Clinical Neuroscience of ECT (CNECT)

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 Dec 1;39(4):275-276. doi: 10.1097/YCT.0000000000000940. Epub 2023 Jun 5. PMID:  37310129   Review.   The LTE is here . And here: Transient neurological dysfunctions after ECT are always interesting, scary (justifiably often prompting brain imaging), and usually completely benign.  Here, our French colleagues give us a pretty good clinical story, but leave us a bit disappointed with the vagueness of the most crucial detail; they say the symptoms lasted "less than an hour." Well, 59 minutes is a lot different from 5 minutes. But we will take them at their word (despite some poorly translated ones) and acknowledge that they are indeed reporting an uncommon case of transient, prolonged aphasia. Details of both motor and EEG sei...

Out on PubMed, from CE Coffey, in JECT, is this commentary: Decarbonizing the International Society for  ECT  and Neurostimulation. Coffey CE. J ECT. 2023 Dec 1;39(4):213. doi: 10.1097/YCT.0000000000000968. PMID:  38009969 The commentary is here . And here: Renowned senior ECT scholar Ed Coffey reminds us that our ECT society should do everything possible to reduce its carbon footprint. A good message, very nicely presented. (When I first read the word "decarbonizing" here, I thought he might be referring to some pruning of the ISEN old guard, analogous to the maintenance required on certain German car engines that tend to have carbon build up on their cylinder heads...)

Out on PubMed, from investigators in Georgia, is this review: The abstract is copied below: Abstract: Longitudinal observational studies have shown a meaningful decrease in suicidal thinking and suicidal behavior after receipt of electroconvulsive therapy (ECT). The antisuicide effect of ECT may be related to success in the global relief of the presenting syndrome such as depressive or psychotic illness.However, it is possible that the antisuicide effect is specific to ECT per se, over and above the relief of the clinical syndrome. Electroconvulsive therapy is associated with many observable neurochemical and physiologic effects, and some of these may plausibly be specifically linked to an antisuicide effect. The phenomenon of physiologic hyperarousal has been named as a candidate mechanism driving the risk for suicide. Hyperarousal is associated with decreased neuropsychological executive function responsible for response inhibition and can lead to impulsive action. T he level of arou...

  I will be taking a break from the blog around the Thanksgiving holiday. Happy Thanksgiving to all who celebrate! The blog will resume towards the end of the month.

Out on PubMed, from authors in Italy, is this review: Safety of electroconvulsive therapy ( ECT ) in pregnancy: a systematic review of case reports and case series. Cipolla S, Catapano P, Messina M, Pezzella P, Giordano GM. Arch Womens Ment Health. 2023 Nov 14. doi: 10.1007/s00737-023-01394-1. Online ahead of print. PMID:  37957411   Review. The abstract is copied below: Pregnancy and the immediate postpartum period are considered at high risk for women who have already received a previous psychiatric diagnosis and might represent a stressful event favoring the onset of new psychiatric disorders. The electroconvulsive therapy (ECT) is effective for the treatment of severe, treatment-resistant mental disorders, and it could represent a therapeutic choice for psychiatric conditions during pregnancy. The purpose of this systematic review is to evaluate the safety of ECT during pregnancy and to update the state of the art of its use . An extensive literature search on PubMed, APA ...

 Out on PubMed, from investigators in Belgium and The Netherlands, is this review book chapter: Mechanism of Action of  ECT  in Depression. Belge JB, van Eijndhoven P, Mulders PCR. Curr Top Behav Neurosci. 2023 Nov 15. doi: 10.1007/7854_2023_450. Online ahead of print. PMID:  37962811 The abstract is copied below: Electroconvulsive therapy (ECT) remains the most potent antidepressant treatment available for patients with major depressive disorder (MDD). ECT is highly effective, achieving a response rate of 70-80% and a remission rate of 50-60% even in treatment-resistant patients. The underlying mechanisms of ECT are not fully understood, although several hypotheses have been proposed, including the monoamine hypothesis, anticonvulsive hypothesis, neuroplastic effects, and immunomodulatory properties. In this paper, we provide an overview of magnetic resonance imaging evidence that addresses the neuroplastic changes that occur after ECT at the human systems level an...

