Clinical Neuroscience of ECT (CNECT)

Out on PubMed, from authors in Spain, is this study: Does Lidocaine Shorten Seizure Duration in Electroconvulsive Therapy? López-Ilundain J, Prados AB, Enriquez ÁSR, Enguita-Germán M, Rosquil EU, Gil JL, Fábrega AM, Martinez de Zabarte Moraza E, Maughan AR, Yoldi-Murillo J. Pharmacopsychiatry. 2023 Aug 29. doi: 10.1055/a-2114-4327. Online ahead of print. PMID:  37643731 The abstract is copied below: Background: Electroconvulsive therapy (ECT) is an effective short-term treatment for schizophrenia and depression, amongst other disorders. Lidocaine is typically added to reduce pain from intravenous propofol injection. However, depending on the dose used in the ECT setting, it can shorten seizure duration. The aim of this study was to investigate the effect of lidocaine dose on seizure duration. Methods: This retrospective, naturalistic cohort study included 169 patients treated with ECT. We examined 4714 ECT sessions with propofol or propofol plus lidocaine. Ictal quality was manuall...

Out on PubMed, in Acta, from the Harvard group and MUSC, is this study: Changes in self-reported suicidal ideation during treatment with electroconvulsive therapy: A retrospective cohort study. Luccarelli J, Humphrey D, McCoy TH Jr, Henry ME, Mueller M, Seiner SJ. Acta Psychiatr Scand. 2023 Aug 29. doi: 10.1111/acps.13603. Online ahead of print. PMID:  37643775 The abstract is copied below: Objective: Suicidal ideation (SI) is common in patients with depressive symptoms, who are the most common recipients of electroconvulsive therapy (ECT). We sought to quantify changes in self-reported SI occurring during treatment with ECT, and to identify factors associated with persistence of SI in patients beginning treatment with SI. Method: Retrospective, single-center cohort study of patients receiving ECT and who self-reported symptoms using Quick Inventory of Depressive Symptomatology (QIDS) prior to ECT and after treatment #5 or #10. Changes in QIDS-reported SI over the course of ECT wer...

Out on PubMed, from authors in Korea, is this paper:  Electroconvulsive therapy and seizure: a double-edged sword? Shin HR, Kim M, Park KI. Encephalitis. 2023 Jul 13. doi: 10.47936/encephalitis.2023.00059. Online ahead of print. PMID:  37621189 The abstract is copied below: Electroconvulsive therapy (ECT) is a widely used therapeutic option of drug-refractory psychiatric disorders. ECT treats psychiatric symptoms by inducing brief controlled seizures through electrical stimulation, but ECT does not generally cause prolonged seizures or epilepsy. However, several studies have reported cases of prolonged seizures after ECT. This review aimed to determine the mechanism of epileptogenesis with neurobiological changes after ECT. Contrary to epileptogenesis by ECT, several cases have reported that ECT was successfully applied for treatment of refractory status epilepticus. In addition, ECT might be applied to hyperkinetic movement and psychiatric symptoms of encephalitis. We also in...

Out on PubMed, from researchers in Japan, is this paper: Triple network connectivity changes in patients with major depressive disorder versus healthy controls via structural network imaging after electroconvulsive therapy treatment. Chibaatar E, Watanabe K, Quinn PM, Okamoto N, Shinkai T, Natsuyama T, Hayakawa G, Ikenouchi A, Kakeda S, Yoshimura R. J Affect Disord. 2023 Aug 18:S0165-0327(23)00996-5. doi: 10.1016/j.jad.2023.08.020. Online ahead of print. PMID:  37598718 The abstract is copied below: Objective: To investigate the effect of electroconvulsive treatment (ECT) on dynamic structural network connectivity in major depressive disorder (MDD), based on the triple-network model. Methods: Twenty-one first-episode, drug-naïve patients with MDD and 21 age- and sex-matched healthy subjects were recruited. Bilateral electrical stimulation was performed thrice a week for a total of 4-5 weeks in the MDD group. MRI data were obtained, and triple-network structural connectivity was eva...

