Clinical Neuroscience of ECT (CNECT)

 Out on PubMed, from authors in Serbia, is this article: Electroconvulsive therapy in the Fourth Industrial Revolution (Review). Stojanović Z, Simić K, Tepšić Ostojić V, Gojković Z, Petković-Ćurčin A. Biomed Rep. 2024 Jul 8;21(3):129. doi: 10.3892/br.2024.1817. eCollection 2024 Sep. PMID:  39070111 The abstract is copied below: There are very few treatments in psychiatry, even in medicine, that have experienced longevity and effectiveness such as electroconvulsive therapy (ECT), despite the controversies and stigma that accompany it. The experience of the COVID-19 pandemic has highlighted the need to strengthen mental health systems in most countries, given that depression is one of the leading health problems and that there is an evident shortage of psychiatrists worldwide. The Fourth Industrial Revolution, has witnessed great progress in artificial intelligence (AI) technology, which opens up the possibility of its application both in the diagnosis and in the therapy of ment...

 Out on PubMed, from investigators in Sweden, is this study: Seizure Duration and Electroconvulsive Therapy in Major Depressive Disorder. Gillving C, Ekman CJ, Hammar Å, Landén M, Lundberg J, Movahed Rad P, Nordanskog P, von Knorring L, Nordenskjöld A. JAMA Netw Open. 2024 Jul 1;7(7):e2422738. doi: 10.1001/jamanetworkopen.2024.22738. PMID:  39052292 The abstract is copied below: Importance: Electroconvulsive therapy (ECT), wherein a generalized epileptic seizure is induced, is a treatment for major depressive disorder (MDD). Currently, it is unclear whether there is an association between seizure length and treatment outcome. Objective: To explore the association between seizure duration, potential confounding variables, and ECT treatment outcome. Design, setting, and participants: This population-based cohort study obtained data from the Swedish National Quality Register for ECT. Patients treated for unipolar MDD with unilateral electrode placement between January 1, 2012, an...

Out on PubMed, from US investigators, is this LTE:  The LTE is here . And here: This is a thoughtful letter, with a careful re-examination of the data presented in the Wright et al. scoping review of ECT in NMDARE. The more positive view of ECT here, based on the idea that it is treating catatonia, and not the immunological illness, is certainly in line with clinical experience. That said, the more radical conceptualization that ECT might actually be a primary, or definitive, treatment in selected cases (e.g. those without a malignancy) should not be abandoned prematurely. More clinical experience should bring better answers in the future. Kudos to these authors for their careful examination of the data presented in the literature.

Out on PubMed, from authors in Australia, in JECT, is this paper: Electroconvulsive Therapy With Brain Cyst: A Simulation Study. Ahmad Bakir A, Martin DM, Alduraywish A, Dokos S, Loo CK. J ECT. 2024 Jul 18. doi: 10.1097/YCT.0000000000001045. Online ahead of print. PMID:  39024187  The abstract is copied below: Introduction: Electroconvulsive therapy (ECT) is effective in treating severe depression and other neuropsychiatric disorders, but how the presence of an anatomical anomaly affects the electrical pathways between the electrodes remains unclear. We investigate the difference in electric field (E-field) distribution during ECT in the brain of a patient with an arachnoid cyst relative to hypothetical condition where the cyst was not present. Methods: Magnetic resonance imaging scans of the head of a patient with a large left frontal cyst were segmented to construct a finite element model to study the E-field distribution during ECT. Five electrode configurations were invest...

Out on PubMed, from investigators in Singapore, is this study:  The influence of age on  ECT  efficacy in depression, mania, psychotic depression and schizophrenia: A transdiagnostic analysis. Mahmood S, Tan X, Chen B, Tor PC. J Psychiatr Res. 2024 Jul 14;177:203-210. doi: 10.1016/j.jpsychires.2024.07.012. Online ahead of print. PMID:  39032274 The abstract is copied below: Aim: ECT use is variable across age groups. We aim to investigate the effect of age on ECT response among patients with depression, psychotic depression, mania and schizophrenia. Methods: Our retrospective observational study included patients from the Institute of Mental Health (Singapore) who were initiated on ECT (March 2017-February 2023). MADRS and BPRS scores were assessed 1-2 days before the first ECT and after the 6th session. The association between age group and ECT response was analyzed by ANOVA and generalized linear regression. A one-way sensitivity analysis was performed with age as ...

Out on PubMed, in JECT, from authors in India, is this LTE: Safety of  Electroconvulsive  Therapy in a Patient With Bipolar Mania Receiving Oral Anticoagulants: A Case Report. Joseph JT, Jammigumpula A, Kurariya A, Praharaj SK. J ECT. 2024 Jul 18. doi: 10.1097/YCT.0000000000001058. Online ahead of print. PMID:  39024188    The LTE is here . And here: Here is another report of the safety of ECT with the "newer" class of oral anticoagulants. Evidence and clinical caution are always good.  But the theoretical risks of anticoagulation with ECT may be exaggerated, based on the false conflation of ECT with "surgery" where tissue is cut and bleeds. Outside of the infinitesimally small risk of the rupture of an unknown aneurysm due to increased blood pressure during the procedure, where is the risk?  Ironically the two "mild lip bites," possibly due to improper bite block placement, were the only times when anticoagulation may have posed any risk.