Out on PubMed, from Swedish investigators, is this article: Vi förutspår ingen revolution inom depressio nssjukvården. (We don't predict a revolution in depression care) Nordenskjöld A, Movahed P. Lakartidningen. 2023 Nov 15;120:23149. PMID:  37966105   Swedish.   No abstract available. The article is here: https://lakartidningen.se/klinik-och-vetenskap-1/kommentar/2023/11/vi-forutspar-ingen-revolution-inom-depressionssjukvarden/ Text excerpts are translated below: Major depression is associated with very low quality of life, long-term cognitive impairment and an increased risk of death by suicide. Electroconvulsive therapy (ECT) is the most effective treatment for major depression. ECT involves inducing epileptic seizures with an electric current under general anesthesia. The treatment was introduced in the 1930s, but drug-induced seizures had already been used to treat depression for a long time. The mechanisms of action are thought to include the regeneration of brain ...

Out on PubMed, from researchers in Japan, is this study: Adequate Oxygenation State Maintained during  Electroconvulsive  Therapy in Nonobese Patients Using the Oxygen Reserve Index: A Pilot Study. Kadoi Y, Ohta J, Sasaki Y, Saito S. Case Rep Anesthesiol. 2023 Nov 6;2023:7807693. doi: 10.1155/2023/7807693. eCollection 2023. PMID:  37965073 The abstract is copied below: Some controversial reports have observed oxygen desaturation (defined as percutaneous oxygen saturation (SpO2) < 90%) during electroconvulsive therapy (ECT). T he purpose of this pilot study was to examine oxygenation states in eight patients during ECT. In addition to the usual hemodynamic monitors and pulse oximeter, the oxygen reserve index (ORi) was monitored using a pulse oximeter. Patients received either no preoxygenation or preoxygenation with 100% oxygen via a tight-fitting mask for 1 or 3 min before induction of anesthesia. ORi increased after preoxygenation. ORi differed significantly between ...

[Successful treatment with  ECT  of comorbid psychotic depression in Segawa syndrome]. Gheysens T, Van Diermen L, Madani Y, Schrijvers D. Tijdschr Psychiatr. 2023;65(9):584-587. PMID:  37947471   Free article.   Dutch. The abstract is copied below: We report the case of a 70-year-old man with Segawa syndrome who achieved full remission in three episodes of psychotic depression following electroconvulsive therapy (ECT). As maintenance drug therapy was unable to prevent relapse, maintenance ECT seemed necessary. Segawa syndrome is a rare metabolic disorder characterized by dystonia and possibly psychiatric symptoms. We highlight the psychiatric vulnerability of patients with Segawa syndrome and point out some considerations in treating comorbid psychiatric disorders. The report is here . And from the text (translated): Segawa syndrome is a rare hereditary metabolic disorder.  The original described syndrome concerns dystonia with diurnal variation.  1 ...

Oot  on PubMed, from authors in Taiwan and Australia, is this case report: Electroconvulsive therapy for obsessive compulsive symptoms in a patient with schizophrenia: a brief report. Lin CY, Kuo HY, Chang CH, Pan CC, Chu CS, Couper J, Chiang YC. Neurocase. 2023 Nov 9:1-3. doi: 10.1080/13554794.2023.2280274. Online ahead of print.  PMID:   37943998 The abstract is copied below: Comorbid obsessive-compulsive disorder (OCD) is common among patients with schizophrenia. The role of electroconvulsive therapy (ECT) in the treatment of OCD in schizophrenia is unclear. Herein, we present a 45-year-old man who was diagnosed with schizophrenia along with OCD and received ECT due to relapse of psychosis owing to refractive schizophrenia. Together with psychotic symptoms, obvious symptoms of OCD were observed prior to treatment, including obsessive thoughts, difficulty in starting activities, and repetitive and ritualistic behavior. After 12 sessions of ECT, symptoms of schizophrenia...