"Classics in ECT" brings you this Brief Communication from the American Journal of Psychiatry , 1967: Daily administration of unilateral  ECT . Abrams R. Am J Psychiatry. 1967 Sep;124(3):384-6. doi: 10.1176/ajp.124.3.384. PMID:  6039994   The pdf is here . And here: Here's an oldie but goodie, from Dick Abrams when he was a Captain in the Air Force! An interesting small study demonstrating the feasibility of daily RUL ECT, albeit with the Lancaster electrode placement. Enjoy!

 Out on PubMed, from investigators at Penn State, is this LTE: Developing a definition of early  ECT  dropout and exploring correlates of dropout. Mahgoub Y, Hamlin D, Francis A. Gen Hosp Psychiatry. 2023 Aug 18:S0163-8343(23)00132-9. doi: 10.1016/j.genhosppsych.2023.08.007. Online ahead of print. PMID:  37607847   The letter is here . And here: This LTE is about developing a definition of early dropout from a course of ECT and trying to find reasons for it.  The authors review the literature on the subject, than add retrospective data from their own clinical experience. Patient anxiety comes up as a major issue, something that Dr. Jasmien Obbels has been studying. Kudos to these authors for this thoughtful contribution to the ECT literature.

Out on PubMed, from investigators in the Netherlands, Australia and Canada, is this review: On the Origins of MAOI Misconceptions: Reaffirming their Role in Melancholic Depression. Van den Eynde V, Parker G, Ruhé HG, Birkenhäger TK, Godet L, Shorter E, Gillman PK. Psychopharmacol Bull. 2023 Aug 11;53(3):35-54. PMID:  37601082   Review. The abstract is copied below: The first monoamine oxidase inhibitors (MAOIs) used for the treatment of depression in the 1950-60s were credited with treating severe melancholic depression (MeD) successfully and greatly reducing the need for electroconvulsive therapy (ECT) . Following the hiatus caused by the then ill-understood cheese reaction, MAOI use was relegated to atypical and treatment-resistant depressions only, based on data from insufficiently probing research studies suggesting their comparatively lesser effectiveness in MeD. The siren attraction of new 'better' drugs with different mechanisms amplified this trend. Following a re-eval...

Out on PubMed, from authors in Iran, is this review: Association between postictal suppression and the therapeutic effects of  electroconvulsive   therapy: A systematic review. Langroudi ME, Shams-Alizadeh N, Maroufi A, Rahmani K, Rahchamani M. Asia Pac Psychiatry. 2023 Aug 16:e12544. doi: 10.1111/appy.12544. Online ahead of print. PMID:  37587610   Review The abstract is copied below: Electroconvulsive therapy (ECT) is an effective and safe medical treatment for patients with severe mood and neuropsychiatric disorders. Since the advent of ECT, extensive research has been performed to identify the predictive factors for response to ECT. In recent decades, postictal suppression on an electroencephalogram (EEG) has been considered a potential predictor of response to ECT. We aimed to investigate the direct association between postictal suppression and the therapeutic effects of ECT. In this systematic review, all articles in the field of the association between postict...

Out on PubMed, from authors in San Francisco, is this article: The Use of Electroconvulsive Therapy on Death Row. Shah A, Morris NP, McNiel DE, Binder RL. J Am Acad Psychiatry Law. 2023 Aug 17:JAAPL.230053-23. doi: 10.29158/JAAPL.230053-23. Online ahead of print. PMID:  37591602 Despite high rates of mental illness among incarcerated people in the United States, use of electroconvulsive therapy (ECT) remains limited in jails and prisons. There are some published guidelines regarding the provision of mental health care, including ECT, in U.S. correctional facilities, but little attention has been paid to the use of ECT for individuals sentenced to death. This article examines ECT within the context of the death penalty, including court consideration of ECT in capital cases and historic uses of ECT to facilitate execution of people on death row. Given the unique clinical, legal, and ethics considerations in the use of ECT for people sentenced to death, the authors call for greater a...

