Clinical Neuroscience of ECT (CNECT)

Out on PubMed, from researchers in Sweden, is this study: Alterations in the Serum Proteome Following Electroconvulsive Therapy for a Major Depressive Episode: A Longitudinal Multicenter Study. Göteson A, Clements CC, Juréus A, Joas E, Holmén Larsson J, Karlsson R, Nordenskjöld A, Pålsson E, Landén M. Biol Psychiatry Glob Open Sci. 2022 Dec 12;3(4):884-892. doi: 10.1016/j.bpsgos.2022.11.005. eCollection 2023 Oct. PMID:  37881534 The abstract is copied below: Background: Electroconvulsive therapy (ECT) is the most effective treatment for severe depression, but the biological changes induced by ECT remain poorly understood. Methods: This study investigated alterations in blood serum proteins in 309 patients receiving ECT for a major depressive episode. We analyzed 201 proteins in samples collected at 3 time points (T): just before the first ECT treatment session (T0), within 30 minutes after the first ECT session (T1), and just before the sixth ECT session (T2). Results: Using statis...

 Out on PubMed, from American authors, is this commentary: Choosing Between Ketamine and Electroconvulsive Therapy for Outpatients With Treatment-Resistant Depression-Advantage Ketamine? Mathew SJ, Jha MK, Anand A. JAMA Psychiatry. 2023 Oct 25. doi: 10.1001/jamapsychiatry.2023.3979. Online ahead of print. PMID:  37878334 Plain language summary (in lieu of abstract): This Viewpoint examines key issues stemming from several recent reports of electroconvulsive therapy (ECT) vs ketamine for improving depressive symptoms in treatment-resistant depression (TRD). The paper is here . And here: My "plain language summary" is that this is largely pie-in-the-sky: the conflated false equivalency of a treatment with a nearly 100-year track record (ECT) with another, still experimental treatment (ketamine) based on two recent clinical trials. I take particular umbrage at the title and the beginning of the "Conclusions." How many thousands of patients will have their clinical mana...

Out on PubMed, from authors in India, is this LTE: Is   ECT   better than clozapine for treatment-resistant schizophrenia? Uppinkudru C, Sreeraj VS, Arumugham SS, Praharaj SK, Goyal N, Sinha P, Thirthalli J. Asian J Psychiatr. 2023 Oct 11;90:103798. doi: 10.1016/j.ajp.2023.103798. Online ahead of print. PMID:  37871364   The LTE is here: This is a thoughtful LTE that is mostly about methodological issues with the Mishra study in Schizophrenia Bulletin in 2022 (please see below).  Documentation of the role of ECT in the treatment of schizophrenia remains a very important issue, given that the FDA could not conclude that ECT was clearly indicated, based on the current literature, despite the fact that worldwide, schizophrenia is the number one indication for ECT. =================================== Comparison of Acute Followed by Maintenance ECT vs Clozapine on Psychopathology and Regional Cerebral Blood Flow in Treatment-Resistant  Schizophrenia : A Randomiz...

Out on PubMed, from authors in India, is this LTE: Electroconvulsive  Therapy: A Last Resort for Lorazepam-Resistant Catatonia in Patient with Large Arachnoid Cyst. Parasher G, Yadav BK, Kar SK. CNS Spectr. 2023 Oct 20:1-6. doi: 10.1017/S109285292300634X. Online ahead of print. PMID:  37861074 The letter is here . And from the text: This is a rudimentary case report of successful and safe ECT for catatonic schizophrenia with a likely incidental MRI finding of a large arachnoid cyst. The management was complicated by the use of oral and injectable antipsychotics. Perhaps that is why lorazepam was only partially effective. N o ECT details are given. Despite these shortcomings, this remains a useful and interesting report of ECT in the presence of a neurological abnormality.