Out on PubMed is this review: Catatonia . Heckers S, Walther S. N Engl J Med. 2023 Nov 9;389(19):1797-1802. doi: 10.1056/NEJMra2116304. PMID:  37937779   Review. The review is here . And from the text: I suppose we should be glad that the NEJM has recognized the importance of catatonia, and that the ECT treatment part made it into the review. Nothing overtly bad or incorrect here, but a pretty lackluster review and some gratuitous topic sentence negativity:  Catatonia has been well described but is poorly understood. We do not understand the neural mechanisms of catatonia. On the positive side, the audience is huge and some education will take place as a result of this publication.

Here is a commentary from the September 2023 issue of the AJP Residents' Journal: The pdf is here . And here: This is a very thoughtful commentary about ECT in the media. I did not know about the Canadian effort to encourage responsible reporting on suicide. The authors' call to do the same for ECT is well taken.  Kudos to our resident colleagues in Cleveland for this excellent piece.

The impact of the number of previous illness episodes on early response to electroconvulsive therapy ( ECT ) in psychosis, mania, depression, psychotic depression, and catatonia: A naturalistic transdiagnostic analysis. Birong Chen, Tan XW, Tor PC. Psychiatry Res. 2023 Oct 30;330:115580. doi: 10.1016/j.psychres.2023.115580. Online ahead of print. PMID:  37926055 The abstract is copied below: Electroconvulsive Therapy (ECT) is an effective treatment for mood and psychotic disorders but there is growing evidence of treatment resistant to ECT. Our study aimed to investigate the relationship between the number of previous illness episodes and the symptomatic improvement after acute ECT treatment. We conducted a retrospective naturalistic cohort analysis of patients' ECT registry data from March 2017 to February 2023. We categorized the number of previous illness episodes into "0-3″ and ">3 episodes", paired T-tests were used to compare the changes in scores of clinic...

This brief spot on geriatric depression aired on South carolina Public Radio recently: Depression in Older Adults The link is here: https://www.southcarolinapublicradio.org/podcast/health-focus/2023-11-06/depression-in-older-adults What is the big deal here? Well, the big deal is that there is no big deal:  ECT is mentioned as a treatment for depression that does not respond to pharmacotherapy. No drama, no caveats, no "buts." That is the way it should be. Of course, most of the time there is no mention of ECT at all... The reminder that cognitive impairment may be a symptom of depression (pseudodementia) is also very helpful. Kudos to Dr. Bryan for this excellent public service announcement.

Out on PubMed, from colleagues in Georgia, is this commentary: Reflections : Psychological Risks With Borderline Personality Disorder in Electroconvulsive Therapy. McCall WV , House A, Rosenquist PB. J ECT. 2023 Jul 20. doi: 10.1097/YCT.0000000000000948. Online ahead of print. PMID:  37530756 The commentary is here . And here: This is an excellent, very thoughtful commentary about the implications of treating depressed patients with comorbid borderline personality disorder. The expectation-setting and consent issues are particularly cogent. I recommend a full read to all ECT healthcare practitioners. Kudos to Drs. McCall, House and Rosenquist.

Out on PubMed, from investigators in Japan, is this study: Effect of Remifentanil on the Tpeak-Tend Interval During Electroconvulsive Therapy. Eda K, Akutsu K, Takasusuki T, Yamaguchi S. Adv Ther. 2023 Nov 1. doi: 10.1007/s12325-023-02713-9. Online ahead of print. PMID:  37910266 The abstract is copied below: Introduction: QT interval dispersion, which reflects the regional heterogeneity of ventricular repolarization, increases during electroconvulsive therapy (ECT). Tpeak-Tend (TpTe) is considered a new marker of the transmural dispersion of ventricular repolarization (TDR). This study aimed to evaluate the effect of remifentanil on TpTe during ECT. Methods: Forty-two patients who were scheduled to undergo ECT with American Society of Anesthesiologists physical status I or II randomly received 0.1 μg/kg remifentanil (group R: n = 21) or saline (group C: n = 21). After the induction of general anesthesia, we measured the TpTe, TpTe/QT, TpTe/QTc, TpTe/RR, TpTe/√RR and TpTe/3√RR ever...