. Online ahead of print. PMID:  37331685   Review. The abstract is copied below: Background: Electroconvulsive therapy (ECT) remains the one of the most effective of biological antidepressant interventions. However, the exact neurobiological mechanisms underlying the efficacy of ECT remain unclear. A gap in the literature is the lack of multimodal research that attempts to integrate findings at different biological levels of analysis METHODS: We searched the PubMed database for relevant studies. We review biological studies of ECT in depression on a micro- (molecular), meso- (structural) and macro- (netwo...

Out on PubMed, in JECT, is this obituary: I n Memoriam: Jan-Otto Ottosson. Shorter E, Fink M, Ottosson M. J ECT. 2023 Jun 12. doi: 10.1097/YCT.0000000000000939. Online ahead of print. PMID:  37310117   The pdf is here . The obituary is here: One of the greats of ECT, Jan-Otto Ottosson, died this spring at the age of 97. This tribute nicely summarizes his impact on the field, and how much he will be missed.

 Forget the New England Journal of Medicine! Making it to Jeopardy! is really having arrived in American culture. (Thanks to W. Vaughn McCall for sharing this)

Out on PubMed, from clinicians in France, in JECT, is this case report: Aphasia Following Electroconvulsive Therapy: A Case Report With a Literature Review of Published Cases. Kassir S, Endomba FT, Amghar C, Guillet C. J ECT. 2023 Jun 5. doi: 10.1097/YCT.0000000000000940. Online ahead of print. PMID:  37310129   The report is here . And here. This report describes a rare, interesting, and almost always benign neurological effect of ECT. The authors' speculation that it was attributable to bilateral electrode placement and/or high stimulus dose is just that, speculation. I would have liked to see the title include the word "transient." It is helpful to be reminded of this phenomenon, and the literature review is useful.

Out on PubMed, from authors in the USA, is this review: Ketamine Augmentation of Electroconvulsive Therapy: A Scoping Review of Dose-Dependent Effects in Major Depressive Disorder. Nagi T, Jagtiani A, Somvanshi S, Seegobin SA, Singh J, Bachu AK, Pathak M. Cureus. 2023 Jun 7;15(6):e40087. doi: 10.7759/cureus.40087. eCollection 2023 Jun. PMID:  37292107 The abstract is copied below: Intravenous ketamine infusions in subanesthetic doses have been shown to rapidly alleviate depressive symptoms. However, the efficacy of ketamine as an anesthetic during electroconvulsive therapy (ECT) for major depression has not yet been answered by a large randomized control trial (RCT). This scoping review aims to examine the available literature to determine whether the dose of ketamine used during ECT influences the response to treatment. A literature search was conducted on PubMed to identify all published RCTs within the last 10 years which compared ketamine anesthesia during ECT for major depress...

Out on Pubmed, about a couple of weeks ago, was this editorial: Ketamine   and ECT in Depression - Risks and Rewards. Freedman R. N Engl J Med . 2023 May 24. doi: 10.1056/NEJMe2305130. Online ahead of print. PMID:  37224235   No abstract available. The editorial is here: As promised, here is the Freedman editorial that accompanied the Anand et al. ELEKT-D study. I find it slightly misguided, much like the study, with a misunderstanding of the heterogeneity of the study population (chronic and comorbid does not equal severe) and a weird emphasis on the opioid qualities of ketamine.

Out on PubMed, from investigators in Singapore and Australia, is this paper: The association between outpatient continuation/maintenance electroconvulsive therapy, readmission risk and total direct cost in patients with depressive, bipolar and psychotic disorders: A naturalistic retrospective cohort study. Koh AHK, Tan XW, Tor PC, Chatterton ML, Martin DM, Loo CK. J Affect Disord. 2023 Jun 7:S0165-0327(23)00772-3. doi: 10.1016/j.jad.2023.06.016. Online ahead of print. PMID:  37295655 The abstract is copied below: Background: The transdiagnostic effect of continuation/maintenance ECT (CM-ECT) across mood and psychotic disorders on hospital psychiatric readmission risk and total direct cost remains unclear. Methods: A naturalistic retrospective analysis of 540 patients who received inpatient acute ECT treatment from May 2017 to Mar 2021 in a tertiary psychiatric institution . Patients were assessed with validated clinical rating scales pre-ECT and after the first 6 treatments of a co...

Out on PubMed, from investigators in Maryland, is this case series: Evaluating salvage electroconvulsive therapy for the treatment of prolonged super refractory status epilepticus: A case series. Woodward MR, Doddi S, Marano C, Regenold W, Pritchard J, Chen S, Margiotta M, Chang WW, Alkhachroum A, Morris NA. Epilepsy Behav. 2023 Jun 3;144:109286. doi: 10.1016/j.yebeh.2023.109286. Online ahead of print. PMID:  37276802 The abstract is copied below: Background and objectives: Clinicians have treated super refractory status epilepticus (SRSE) with electroconvulsive therapy (ECT); however, data supporting the practice are scant and lack rigorous evaluation of continuous electroencephalogram (cEEG) changes related to therapy. This study aims to describe a series of patients with SRSE treated at our institution with ECT and characterize cEEG changes using a blinded review process. Methods: We performed a single-center retrospective study of consecutive patients admitted for SRSE and trea...

A recent news piece about the war in Ukraine (the issue of giving equal time/news coverage to Russia and Ukraine) prompts me to reprise this commentary: Electroconvulsive Therapy (ECT) in the News: "Balance" Leads to Bias. Choy MM,  Farber KG , Kellner CH. J ECT. 2017 Mar;33(1):1-2. doi: 10.1097/YCT.0000000000000376. PMID:  27930428 The commentary is here:

 Out on PubMed, from Danish clinicians,  in the Danish Medical Journal, is this case report: ECT for Cotard syndrome in a 13-year-old. Kjærgaard AL, Jensen LN, Taastrøm A, Rimvall MK. Ugeskr Laeger. 2023 May 15;185(20):V11220696. PMID:  37264869   Danish. The abstract is copied below: This is a case report about a 13-year-old girl who presented with depression, severely reduced daily functioning, and eventually nihilistic delusions about being dead. The condition was interpreted as a presentation of Cotard syndrome as part of early-onset schizophrenia. Treatment with an antidepressant and multiple antipsychotic medications was not effective. The patient was then treated with ECT, resulting in subjective and measurable positive effects. The case report is here . We only have the abstract in English, but this looks to be successful ECT in an adolescent with a severe, psychotic illness. Perhaps a Danish colleague who follows this blog could help us with a few more deta...

Out on PubMed, from investigators in the US, is this study: Ketamine versus  ECT   for Nonpsychotic Treatment-Resistant Major Depression. Anand A, Mathew SJ, Sanacora G, Murrough JW, Goes FS, Altinay M, Aloysi AS, Asghar-Ali AA, Barnett BS, Chang LC, Collins KA, Costi S, Iqbal S, Jha MK, Krishnan K, Malone DA, Nikayin S, Nissen SE, Ostroff RB, Reti IM, Wilkinson ST, Wolski K, Hu B. N Engl J Med. 2023 May 24. doi: 10.1056/NEJMoa2302399. Online ahead of print. PMID:  37224232 The abstract is copied below: Background:  Electroconvulsive therapy (ECT) and subanesthetic intravenous ketamine are both currently used for treatment-resistant major depression, but the comparative effectiveness of the two treatments remains uncertain. Methods:  We conducted an open-label, randomized, noninferiority trial involving patients referred to ECT clinics for treatment-resistant major depression . Patients with treatment-resistant major depression without psychosis were recruited a...