Clinical Neuroscience of ECT (CNECT)

 I will be on hiatus until sometime after the New Year. Happy Holidays to all blog followers, readers and your families. CK

Out on PubMed, from authors in China, is this review: Long-term cognitive effects of  electroconvulsive  therapy in major depressive disorder: A systematic review and meta-analysis. Guo Q, Wang Y, Guo L, Li X, Ma X, He X, Li J, Zhang X, Shang S. Psychiatry Res. 2023 Dec 1;331:115611. doi: 10.1016/j.psychres.2023.115611. Online ahead of print. PMID:  38101070   Review. The abstract is copied below: Objective: Electroconvulsive therapy (ECT) is endorsed as a principal treatment approach for major depressive disorder (MDD) worldwide. Despite prior studies highlighting potential short-term cognitive deficits post-ECT, the debate regarding its long-term implications persists. This study endeavors to elucidate the reasons for this contention using an evidence-based approach. Methods: This investigation, meticulously aligned with PRISMA guidelines, was prospectively enlisted on PROSPERO (CRD42023439259). A comprehensive search was performed across various databases, includi...

Individual Prediction of Optimal Treatment Allocation Between  Electroconvulsive  Therapy or Ketamine using the Personalized Advantage Index. Wade B, Pindale R, Camprodon J, Luccarelli J, Li S, Meisner R, Seiner S, Henry M. Res Sq. 2023 Nov 30:rs.3.rs-3682009. doi: 10.21203/rs.3.rs-3682009/v1. Preprint. PMID:  38077094 The abstract is copied below: Introduction: Electroconvulsive therapy (ECT) and ketamine are two effective treatments for depression with similar efficacy; however, individual patient outcomes may be improved by models that predict optimal treatment assignment. Here, we adapt the Personalized Advantage Index (PAI) algorithm using machine learning to predict optimal treatment assignment between ECT and ketamine using medical record data from a large, naturalistic patient cohort . We hypothesized that patients who received a treatment predicted to be optimal would have significantly better outcomes following treatment compared to those who received a non-opti...

 Out on PubMed, from investigators in Iran, is this review: Investigating the Relationship between Electroconvulsive Therapy and Heart Rate Variability: A Systematic Review. Rahimian A, Rahmani B, Garshad J, Salarvand A, Mansourian M. Adv Biomed Res. 2023 Aug 31;12:210. doi: 10.4103/abr.abr_95_23. eCollection 2023. PMID:  38073723 The abstract is copied below: Physical therapies such as electroconvulsive therapy (ECT) may result in higher response and recovery rates, especially in patients who have treatment-resistant depression. Various studies have reported different changes in heart rate variability (HRV) parameters before and after depression treatment with ECT. Therefore, the present study reviews systematically the evidence describing changes in HRV parameters and the cardiac autonomic nervous system associated with ECT. Scopus, Web of Science, PubMed, and Embase electronic databases were searched for papers published up to September 8, 2022, without any restriction on t...

Out on PubMed, from Swedish and Canadian investigators, is this study: Association between pulse width and health-related quality of life after  electroconvulsive  therapy in patients with unipolar or bipolar depression: an observational register-based study. Ernstsson O, Heintz E, Nordenskjöld A, Johnson JA, Korkmaz S, Zethraeus N. Nord J Psychiatry. 2023 Dec 11:1-9. doi: 10.1080/08039488.2023.2289915. Online ahead of print. PMID:   38079191   The abstract is copied below: Aims: To examine the association between pulse width and HRQoL measured within one week after electroconvulsive therapy (ECT) and at six-month follow-up in patients with unipolar or bipolar depression. Methods: This was an observational register study using data from the Swedish National Quality Registry for ECT (2011-2019). Inclusion criteria were: age ≥18 years; index treatment for unipolar/bipolar depression; unilateral electrode placement; information on pulse width; EQ-5D measurements before ...

Electroconvulsive Therapy Versus Repetitive Transcranial Magnetic Stimulation in Patients With a Depressive Episode: A Register-Based Study. Strandberg P, Nordenskjöld A, Bodén R, Ekman CJ, Lundberg J, Popiolek K. J ECT. 2023 Nov 30. doi: 10.1097/YCT.0000000000000971. Online ahead of print. PMID:  38048154 The abstract is copied below: Objectives: Electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) are both effective in treating depression. Although rTMS induces fewer adverse effects, its effectiveness relative to ECT is not well established. The aim of this study was to investigate the treatment outcomes of ECT and rTMS in patients who have received both interventions. Methods: This was a register-based observational crossover study in patients with depression who had undergone ECT and rTMS in Sweden between 2012 and 2021. Primary outcome was reduction in the Montgomery-Åsberg Depression Rating Scale-Self-report (MADRS-S) score. Secondary outcom...

Out on PubMed, from a German author, is this article: Using coercion in mental disorders or risking the patient's death? An analysis of the protocols of a clinical ethics committee and a derived decision algorithm. Steinert T. J Med Ethics. 2023 Nov 23:jme-2023-109578. doi: 10.1136/jme-2023-109578. Online ahead of print. PMID:  38050143 The abstract is copied below: While principle-based ethics is well known and widely accepted in psychiatry, much less is known about how decisions are made in clinical practice, which case scenarios exist, and which challenges exist for decision-making. Protocols of the central ethics committee responsible for four psychiatric hospitals over 7 years (N=17) were analysed. While four cases concerned suicide risk in the case of intended hospital discharge, the vast majority (N=13) concerned questions of whether the responsible physician should or should not initiate the use of coercion in patients lacking mental capacity. The committee's recommenda...

