Clinical Neuroscience of ECT (CNECT)

 Out on PubMed, from authors in Romania,   is this article: Evaluating Anesthesia Practices, Patient Characteristics, and Outcomes in Electroconvulsive Therapy: A Two-Year Retrospective Study. Vintilă BI, Anghel CE, Sava M, Bereanu AS, Codru IR, Stoica R, Vulcu Mihai AM, Grama AM, Cătană AC, Boicean AG, Hașegan A, Mihețiu A, Băcilă CI. J Clin Med. 2024 Oct 19;13(20):6253. doi: 10.3390/jcm13206253. PMID:  39458203   The abstract is copied below: Background: Electroconvulsive therapy (ECT) is a well-established treatment for various psychiatric disorders. T his retrospective study evaluates anesthesia practices, patient characteristics, and outcomes in ECT over a two-year period at the "Dr. Gheorghe Preda" Clinical Psychiatry Hospital in Sibiu, Romania. Methods: From March 2022 to July 2024, the Neuroscience Scientific Research Collective at our institution carried out a retrospective observational study on patients who underwent ECT. The evaluation and treatment...

  Here, IMO, is a slightly provocative test question that OE answers definitively and with nuance. The labeling of ECT as "non-invasive" is particularly apt and helpful. 

 Out on PubMed, from authors in the Netherlands, is this paper: A prediction model for  electroconvulsive  therapy effectiveness in patients with major depressive disorder from the Dutch ECT Consortium (DEC). Loef D, Hoogendoorn AW, Somers M, Mocking RJT, Scheepens DS, Scheepstra KWF, Blijleven M, Hegeman JM, van den Berg KS, Schut B, Birkenhager TK, Heijnen W, Rhebergen D, Oudega ML, Schouws SNTM, van Exel E, Rutten BPF, Broekman BFP, Vergouwen ACM, Zoon TJC, Kok RM, Somers K, Verwijk E, Rovers JJE, Schuur G, van Waarde JA, Verdijk JPAJ, Bloemkolk D, Gerritse FL, van Welie H, Haarman BCM, van Belkum SM, Vischjager M, Hagoort K, van Dellen E, Tendolkar I, van Eijndhoven PFP, Dols A. Mol Psychiatry. 2024 Oct 24. doi: 10.1038/s41380-024-02803-2. Online ahead of print. PMID:  39448805 The abstract is copied below: Reliable predictors for electroconvulsive therapy (ECT) effectiveness would allow a more precise and personalized approach for the treatment of major depressi...

Out on PubMed, from authors in Sweden, is this review: Ketamine and Esketamine in Clinical Trials: FDA-Approved and Emerging Indications, Trial Trends With Putative Mechanistic Explanations. Vekhova KA, Namiot ED, Jonsson J, Schiöth HB. Clin Pharmacol Ther. 2024 Oct 20. doi: 10.1002/cpt.3478. Online ahead of print. PMID:  39428602   Review. The abstract is copied below: Ketamine has a long and very eventful pharmacological history. Its enantiomer, esketamine ((S)-ketamine), was approved by the US Food and Drug Administration (FDA) and EMA for patients with treatment-resistant depression (TRD) in 2019. The number of approved indications for ketamine and esketamine continues to increase, as well as the number of clinical trials. This analysis provides a quantitative overview of the use of ketamine and its enantiomers in clinical trials during 2014-2024. A total of 363 trials were manually assessed from clinicaltrial.gov with the search term "Ketamine." The highest number of tri...

Out on PubMed, from authors in Denmark and the US, is this LTE in JAMA:  Management of Depression. Jorgensen A,  Kellner C , Jorgensen MB. JAMA. 2024 Oct 21. doi: 10.1001/jama.2024.18402. Online ahead of print. PMID:  39432280   The LTE is here . Here is our LTE, in response to: Management of depression in adults: a review , JAMA 2024;332(2):141-152, which gave seriously short shrift to ECT. We emphasize ECT as a treatment for severe illness, again trying to lean away from the fraught concept of TRD. This letter is an attempt to further educate the wider medical audience about ECT; JAMA is one of the best places to do that. Kudos and thanks to my Danish colleagues!