Out on PubMed, from international authors, is this review: Major depressive disorder. Marx W , Penninx BWJH, Solmi M, Furukawa TA, Firth J, Carvalho AF, Berk M. Nat Rev Dis Primers. 2023 Aug 24;9(1):44. doi: 10.1038/s41572-023-00454-1. PMID:  37620370   Review. The abstract is copied below: Major depressive disorder (MDD) is characterized by persistent depressed mood, loss of interest or pleasure in previously enjoyable activities, recurrent thoughts of death, and physical and cognitive symptoms. People with MDD can have reduced quality of life owing to the disorder itself as well as related medical comorbidities, social factors, and impaired functional outcomes. MDD is a complex disorder that cannot be fully explained by any one single established biological or environmental pathway. Instead, MDD seems to be caused by a combination of genetic, environmental, psychological and biological factors. Treatment for MDD commonly involves pharmacological therapy with antidepressant m...

Out on PubMed, from investigators in Sweden, is this study: Safety of and response to electroconvulsive therapy during pregnancy: Results from population-based nationwide registries. Arnison T, Rask O, Nordenskjöld A, Movahed Rad P. Acta Psychiatr Scand. 2023 Oct 18. doi: 10.1111/acps.13623. Online ahead of print. PMID:  37852926 The abstract is copied below: Introduction: Psychiatric disorders are common during pregnancy, affecting up to 16% of pregnant women. Severe depression and anxiety have significant negative effects on the health of both the mother and the developing fetus. Electroconvulsive therapy (ECT) is considered a treatment option for pregnant women with severe psychiatric disorders when other treatments have been ineffective or pose risks to the fetus. Knowledge of the safety and efficacy of ECT during pregnancy, however, remains limited. Methods: Data were obtained from nationwide registries of pregnant women in Sweden who received ECT for a severe psychiatric diso...

Out on PubMed, from a consortium of US investigators, is this paper: A Novel Approach to Monitoring Cognitive Adverse Events for Interventional Studies Involving Advanced Dementia Patients: Insights From the  Electroconvulsive  Therapy for Agitation in Dementia Study. Park S, Forester BP, Lapid MI, Harper DG, Hermida AP, Inouye SK, McClintock SM, Nykamp L, Petrides G, Schmitt EM, Seiner SJ, Mueller M, Patrick RE. J Geriatr Psychiatry Neurol. 2023 Oct 17:8919887231207641. doi: 10.1177/08919887231207641. Online ahead of print. PMID:  37848185 The abstract is copied below: Objective: To develop an individualized method for detecting cognitive adverse events (CAEs) in the context of an ongoing trial of electroconvulsive therapy for refractory agitation and aggression for advanced dementia (ECT-AD study). Methods: Literature search aimed at identifying (a) cognitive measures appropriate for patients with advanced dementia, (b) functional scales to use as a proxy for cognitive ...

  Out on PubMed, from investigators in Denmark, is this review: Blood-brain barrier permeability and  electroconvulsive  therapy - a systematic review. Lundsgaard CC, Gbyl K, Videbech P. Acta Neuropsychiatr. 2023 Oct 16:1-21. doi: 10.1017/neu.2023.48. Online ahead of print. PMID:  37842858   Review. The abstract is copied below: Objective: The cause of cognitive side-effects after electroconvulsive therapy (ECT) is largely unknown. Alterations in the blood-brain barrier (BBB) has been considered in several recent ECT studies. We therefore found it worthwhile to perform a systematic review of the literature to examine if electrically induced seizures affect the permeability of the BBB. Methods: PubMed/MEDLINE and Embase were searched 16 November 2022. Studies with a direct measurement of BBB permeability in animals treated with modified electroconvulsive stimulation (ECS) and in humans treated with ECT were included. Synthesis of results were narrative due to the...

The 13th Annual EFFECT meeting was recently held in Barcelona. The program is here: https://www.theeffect.eu/13th-annual-effect-meeting-barcelona And here: This was an excellent meeting, thanks to both the EFFECT officers and the gracious local Spanish hosts. ECT practice and research are thriving in Spain. There were ~ 60 ECT professionals at the meeting and each presentation was followed by vigorous discussion. All in all a great meeting, Kudos to the organizers. I encourage you to join EFFECT and attend their future meetings.

