Clinical Neuroscience of ECT (CNECT)

 I will be on hiatus for the last week in January and into the first week of February. Please check PubMed for new additions to the literature. CK

Comparative efficacy and tolerability of different anesthetics in electroconvulsive therapy for major depressive disorder: A systematic review and network meta-analysis. Ren L, Yu J, Zeng J, Wei K, Li P, Luo J, Shen Y, Lv F, Min S. J Psychiatr Res. 2024 Jan 16;171:116-125. doi: 10.1016/j.jpsychires.2024.01.031. Online ahead of print. PMID:  38271762 The abstract is copied below: Electroconvulsive therapy (ECT) is one of the most effective treatments for major depressive disorder. Modern ECT is conducted with anesthesia, however, the optimal anesthetic agent for ECT is yet to be understood. This study is aimed to compare the effects of different anesthetic agents on antidepressant efficacy and tolerability in depressed individuals undergoing ECT. We searched MEDLINE, EMBASE, the CENTRAL and PsycINFO for randomized controlled trials from database inception until Nov 13, 2022 (PROSPERO: CRD42022375407). Global and local inconsistencies, heterogeneity and publication bias were assessed...

 Out on PubMed, from authors at Vanderbilt and Mass General,, is this article: Use of   ECT   for Children With and Without Catatonia: A Single-Site Retrospective Analysis. Smith JR, Baldwin I, Termini KA, McGonigle T, Vandekar S, Luccarelli J. J ECT. 2024 Jan 25. doi: 10.1097/YCT.0000000000000993. Online ahead of print. PMID:  38265759 The abstract is copied below: Objectives: The objective study was to investigate the safety and efficacy of electroconvulsive therapy (ECT) in a retrospective cohort of pediatric patients. Methods: A single-site retrospective analysis was conducted of patients aged younger than 18 years who received ECT in a private university hospital from January 28, 2012 to April 8, 2023. Treatment efficacy and adverse events were determined retrospectively through review of the medical record. Results: A total of 36 pediatric patients met the inclusion criteria. Catatonia was the most common presenting indication for ECT, followed by psychosis and...

Out on PubMed, from authors in India, is this case series: Valproate-induced hyperammonemia, neuroleptic sensitivity, and cerebellar atrophy-A clinical conundrum in the management of bipolar disorder. Shetty SS, AnnajiGowda HH, Dahale AB. Bipolar Disord. 2024 Jan 22. doi: 10.1111/bdi.13403. Online ahead of print. PMID:  38253983 The abstract is copied below: Objective: Treatment of bipolar disorder (BD) involves complexities especially when patients come with significant sensitivity to various psychotropic medications and comorbidities. The following cases aim to recapitulate and discuss some of such situations. Cases: Case 1: A 36-year-old man with intellectual development disorder and BD experienced catatonia, seizures, and hyperammonemia following valproate administration. Treatment involved electroconvulsive therapy (ECT) and a tailored medication regimen, ultimately leading to stability. Case 2: A 63-year-old man with long-standing BD exhibited resistance to lithium and valpro...

Out on PubMed, from authors Czechia, is this study: Electroconvulsive therapy portrayal in contemporary video games. Buday J, Neumann M, Žaludová Heidingerová J, Mareš T, Magyarová E, Thai Le H, Divácký D, Jirečková G, Albrecht J, Kališová L, Pol M, Mahrík J, Buday P, Anders M. Front Psychiatry. 2024 Jan 5;14:1336044. doi: 10.3389/fpsyt.2023.1336044. eCollection 2023. PMID:  38250273   The abstract is copied below: Electroconvulsive therapy (ECT) is an important treatment modality in psychiatry, considered to be the most effective option for pharmaco-resistant affective and psychotic disorders. Despite its great efficacy, it still remains a rather controversial method, which hinders its full potential. It is feasible to say that in part, this controversy is caused by a largely negative image of ECT displayed through media. The depiction of ECT in movies has been studied and well documented in the past. The aim of our study was to provide an overview of how ECT is represented i...