 Out on PubMed, from authors in Japan, is this case report and review: Successful  Electroconvulsive  Therapy for Tardive Dyskinesia and Tardive Dystonia Refractory to Valbenazine Treatment: A Case Report and Narrative Literature Review. Irinaka K, Itoh Y, Yoshizawa K, Ogasawara M, Ayabe N, Mishima K, Takeshima M. Clin Psychopharmacol Neurosci. 2024 Nov 30;22(4):688-696. doi: 10.9758/cpn.24.1185. Epub 2024 Aug 7. PMID:  39420617 The abstract is copied below: Tardive dyskinesia and dystonia are intractable extrapyramidal symptoms caused by the blockade of dopamine receptors by antipsychotic drugs. In addition to the reduction or discontinuation of the causative drug, valbenazine for tardive dyskinesia and botulinum toxin for tardive dystonia have been reported to be effective. However, their efficacy has not been fully demonstrated. In this study, we report the case of a female patient with bipolar disorder, valbenazine-resistant tardive dystonia, and tardive dyskines...

Out on PubMed, from researchers in Ireland, is this study: Gene expression of kynurenine pathway enzymes in depression and following  electroconvulsive  therapy. Ryan KM, Corrigan M, Murphy TM, McLoughlin DM, Harkin A. Acta Neuropsychiatr. 2024 Oct 17:1-10. doi: 10.1017/neu.2024.34. Online ahead of print. PMID:   39417574   The abstract is copied below: Objective: This study aimed to investigate changes in mRNA expression of the kynurenine pathway (KP) enzymes tryptophan 2, 3-dioxygenase (TDO), indoleamine 2, 3-dioxygenase 1 and 2 (IDO1, IDO2), kynurenine aminotransferase 1 and 2 (KAT1, KAT2), kynurenine monooxygenase (KMO) and kynureninase (KYNU) in medicated patients with depression (n = 74) compared to age- and sex-matched healthy controls (n = 55) and in patients with depression after electroconvulsive therapy (ECT). Associations with mood score (24-item Hamilton Depression Rating Scale, HAM-D24), plasma KP metabolites and selected glucocorticoid and inflammatory...

 Out on PubMed, from researchers in China, is this paper: A novel approach to investigate the mechanism of  electroconvulsive  therapy in the treatment of major depression disorder: Diffusion kurtosis imaging. Yang J, Tong P, Dong LP, Shi YH. J Psychiatr Res. 2024 Sep 24;179:372-378. doi: 10.1016/j.jpsychires.2024.09.036. Online ahead of print. PMID:  39368399 The abstract is copied below: Background: Major depression disorder (MDD) exhibits a high global incidence; however, its pathogenesis remains elusive. In this prospective study, we employed diffusion kurtosis imaging (DKI) to investigate changes in brain function among patients with MDD both pre- and post-electroconvulsive therapy (ECT). Methods: We divided a sample of 22 MDD patients into ECT group, which received six treatments over a span of two weeks, and control group (n = 12). DKI scanning was performed before and after treatment. The Hamilton Depression Rating Scale (HAMD) and Life Satisfaction Rating Sc...

  This is a followup to yesterday's calling out of the article in Psychiatric Times for not mentioning ECT as a treatment for postpartum psychosis. Looks like the evidence is pretty clear...

 The current issue of Psychiatric Times  (October, 2024 Vol. 41, No. 10) has this article: So the article states: "inpatient hospitalization is usually required, given the rapid deterioration and risk of suicide and infanticide." And the Treatment section   says: "Treatment of postpartum psychosis includes psychoeducation, assessment of the appropriate level of care, and pharmacotherapy."  Not even a whisper about ECT! IMO, this is frankly irresponsible. Have we learned nothing from the Andrea Yates tragedy?