Out on PubMed, from a practitioner in Iowa, in JECT, is this case report: Development of Complete Heart Block During  ECT  Requiring Emergent Implantation of a Permanent Pacemaker. Purgianto A. J ECT. 2023 Aug 3. doi: 10.1097/YCT.0000000000000953. Online ahead of print. PMID:  37561914 Here is a nicely presented case report of a series of cardiac complications. I have two minor critiques: the author did not make clear if the ECT stimulus was delivered at the first problem treatment (I think not) and there was not enough description of the patient's status in the minutes awaiting pacemaker implant. But overall, a very useful addition to the cardiac literature in ECT. Kudos to Dr. Purgianto.

Out on PubMed, from authors in New Hampshire and Georgia, is this review: Electroconvulsive  Therapy in Heart Transplant Patients: To Avoid or Embrace? Ketcham E, Glass OM, Hermida AP. J ECT. 2023 Aug 3. doi: 10.1097/YCT.0000000000000954. Online ahead of print. PMID:  37561916 The article is here . And from the text: Here is s very nice review of the 6 cases in the literature of cardiac transplant patients who have received ECT. Because of vagal denervation, the risk of bradycardia is lessened; the theory of sympathetic supersensitivity is interesting. In any case (or at least all treated so far), the answer to the title question is a resounding, "embrace." Kudos to these authors for this helpful contribution to the ECT literature.

https://en.wikipedia.org/wiki/Electroconvulsive_therapy Today's post is a reminder to blog readers to check out the ECT entry on Wikipedia.It has some accurate and useful information, but has an overall skeptical and damning-with-faint-praise tone.The introductory obsession with electrical details is unnecessary and off-putting.There is much more that could be improved, but I will leave you to read it for yourselves and form an opinion. I have long thought that some experts in the field should take on the task of improving this Wiki entry and seeing to it that it is kept free of anti-ECT bias. Your comments will be most welcome

Out on PubMed, from authors in Brazil, is this review:  Electroconvulsive therapy for treating patients with agitation and related behavioral disorders due to dementia: a systematic review. Stella F, Radanovic M, Gallucci-Neto J, Forlenza OV. Dement Neuropsychol. 2023 Jul 24;17:e20230007. doi: 10.1590/1980-5764-DN-2023-0007. eCollection 2023. PMID:  37533598   The abstract is copied below: Behavioral disturbances are clinically relevant in patients with dementia, and pharmacological regimens to mitigate these symptoms have provided limited results. Proven to be effective in several psychiatric conditions, electroconvulsive therapy is a potentially beneficial strategy for treating severe agitation due to dementia. Objective: This review aimed to examine the publications on the efficacy, safety and tolerability of electroconvulsive therapy in treating patients with agitation due to dementia. Methods: We performed a systematic analysis on the electroconvulsive therapy to tre...

 Out on PubMed, in JECT, is this study: A Retrospective Matched Comparison Study of Prolonged Seizures in  ECT . Isenberg K, Dinwiddie SH, Song J, North CS. J ECT. 2023 Jul 20. doi: 10.1097/YCT.0000000000000951. Online ahead of print. PMID:  37530874 The abstract is copied below: Objective: This study assessed the incidence of and risk factors for prolonged seizures (>180 sec) in electroconvulsive therapy (ECT). Method: I n 611 adult patients undergoing 6697 ECT treatments administered over a 2.5-year study period, 29 individuals experienced 42 prolonged seizures. A comparison sample (n = 29) was matched on sex, age, and treatment, and compared on psychiatric and medical diagnoses, as well as current medications. To examine the association between the characteristics and prolonged seizure, conditional logistic regression models or exact McNemar tests were conducted. Results: Prolonged seizures occurred on average in 1 of every 167 treatments. No specific psychiatric di...