 Out on PubMed, in JECT, is this editorial: Transitions in the Journal of  ECT : An Introduction and Vision. Espinoza RT. J ECT. 2024 Jan 16. doi: 10.1097/YCT.0000000000000995. Online ahead of print. PMID:  38232048   The editorial is here . And here: Here is Dr. Espinoza's cogent and articulate assessment of   the current status of ECT and the role of JECT going forward. He discusses ECT compared to other neuromodulation methods, stigma, and advocacy for ECT. He describes the need for expanding and diversifying the clinical ECT workforce, with renewed educational outreach. Finally, he notes the unique position of ECT as a platform for research to understand the neurobiology of psychiatric illness and its treatments. Kudos to Dr. Esoinoza; he is off to a fine start and we wish him the best as the new steward of JECT.

Out on PubMed, in JECT, is this note from Dr. W.V. McCall: This is the second, of three, notes about the editorial transition at JECT. Major kudos and thanks to Dr. McCall for two decades of superb leadership.

Out on PubMed, In JECT, is this editorial: Welcome to the New Journal Editor, Dr Espinoza. Fink M, Kellner CH. J ECT. 2024 Jan 16. doi: 10.1097/YCT.0000000000000989. Online ahead of print. PMID:  38232040 The editorial pdf is here . Kudos to both Drs. Espinoza and McCall. JECT has been, and will be, in very good hands! (more about the editorial transition coming to the blog next week...)

Out on PubMed, from clinicians in Turkey, is this study: Oral Complications in Patients With Psychiatric Illness Undergoing Electroconvulsive Therapy in Istanbul, Turkey. Oflezer C, Oflezer Ö, Canbek Ö, Eskil Çiçek Ö, Bahadir H. J ECT. 2024 Jan 16. doi: 10.1097/YCT.0000000000000994. Online ahead of print. PMID:  38227895 The abstract is copied below: ObjectiveDespite advances in pharmacotherapy, electroconvulsive therapy (ECT) remains a mainstay treatment option in psychiatry. This study aims to determine the occurrence of oral injury from ECT modified with the use of an inexpensive, disposable, hand-made oral protector customized to the dental needs of the individual patient. MethodBased on data collected between January 1, 2013, and December 31, 2018, registered patients who had received ECT were evaluated retrospectively. We investigated the incidence of oral complications such as dental fractures, dental avulsion, temporomandibular joint dislocation, jaw pain, and soft tissue, ...

 Out on PubMed, from authors in Minnesota, is this commentary: Advances in precision neuromodulation:  electroconvulsive  therapy amplitude titration. Croarkin PE, Opitz A. Neuropsychopharmacology. 2024 Jan 9. doi: 10.1038/s41386-024-01797-3. Online ahead of print. PMID:  38195909 The article is here . And here. So here is a commentary about the Abbott et al. article I discussed yesterday on the blog. It nicely summarizes the study, as well as its limitations. To simplify, standard ECT is too powerful for some patients, so it is helpful to be able to offer less powerful treatments to other patients. E-field may be a good measure of "strength," or "power," but at present can only be crudely estimated, or require complicated additional investigations for better estimates. Is electrical dosing analogous to milligram dosing with pharmaceuticals? To a certain extent, yes. With drugs, most patients get the same dose in a pill; only when drugs are given IV are the...

Amplitude-determined seizure-threshold, electric field modeling, and electroconvulsive therapy antidepressant and cognitive outcomes. Abbott CC, Miller J, Farrar D, Argyelan M, Lloyd M, Squillaci T, Kimbrell B, Ryman S, Jones TR, Upston J, Quinn DK, Peterchev AV, Erhardt E, Datta A, McClintock SM, Deng ZD. Neuropsychopharmacology. 2024 Jan 11. doi: 10.1038/s41386-023-01780-4. Online ahead of print. PMID:  38212442 The abstract is copied below: Electroconvulsive therapy (ECT) pulse amplitude, which dictates the induced electric field (E-field) magnitude in the brain, is presently fixed at 800 or 900 milliamperes (mA) without clinical or scientific rationale. We have previously demonstrated that increased E-field strength improves ECT's antidepressant effect but worsens cognitive outcomes. Amplitude-determined seizure titration may reduce the E-field variability relative to fixed amplitude ECT. In this investigation, we assessed the relationships among amplitude-determined seizure-t...

