Clinical Neuroscience of ECT (CNECT)

  Dear blog readers, I will be away from the blog until sometime in mid-October. In the meantime please check PubMed for new entries and feel free to peruse the archives of this blog. (Those classics never get old!) Thanks!

Out on PubMed, from authors in England and the Netherlands, is this paper: What makes a medical intervention invasive? De Marco G , Simons J, Forsberg L, Douglas T. J Med Ethics. 2023 Sep 18:jme-2023-109301. doi: 10.1136/jme-2023-109301. Online ahead of print. PMID:  37722810 The article is here . And from the text: Here's an article I never would have found were it not for the ECT citations at the end.  I think the concept is interesting, and have always liked the standard definition because it clearly categorizes ECT as non-invasive.  Similarly, I have often argued for the cognitive effects of ECT to be categorized as a "tolerability" rather than a "safety" issue, since the standard definition of medical safety involves physical injury or death. I hope you will peruse this article and please comment.

Out on PubMed, from authors in Spain, is this case report:  Catatonic postpartum paternal depression as a first debut of a bipolar disorder: a case report. de Juan O, Mas A, Giménez-Palomo A, Gil-Badenes J, Ilzarbe L, Colomer L, Andreu H, Bueno L, Olivier L, Estévez B, Fernández-Plaza T, Tardón-Senabre L, Arbelo N, Valentí M, Gomes da Costa S, Pujol-Fontrodona G, Vieta E, Pacchiarotti I. Int Clin Psychopharmacol. 2023 Sep 20. doi: 10.1097/YIC.0000000000000480. Online ahead of print. PMID:  37729655 The abstract is copied below: Paternal postpartum depression (PD) is considered an affective disorder that affects fathers during the months following childbirth. Interestingly, it has been observed that during these months the chances of a male parent suffering from depression are double that for a non-parent male counterpart. We present the case of a 34-year-old man with no relevant medical history in who, overlapping her daughter's birth, several depressive symptoms emerged, such...

Out on PubMed, from investigators in China, is this LTE: Inflammatory mediators and the effect of  electroconvulsive   therapy in patients with schizophrenia. Chen Q, Li X, Weng K, Zhang Y, Xu Z, Fang Z, Liu Y, Zhang H, Huang Q. Schizophr Res. 2023 Sep 15;261:125-127. doi: 10.1016/j.schres.2023.09.003. Online ahead of print. PMID:  37717510 The letter is here . And here: Well, I thought this one would be boring, but no! Short and well presented, with very interesting data about white cell decrease after ECT in patients with schizophrenia. This should be fairly easy to try to replicate. If it holds up, it would be good data about the inflammatory hypothesis of psychiatric illness and ECT as an immune modulator/anti-inflammatory treatment.

Out on PubMed, from authors in Singapore, is this study: Effect of early electroconvulsive therapy on length of stay in patients with bipolar, depressive and psychotic disorders. Goh SE, Tan XW, Tor PC. Schizophr Res. 2023 Sep 16;261:139-144. doi: 10.1016/j.schres.2023.09.022. Online ahead of print. PMID:  37722210 The abstract is copied below: Objective: There is limited literature examining the effect of early electroconvulsive therapy(ECT) on the length of stay(LOS), especially for psychotic disorders. This study aimed to evaluate the association between early ECT and LOS in three main groups of patients with bipolar, depressive and primary psychotic disorders. Method: A retrospective descriptive analysis of 464 patients who received inpatient ECT from May 2017 to March 2021 in a large tertiary psychiatric institution was conducted. Early ECT was defined as ECT done before the mean number of days from admission to initiation of ECT by diagnosis . The main outcome measure was LOS...

Out on PubMed, from a star-studded cast of international experts, is this review: Treatment-resistant depression: definition, prevalence, detection, management, and investigational interventions. McIntyre RS, Alsuwaidan M, Baune BT, Berk M, Demyttenaere K, Goldberg JF, Gorwood P, Ho R, Kasper S, Kennedy SH, Ly-Uson J, Mansur RB, McAllister-Williams RH, Murrough JW, Nemeroff CB, Nierenberg AA, Rosenblat JD, Sanacora G, Schatzberg AF, Shelton R, Stahl SM, Trivedi MH, Vieta E, Vinberg M, Williams N, Young AH, Maj M. World Psychiatry. 2023 Oct;22(3):394-412. doi: 10.1002/wps.21120. PMID:  37713549   The abstract is copied below: Treatment-resistant depression (TRD) is common and associated with multiple serious public health implications. A consensus definition of TRD with demonstrated predictive utility in terms of clinical decision-making and health outcomes does not currently exist. Instead, a plethora of definitions have been proposed, which vary significantly in their concept...