 Out on PubMed, from international investigators,  is this review: The genetics of severe depression. Franklin CE, Achtyes E, Altinay M, Bailey K, Bhati MT, Carr BR, Conroy SK, Husain MM, Khurshid KA, Lencz T, McDonald WM, Mickey BJ, Murrough J, Nestor S, Nickl-Jockschat T, Nikayin S, Reeves K, Reti IM, Selek S, Sanacora G, Trapp NT, Viswanath B, Wright JH, Sullivan P, Zandi PP, Potash JB. Mol Psychiatry. 2024 Oct 15. doi: 10.1038/s41380-024-02731-1. Online ahead of print. PMID:  39406997   Review. The abstract is copied below: Genome-wide association studies (GWASs) of major depressive disorder (MDD) have recently achieved extremely large sample sizes and yielded substantial numbers of genome-wide significant loci. Because of the approach to ascertainment and assessment in many of these studies, some of these loci appear to be associated with dysphoria rather than with MDD, potentially decreasing the clinical relevance of the findings. An alternative approach to MDD...

 Out on PubMed, from researchers in Sweden, is this study: Allopregnanolone and progesterone in relation to a single electroconvulsive therapy seizure and subsequent clinical outcome: an observational cohort study. Thörnblom E, Cunningham JL, Gingnell M, Landén M, Bergquist J, Bodén R. BMC Psychiatry. 2024 Oct 15;24(1):687. doi: 10.1186/s12888-024-06167-3. PMID:  39407178 The abstract is copied below: Background: Electroconvulsive therapy (ECT) is an important treatment for several severe psychiatric conditions, yet its precise mechanism of action remains unknown. Increased inhibition in the brain after ECT seizures, mediated by γ-aminobutyric acid (GABA), has been linked to clinical effectiveness. Case series on epileptic patients report a postictal serum concentration increase of the GABAA receptor agonist allopregnanolone. Serum allopregnanolone remains unchanged after a full ECT series, but possible transient effects directly after a single ECT seizure remain unexplored. T...

 Out on PubMed, from authors in Germany and Canada, is this article: Role of stimulus dose on neuropsychological functioning after electroconvulsive therapy in patients with major depressive disorder. Rummel L, Göke K, Philipsen A, Hurlemann R, Kiebs M. Front Psychiatry. 2024 Sep 26;15:1443270. doi: 10.3389/fpsyt.2024.1443270. eCollection 2024. PMID:  39398962   The abstract is copied below: Introduction: Electroconvulsive therapy (ECT) is the most effective treatment for patients suffering from treatment-resistant depression but its use is often limited by the concern for cognitive side effects. This study examines the effect of ECT on autobiographical and verbal memory compared to a healthy control group and the impact of the mean stimulus dose on cognition after ECT. Methods: Autobiographical and verbal memory were assessed in depressed patients and healthy controls before the first and within one week after the last ECT treatment. Neuropsychological testing included t...

 Once again, from OpenEvidence: I hope you will not mind another "meta" post, that is, not going to a new, original article. But OpenEvidence is so good, I want to encourage its use for ECT questions. Ask away, and let me know what you think!

Out on PubMed, from researchers in Korea, is this study:  MRI textural plasticity in limbic gray matter associated with clinical response to electroconvulsive therapy for psychosis. Choe E, Kim M, Choi S, Oh H, Jang M, Park S, Kwon JS. Mol Psychiatry. 2024 Sep 26. doi: 10.1038/s41380-024-02755-7. Online ahead of print. PMID:  39327507 The abstract is copied below: Electroconvulsive therapy (ECT) is effective against treatment-resistant psychosis, but its mechanisms remain unclear. Conventional volumetry studies have revealed plasticity in limbic structures following ECT but with inconsistent clinical relevance, as they potentially overlook subtle histological alterations. Our study analyzed microstructural changes in limbic structures after ECT using MRI texture analysis and demonstrated a correlation with clinical response. 36 schizophrenia or schizoaffective patients treated with ECT and medication, 27 patients treated with medication only, and 70 healthy controls (HCs) wer...