 I recently re-watched the 1975 movie,  One Flew Over the Cuckoo's Nest, directed by Miloš Forman,  and based on the 1962 novel by Ken Kesey. First off, the book is superb, beautifully written and with a dreamlike quality. Definitely worth a careful read. A great classic of American literature. Now to the movie, one scene from which has done such tremendous harm to ECT and patients over the last five decades. I watched the movie again last week and could not help thinking it is a true masterpiece. Amazing performances, beautifully directed, very poignant and compelling. Remove the ECT scene and the history of problems for us melts away. And here is a trailer from Youtube that does not contain THE scene: https://www.youtube.com/watch?v=OXrcDonY-B8 Here is my new experience of the film and its relation to ECT: the ECT scene is so stylized and old fashioned, and the psychiatrist is so stereotypically evil and arrogant, that there is no reason to see the scene as other than a...

Out on Pubmed, from investigators in The Netherlands and Belgium, is this study: Pre-treatment predictors of cognitive side-effects after treatment with electroconvulsive therapy in patients with depression: A multicenter study. Loef D, van Eijndhoven P, van den Munckhof E, Hoogendoorn A, Manten R, Spaans HP, Tendolkar I, Rutten B, Nuninga J, Somers M, van Dellen E, van Exel E, Schouws S, Dols A, Verwijk E. J Affect Disord. 2024 Jan 7:S0165-0327(24)00059-4. doi: 10.1016/j.jad.2024.01.049. Online ahead of print. PMID:  38195009 The abstract is copied below: Background: Electroconvulsive therapy (ECT) is a highly effective treatment for major depressive episodes (MDE). However, ECT-induced cognitive side-effects remain a concern. Identification of pre-treatment predictors that contribute to these side-effects remain unclear. We examined cognitive performance and individual cognitive profiles over time (up to six months) following ECT and investigated possible pre-treatment clinical a...

Out on PubMed, from authors in Denmark and the USA, is this article: Clinical and Legal Differences in the Use of Involuntary Electroconvulsive Therapy for Life-Threatening Illness Across European Countries. Krarup M, Kellner CH, Østergaard SD. J ECT. 2024 Jan 4. doi: 10.1097/YCT.0000000000000984. Online ahead of print. PMID:  38194602 The abstract is copied below: Objectives: Electroconvulsive therapy (ECT) can be life-saving in situations where patients are at risk of dying from severe manifestations of psychiatric illness. In some of these cases, patients are unwilling/unable to consent to ECT, and involuntary ECT is required. Such use of involuntary ECT varies substantially across European countries for unclear reasons. The aim of this study was to examine clinical and legal differences in this use of involuntary ECT across European countries. Methods: A questionnaire based on a case vignette (a 55-year-old female inpatient with psychotic depression at imminent risk of dying fr...

Out on PubMed, from authors in Australia, is this paper: Examining the clinical effectiveness of continuation and maintenance  electroconvulsive  therapy in schizophrenia. George R, Krishnan V, Talbot D, Elhindi J, Mayur P, Harris A. Asian J Psychiatr. 2023 Dec 25;92:103895. doi: 10.1016/j.ajp.2023.103895. Online ahead of print. PMID:  38157717 The abstract is copied below: Objective: There are few studies that examine the effectiveness of Continuation/Maintenance Electroconvulsive Therapy (C/M-ECT) in schizophrenia, despite the documented effectiveness of acute ECT treatment. We aimed to investigate the clinical effectiveness of C/M-ECT for in-patients with Schizophrenia in a naturalistic setting. We examined the medical records of 46 in-patients who were diagnosed with Schizophrenia and had received C/M-ECT belonging to non-acute extended care service in a public psychiatry hospital in Sydney, Australia. The focus of analysis was on 138 treatment cycles (71 acute only ...

Out on PubMed, from authors across Asia, is this review: Electroconvulsive therapy in South Asia: Past, present, and future. Menon V, Kar SK, Gupta S, Baminiwatta A, Mustafa AB, Sharma P, Abhijita B, Arafat SMY. Asian J Psychiatr. 2023 Dec 17;92:103875. doi: 10.1016/j.ajp.2023.103875. Online ahead of print.  PMID:  38157713  The abstract is copied below: The practice of electroconvulsive therapy (ECT) varies both between and within countries. We aimed to review historical and current trends in ECT practices, perceptions, and legislations in South Asia, a region with a high burden of mental illness and suicide. We searched MEDLINE (PubMed) and Google Scholar databases for relevant literature on ECT from each country. Additionally, a team of country-specific investigators performed supplemental searches and contacted key country contacts for relevant information. Relevant data were abstracted under the following headings: ECT practices, perceptions, and legislations. Knowl...