Out on PubMed, from authors in Pennsylvania, is this case report: A Case of Cannabis-Induced Catatonia and Management With Electroconvulsive Therapy. Sharma A, Sharma V. Cureus. 2023 Aug 14;15(8):e43478. doi: 10.7759/cureus.43478. eCollection 2023 Aug.  PMID:  37711932   The abstract is copied below: This is a case of cannabis-induced catatonia in an 18-year-old Hispanic male with no prior psychiatric history. Shortly after consuming marijuana, the patient experienced catatonic symptoms and demonstrated resistance to several medicinal therapies. Electroconvulsive therapy (ECT) proved to be a useful treatment choice, resulting in significant improvement in symptoms. This example emphasizes the potential dangers of cannabis usage, particularly in susceptible individuals, and underscores the importance of recognizing and treating catatonia as a possible side effect of cannabis use. Keywords:  cannabis induced catatonia; cannabis legalization; cannabis use; electroconvul...

Out on PubMed, from authors in India and the UK, is this review: Role of adjunctive nonpharmacological strategies for treatment of rapid-cycling bipolar disorder. Chakrabarti S, Jolly AJ, Singh P, Yadhav N. World J Psychiatry. 2023 Aug 19;13(8):495-510. doi: 10.5498/wjp.v13.i8.495. eCollection 2023 Aug 19. PMID:  37701540   The abstract is copied below: Rapid-cycling bipolar disorder (RCBD) is a phase of bipolar disorder defined by the presence of ≥ 4 mood episodes in a year. It is a common phenomenon characterized by greater severity, a predominance of depression, higher levels of disability, and poorer overall outcomes. It is resistant to treatment by conventional pharmacotherapy. The existing literature underlines the scarcity of evi-dence and the gaps in knowledge about the optimal treatment strategies for RCBD. However, most reviews have considered only pharmacological treatment options for RCBD. Given the treatment-refractory nature of RCBD, nonpharmacological interventi...

Out on PubMed, from investigators in Germany, is this study: Baseline levels of miR-223-3p correlate with the effectiveness of electroconvulsive therapy in patients with major depression. Kaurani L, Besse M, Methfessel I, Methi A, Zhou J, Pradhan R, Burkhardt S, Kranaster L, Sartorius A, Habel U, Grözinger M, Fischer A, Wiltfang J, Zilles-Wegner D. Transl Psychiatry. 2023 Sep 13;13(1):294. doi: 10.1038/s41398-023-02582-4. PMID:  37699900 PMID:  37699900 The abstract is copied below: There is a strong medical need to develop suitable biomarkers to improve the diagnosis and treatment of depression, particularly in predicting response to certain therapeutic approaches such as electroconvulsive therapy (ECT). MicroRNAs are small non-coding RNAs that have the ability to influence the transcriptome as well as proteostasis at the systems level. Here, we investigate the role of circulating microRNAs in depression and response prediction towards ECT. Of the 64 patients with treatment-...

Out on PubMed, from clinicians at Tufts and Johns Hopkins, is this case report: Repeated  cerebellar   symptoms post-ECT in a geriatric patient. Hasoglu T, Lee BJ, Reti IM. J Acad Consult Liaison Psychiatry. 2023 Sep 4:S2667-2960(23)00123-4. doi: 10.1016/j.jaclp.2023.08.006. Online ahead of print. PMID:  37673401   The pdf is here . And from the text: This is a helpful contribution to the literature, but with a misleading title, and a dog's breakfast organization to the (otherwise well written) case report. Here is the summary: the patient had transient cerebellar symptoms (?hours, but timeline not fully described) after two of eight ECT, having had two similar episodes at home after lorazepam; stroke evaluation was negative; there was a family history of cerebellar disease; her depression remitted. How about "Safe Resumption of ECT after Transient Cerebellar Symptoms" for the title?

Out on Pubmed, from authors at Columbia University, is this paper: Changes in Personality, Mood, and Behavior with TMS and   ECT : Current Knowledge and Challenges. Verne ZJ, Zabinski JS. AJOB Neurosci. 2023 Jul-Sep;14(3):325-327. doi: 10.1080/21507740.2023.2243870. PMID:  37682665   The pdf is here . And from the text: I wanted to read this to make sure there was not too much gratuitous bad-mouthing of ECT. There is only a bit, and this is mostly an interesting thought piece. It is in the context of several articles in this journal discussing the issue of possible personality change with DBS. Since DBS is an invasive procedure with ongoing effects on deep brain structures, the possibility of "pathological personality change" is more relevant. For ECT, "personality change" has been used by the anti-ECT crowd as a dog whistle for their claims of "brain damage." As most of us know from experience, what actually typically happens is that the ECT patient who i...