Out on PubMed, in JECT, is this LTE:  JAMA Patient Page on Perinatal Depression: No Mention of ECT. Kellner CH . J ECT. 2024 Jul 18. doi: 10.1097/YCT.0000000000001055. Online ahead of print. PMID:  39024195 The letter is here . And here: I thank Dr.Espinoza for publishing this LTE when JAMA ignored it. Infanticide by a psychotic mother is a terrible thing, made even more terrible when easily preventable  by adequate, standard treatment (ECT). Appropriate prescription of ECT in severe postpartum states would clearly save both maternal and infant lives. It remains my hope that one day the title of the JAMA Patient Page will be : What is ECT?

  Out on PubMed, from clinicians in Japan, is this case report: A case with temporal spikes on electroencephalography induced by over 80 sessions of  electroconvulsive  therapy. Omori H, Hata M, Kobayashi M, Miyazaki Y, Hirashima A, Takahashi S, Ikeda M. PCN Rep. 2024 Jul 16;3(3):e227. doi: 10.1002/pcn5.227. eCollection 2024 Sep. PMID:  39015733   The abstract is copied below: Background: Electroconvulsive therapy (ECT) is widely recognized as one of the most effective treatments for various psychiatric disorders and is generally considered safe. However, a few reports have mentioned that multiple ECT sessions could induce electroencephalography (EEG) abnormalities and epileptic seizures, a serious side effect of ECT. We experienced a case with EEG abnormalities after multiple ECT sessions and aimed to share our insights on conducting ECT safely. Case presentation: We present the case of a 73-year-old female diagnosed with major depressive disorder. She underwen...

  Letter to the Editor concerning " Electroconvulsive  therapy in the maintenance phase of psychotic unipolar depression". Alves M, Durães D, Afonso P. Acta Psychiatr Scand. 2024 Jul 10. doi: 10.1111/acps.13732. Online ahead of print. PMID:  38987925 The letter is also here . Any  discussion of maintenance ECT is welcome, so kudos to these authors. That said, this is mostly a re-stating of well known issues related to ECT performed after the acute (index) course. And I disagree with the need to perpetuate the distinction between "continuation" and "maintenance" ECT. We should just call it all maintenance ECT.

Out on PubMed, in JECT, is this LTE: Reply to "Glucagon-Like Peptide-1 Receptor Agonists During  Electroconvulsive  Therapy: Case Report With Evolving Concerns and Management Considerations". Jacobi D. J ECT. 2024 Jul 10. doi: 10.1097/YCT.0000000000001053. Online ahead of print. PMID:  38984842     The LTE is here: Here is an LTE about management strategies for ECT patients on the new GLP-1 receptor agonists. The issue is delayed gastric emptying and the risk of aspiration. I think  we are still in a period in which we are learning how much of an actual clinical risk this really is. Please see also: Glucagon-Like Peptide-1 Receptor Agonists During  Electroconvulsive  Therapy: Case Report With Evolving Concerns and Management Considerations. Espinoza RT, Antongiorgi Z. J ECT. 2024 Feb 2. doi: 10.1097/YCT.0000000000000992. Online ahead of print. PMID:  38315827

 Your blogger will be on early summer hiatus for a while, picking back up later this month. In the meantime, I trust you will be monitoring PubMed for interesting new ECT articles. Hope you are enjoying your summer! CK

 Out on PubMed, from researchers across the US, is this paper: Electroconvulsive therapy for the acute management of severe agitation in dementia ( ECT -AD): A modified study protocol. Lapid MI, Merrill J, Mueller M, Hermida AP, Nykamp L, Andrus J, Azizi H, Bolton P, Bonsu N, Braga R, Dillon CR, Ecklesdafer D, Evans D, Harper D, Heintz H, Hussain-Krauter S, Holzgen O, Humphrey D, Jiwani S, Johnson EK, Kang S, Kassien J, Kim J, Knapp RG, Kung S, Kremen N, Le K, Mahdasian J, Marzouk T, Masrud JD, Mattingly J, Miller D, Pagali SR, Patrick R, Riva Posse P, Pritchett C, Rahman A, Rath S, Roczniak C, Rummans TA, Sanghani S, Seiner S, Smart L, Tomaschek E, Tsygankova V, VanderSchuur-White L, Walton MP, Wilkins J, Williams A, Williams SM, Petrides G, Forester BP. PLoS One. 2024 Jun 28;19(6):e0303894. doi: 10.1371/journal.pone.0303894. eCollection 2024. PMID:  38941338   The abstract is copied below: Objective: This study began as a single-blind randomized controlled trial (RCT) t...