Clinical Neuroscience of ECT (CNECT)

Out on PubMed, from investigators in Germany, is this study: No Effect of Serum Electrolyte Levels on Electroconvulsive Therapy Seizure Quality Parameters. Karl S, Sartorius A, Aksay SS. J ECT. 2024 Mar 1;40(1):47-50. doi: 10.1097/YCT.0000000000000966. PMID:  38411578 The abstract is copied below: Introduction: Seizure quality is considered to be associated with treatment outcomes of electroconvulsive therapy (ECT). A wide range of treatment parameters and patient characteristics are known to influence seizure quality. However, conflicting results exist for the role of serum electrolyte levels and seizure quality. Methods: We retrospectively analyzed a total of 454 patients and a total of 2119 individual acute ECT sessions irrespective of diagnosis where a clinical evaluation of serum levels of sodium, potassium, and calcium took place routinely up to 2 days before the ECT session. To assess the impact of serum electrolyte levels on seizure quality parameters, we used mixed-effects...

Out on PubMed, from authors in Germany and Australia, is this paper:  Impact of Adjunctive VNS on Drug Load, Depression Severity, and Number of Neuromodulatory Maintenance Treatments. Kavakbasi E, Bauermeister H, Lemcke L, Baune BT. Brain Sci. 2024 Feb 4;14(2):159. doi: 10.3390/brainsci14020159. PMID:  38391733 The abstract is copied below: Vagus nerve stimulation (VNS) is a long-term adjunctive treatment option in patients with difficult-to-treat depression (DTD). A total of n = 20 patients (mean age 52.6 years) were included in the multicenter, prospective, observational, naturalistic RESTORE-LIFE study and were treated with adjunctive VNS as an add-on to treatment as usual . Exploratory and secondary outcome parameters from a single center were investigated for this present analysis. The overall mean drug load slightly decreased from 4.5 at baseline to 4.4 at 12 months (Z = -0.534, p = 0.594). The drug load was lower in previous electroconvulsive therapy (ECT) responders th...

Out on PubMed, from clinicians in Japan, is this case report: A woman with schizophrenia who died due to Takotsubo cardiomyopathy occurring after electroconvulsive therapy. Muto T, Kyono H. BMC Psychiatry. 2024 Feb 19;24(1):139. doi: 10.1186/s12888-024-05593-7. PMID:  38373994 The abstract is copied below: Background: Electroconvulsive therapy (ECT) is a safe treatment for treatment-resistant schizophrenia. However, it has some side effects, and Takotsubo cardiomyopathy is considered one of the minor complications. Several cases of patients developing Takotsubo cardiomyopathy during a course of ECT have been reported, but none have died. We present a case of post-ECT Takotsubo cardiomyopathy that became fatal. Case presentation: We experienced a case of a 67-year-old woman who had delusions and catatonic symptoms due to schizophrenia but was resistant to several medications. Her symptoms improved by conducting ECT, but she had difficulty maintaining her improvement, which caused he...

Recent Advances in the Treatment of Treatment-Resistant Depression: A Narrative Review of Literature Published from 2018 to 2023. Havlik JL, Wahid S, Teopiz KM, McIntyre RS, Krystal JH, Rhee TG. Curr Psychiatry Rep. 2024 Feb 22. doi: 10.1007/s11920-024-01494-4. Online ahead of print. PMID:  38386251   Review. The abstract is copied below: Purpose of review: We review recent advances in the treatment of treatment-resistant depression (TRD), a disorder with very limited treatment options until recently. We examine advances in psychotherapeutic, psychopharmacologic, and interventional psychiatry approaches to treatment of TRD. We also highlight various definitions of TRD in recent scientific literature. Recent findings: Recent evidence suggests some forms of psychotherapy can be effective as adjunctive treatments for TRD, but not as monotherapies alone. Little recent evidence supports the use of adjunctive non-antidepressant pharmacotherapies such as buprenorphine and antipsychot...