 Out on PubMed, is this case report: Pramipexole as an Augmentation Strategy to  Electroconvulsive  Therapy in the Treatment of Bipolar Depression Complicated With Parkinsonism: A Case Report. Bueno L, Bermejo A, Gascón M, Giménez-Palomo A, Arbelo N, Andreu H, De Juan O, Olivier L, Navarro L, Guerra V, Bartolomé I, Salmerón S, Ochandiano I, González-Martínez P, Bioque M, Colomer L, Anmella G, Llach CD, Gil-Badenes J, Benabarre A, Pujol-Fontrodona G, Vieta E, Pacchiarotti I. J Clin Psychopharmacol. 2023 Oct 12. doi: 10.1097/JCP.0000000000001761. Online ahead of print. PMID:  37820075   The case report is here . And here: This is a modestly interesting case report of partial response to ECT in a complex clinical situation. The report mostly extoles the virtues of pramipexole. The underling themes are the utility of ECT in bipolar disorder and PD/parkinsonism (although not so much in this patient). Kudos to our Spanish colleagues for this contribution to the ECT li...

Recently published on the World psychiatric Association website: The statement is here . And excerpts from the text: Kudos to Declan McLoughlin for leading this effort and thanks for including me. I hope you agree it reads well. Given the stature of WPA, this is a fairly important document for ECT. IMO, it functions as an ethics statement about ECT, correcting misperceptions (including those promulgated by the United Nations Office of the High Commissioner on Human Rights which has this quote on one of its official pages: "Electroshock and other harmful therapies needed to be eliminated." ) and the conflation of ECT with unrelated unethical practices. Please share this position statement widely and post any related comments, thank you.

Out on PubMed, from investigators in Portugal and the USA, is this LTE: Single session subconvulsive electrical stimulation has rapid therapeutic effects and reduces length of hospitalization in patients in an acute manic episode. Silva-Dos-Santos A, Youssef NA, Bravo J, Sales M, Velho MV, Simões F, Gaspar B, Gracias MJ, Lopes J, Duarte R, Lara E, Gusmão R, Sackeim HA. Brain Stimul. 2023 Sep 27;16(5):1452-1454. doi: 10.1016/j.brs.2023.09.014. Online ahead of print. PMID:  37769989   No abstract available. The letter is here . And here: Oh boy, here we go again! Is the seizure necessary in ECT? Can we have it both ways, that an RUL seizure at relatively low dose is "completely ineffective"  (in depression), but subconvulsive stimuli are potently anti-manic? Let's express interest in this phenomenon, without losing sight of the methodological limitations of this case series, and the possibility (not mentioned) that the anesthesia may have contributed.

Out on PubMed, from authors in Spain, is this case report: Neuropsychiatric symptoms in a patient under cystic fibrosis transmembrane conductance regulator modulators treatment: a case report. Andreu H, Olivier L, Giménez-Palomo A, Roson-Fernandez C, Bueno L, de Juan Ó, Bartolomé I, Ilzarbe L, Tardón-Senabre L, Fernández-Plaza T, Arbelo N, Valentí M, Gil-Badenes J, Macau E, Pujol-Fontrodona G, Colomer L, Vieta E, Pacchiarotti I. Int Clin Psychopharmacol. 2023 Nov 1;38(6):402-405. doi: 10.1097/YIC.0000000000000475. Epub 2023 Sep 27. PMID:  37767628 The abstract is copied below: In recent times, some research has focused on the study of potential treatments for cystic fibrosis (CF), such as cystic fibrosis transmembrane conductance regulator (CFTR) modulators. These treatments have been reported to produce neuropsychiatric symptoms in a few patients, even though there is still no clear correlation nor underlying mechanism proposed. We present the case of a 23-year-old woman with CF a...