Out on PubMed, from clinicians in Spain, is this case report:  Takotsubo cardiomyopathy secondary to electroconvulsive therapy in a young adult with Down syndrome regression disorder. Ortega MDC, Bullard JP, Del Mar Unceta M, Sánchez-Pedreño FO, Molero P, de Asúa DR. Am J Med Genet C Semin Med Genet. 2023 Dec 1:e32078. doi: 10.1002/ajmg.c.32078. Online ahead of print. PMID:  38041246 The abstract is copied below: We report the case of an 18-year-old woman with Down syndrome (DS) who developed Takotsubo cardiomyopathy (TSC) immediately after the administration of electroconvulsive therapy (ECT), a treatment prescribed for Down syndrome regression disorder resistant to oral psychotropic drugs. TSC is a nonischemic cardiomyopathy related to psychological or physical stress, which has been described as a rare complication of ECT (Kinoshita et al., 2023, Journal of Electroconvulsive Therapy, 39, 185-192). The clinical description of the case is accompanied by a discussion of the p...

 Here is a new editorial from Chittaranjan Andrade: The editorial is here . And here: This editorial by noted ECT scholar Chittaranjan Andrade is a good critique of the Anand et al. NEJM trial comparing ECT and IV ketamine. I completely agree with his penultimate sentence (highlighted above). I do think his last sentence (also highlighted above), about the justification of a ketamine trial before ECT, should be qualified, noting that clinical judgment needs to be applied and that ketamine may not be appropriate for urgently ill patients.

Out on PubMed, from authors in Texas and Arizona, is this review: Atrial fibrillation, electroconvulsive therapy, stroke risk, and anticoagulation. Kapadia M, Jagadish PS, Hutchinson M, Lee H. Egypt Heart J. 2023 Nov 27;75(1):94. doi: 10.1186/s43044-023-00409-7. PMID:  38010438   Review. The abstract is copied below: Background: Electroconvulsive therapy (ECT) is a therapy used to treat refractory mental health conditions, ranging from depression to catatonia, and it has gained renewed prominence in practice and the literature of late. Given that ECT involves the application of direct current to the body, there exists a risk of a change in cardiac rhythm during therapy. When atrial fibrillation is induced, ECT carries a potential risk of stroke. These risks have not been previously analyzed or summarized in the literature to allow physicians to make educated decisions about periprocedural risk and anticoagulation needs. Methods: To better describe this risk, the authors review...

Out on PubMed, from authors in Cambodia, Thailand and Nigeria, in JECT is this LTE: Open AI Chat, Anti-Electroconvulsive Therapy Statements and References: Comment. Kleebayoon A, Mungmunpuntipantip R, Wiwanitkit V. J ECT. 2023 Dec 1;39(4):275. doi: 10.1097/YCT.0000000000000974. PMID:  38009972   No abstract available. The LTE is here . And here: Here is a simple warning about the ethical risks of AI re anti-ECT mis-, or disinformation. The authors' call for expert human oversight to insure accuracy of patient information is well taken.

 Out on PubMed, from investigators in Iran, is this study: The Effects of Remifentanil, Dexmedetomidine, and Metoral as Adjuncts to Thiopental on Hemodynamic Status After Electroconvulsive Therapy in Patients with Major Depressive Disorder: A Randomized Controlled Clinical Trial. Tajabadi N, Kamali A, Alaghmand A, Jamilian H, Pazooki S, Tajerian A. Anesth Pain Med. 2023 Sep 19;13(5):e139383. doi: 10.5812/aapm-139383. eCollection 2023 Oct. PMID:  38028112 The abstract is copied below: Background: Depression is a prevalent mental disorder affecting more than 300 million people of all ages globally. Despite being the first-line treatment for depression, antidepressant medications are only effective for 60% - 70% of patients. Electroconvulsive therapy (ECT) is an effective treatment for severe cases, although it can result in short-term side effects. Objectives: This study aimed to compare the effectiveness of remifentanil, dexmedetomidine, and metoral as premedications for ECT in...

Out on PubMed, from authors in the UK, is this review: Neuromodulation Techniques in Children with Super-Refractory Status Epilepticus. Stavropoulos I, Pak HL, Alarcon G, Valentin A. Brain Sci. 2023 Oct 30;13(11):1527. doi: 10.3390/brainsci13111527. PMID:  38002487 Review. The abstract is copied below: Status epilepticus (SE) is a life-threatening condition and medical emergency which can have lifelong consequences, including neuronal death and alteration of neuronal networks, resulting in long-term neurologic and cognitive deficits in children. When standard pharmacological treatment for SE is not successful in controlling seizures, the condition evolves to refractory SE (rSE) and finally to super-refractory SE (srSE) if it exceeds 24 h despite using anaesthetics. In this systematic review, we present literature data on the potential uses of clinical neuromodulation techniques for the management of srSE in children, including electroconvulsive therapy, vagus nerve stimulation, and...