Out on PubMed, from researchers in Denmark, is this study: Electroconvulsive therapy disrupts functional connectivity between hippocampus and posterior default mode network. Gbyl K, Labanaukas V, Lundsgaard CC, Mathiassen A, Ryszczuk A, Siebner HR, Rostrup E, Madsen K, Videbech P. Prog Neuropsychopharmacol Biol Psychiatry. 2024 Feb 17:110981. doi: 10.1016/j.pnpbp.2024.110981. Online ahead of print. PMID:  38373628 The abstract is copied below: Background: The mechanisms underlying memory deficits after electroconvulsive therapy (ECT) remain unclear but altered functional interactions between hippocampus and neocortex may play a role. Objectives: To test whether ECT reduces functional connectivity between hippocampus and posterior regions of the default mode network (DMN) and to examine whether altered hippocampal-neocortical functional connectivity correlates with memory impairment. A secondary aim was to explore if these connectivity changes are present 6 months after ECT. Methods...

Effectiveness and Safety of Flumazenil Augmentation During  Electroconvulsive  Therapy. Gistelinck L, Van de Velde N, Tandt H, Verslype P, Lemmens G. J ECT. 2024 Feb 12. doi: 10.1097/YCT.0000000000001003. Online ahead of print. PMID:  38373168 The abstract is copied below: Introduction: Benzodiazepines are considered to negatively affect seizure quality and duration during electroconvulsive therapy (ECT). Several researchers have advocated the use of flumazenil, a competitive benzodiazepine receptor antagonist, for patients treated with benzodiazepines during ECT. However, clinical evidence regarding flumazenil use in ECT remains sparse. The aim of this study is to investigate the effects of flumazenil on seizure duration and adverse effects. Methods: All patients with depressive disorders, treated with flumazenil during a course of ECT in 2019 in a tertiary hospital, were identified through a retrospective chart review. Seizure duration was recorded before and after flu...

 Out on PubMed, from Josh Berman at Columbia University, is this article: Teaching  ECT  to Medical Students: Literature Review, Commentary, and a Suggested Change in Perspective. Berman J. J ECT. 2024 Feb 12. doi: 10.1097/YCT.0000000000000975. Online ahead of print. PMID:  38373172   The article is here . And from the text: This is an excellent "thought piece" about changing our perspective on the way we teach medical students about ECT. The main ideas are that we should be less defensive, and consider ECT in the broad domain of procedural medicine. I recommend a full read to all ECT healthcare personnel. Kudos to Dr. Berman for this very insightful and useful contribution to the ECT education literature.

Out on PubMed, from authors in North America, is this case report: The Role of Electroconvulsive Therapy in the Treatment of Catatonia Associated With Lewy Body Dementia: A Case Report. Sahib Din J, Boes T, Navarro Garcia E, Al-Rubaye H. Cureus. 2024 Jan 18;16(1):e52500. doi: 10.7759/cureus.52500. eCollection 2024 Jan. PMID:  38371130   The abstract is copied below: Catatonia is a complex amalgamation of neuropsychiatric symptoms that can manifest in both psychiatric and neurological conditions. The treatment of catatonia related to psychiatric illnesses is well documented as it typically responds to benzodiazepines and electroconvulsive therapy (ECT). However, the treatment of catatonia related to neurological disorders has shown to be more difficult, particularly when associated with Lewy Body Dementia (LBD). Here, we present the case of a 78-year-old woman with LBD, Bipolar I, depressive type, who successfully underwent twelve ECT sessions to treat catatonia refractory to b...

Out on PubMed, in the NEJM, is this review: Treatment-Resistant Depression in Older Adults. Steffens DC . N Engl J Med. 2024 Feb 15;390(7):630-639. doi: 10.1056/NEJMcp2305428. PMID:  38354142   Review.   The article is here . And from the text: This review will be very widely read, because it is in The NEJM. ECT gets pretty fair representation here, despite the typical, "just the facts, no elaboration" treatment. ECT's mention in the figure and Table is good. But the dissing of the PRIDE study as "uncontrolled, observational" is way harsh, according to this observer (biased as I am).  There is a touch of sloppiness in the referencing, but otherwise we thank Dr. Steffens for putting ECT on the world stage in a  favorable light.