Out on PubMed, from international authors, are these LTEs in the NEJM: The pdf is here . The link is here: https://www.nejm.org/doi/full/10.1056/NEJMc2308757 Here are three letters critiquing the recent NEJM PCORI-funded multi-center trial comparing IV ketamine to ECT in non-psychotic patients (mostly outpatients).  To summarize, the trial seemed destined by design to provide a very favorable view of ketamine and a damning-with-faint-praise view of ECT. The extremely poor ECT results (anomalous by any standard)  made ketamine look good in comparison. The poor ECT results, in turn, were the result of suboptimal ECT technique and a patient population not typical of ECT cohorts. I will leave it to you to review all the details, also covered previously in blog posts on June 1 and June 12, 2023.

Classics in ECT brings you this article from the Archives of General psychiatry in 1976: Schizophrenia--a follow-up study of results of treatment. May PR , Tuma AH, Yale C, Potepan P, Dixon WJ. Arch Gen Psychiatry. 1976 Apr;33(4):481-6. doi: 10.1001/archpsyc.1976.01770040047009. PMID: 938185 The pdf is  here . and from the text: Patients who had been treated initially with ECT or with drug therapy showed a trend towards spending less time in hospital after their release, a delayed post hospital advantage above and beyond the initial advantages of higher release rate, speedier release, lessened cost of treatment, and better global condition at the time of release as reported earlier. ..These beneficial effects from drug therapy and ECT are less marked if one considers only those patients whose treatment was declared to be a success.  There were, however, far more successes among the drug- and ECT treated patients than in the other groups (95% to 96% of the drug alone and drug p...

Out on Pubmed, from the Harvard group, is this paper: Residual symptoms following  electroconvulsive  therapy: A retrospective cohort study. Hart KL, McCoy TH Jr, Henry ME, Seiner SJ, Luccarelli J. J Affect Disord. 2023 Sep 1:S0165-0327(23)01121-7. doi: 10.1016/j.jad.2023.08.135. Online ahead of print. PMID:  37661058 The abstract is copied below: Background: Residual depressive symptoms following treatment are a burden for patients and are associated with increased risk of relapse. While this phenomenon has been explored following pharmacotherapy, there is little research into residual symptoms following electroconvulsive therapy (ECT). This study quantifies the frequency and type of residual symptoms following ECT treatment. Methods: This study used retrospective data from patients receiving ECT as part of routine clinical care. Depressive symptomatology was assessed using the Quick Inventory of Depressive Symptomatology - Self-Report 16 item scale (QIDS), which include...

Out on PubMed, from investigators in Germany, is this study: The myth of brain damage: no change of neurofilament light chain during transient cognitive side-effects of  ECT . Besse M, Belz M, Bartels C, Herzig B, Wiltfang J, Zilles-Wegner D. Eur Arch Psychiatry Clin Neurosci. 2023 Sep 1. doi: 10.1007/s00406-023-01686-8. Online ahead of print. PMID:  37656172 The abstract is copied below: Electroconvulsive therapy (ECT) is an effective, safe, and mostly well-tolerated treatment for patients with severe or difficult to treat depression or psychotic disorders. However, a relevant number of patients experience subjective and/or objective cognitive side-effects. The mechanism of these transient deficits is not yet clear. Thus, our study prospectively investigated neurofilament light chain (NfL) concentrations as a highly sensitive biomarker for neuroaxonal damage along with cognitive performance during a course of ECT. Serum NfL concentrations from 15 patients with major depressiv...

Out on PubMed, from researchers in Germany, is this study: Multiomics and blood-based biomarkers of electroconvulsive therapy in severe and treatment-resistant depression: study protocol of the DetECT study. von Mücke-Heim IA, Pape JC, Grandi NC, Erhardt A, Deussing JM, Binder EB. Eur Arch Psychiatry Clin Neurosci. 2023 Aug 30. doi: 10.1007/s00406-023-01647-1. Online ahead of print. PMID:  37644215 The abstract is copied below: Electroconvulsive therapy (ECT) is commonly used to treat treatment-resistant depression (TRD). However, our knowledge of the ECT-induced molecular mechanisms causing clinical improvement is limited. To address this issue, we developed the single-center, prospective observational DetECT study ("Multimodal Biomarkers of ECT in TRD"; registered 18/07/2022, www.clinicalTrials.gov , NCT05463562 ). Its objective is to identify molecular, psychological, socioeconomic, and clinical biomarkers of ECT response in TRD. We aim to recruit n = 134 patients in 3 yea...