Clinical Neuroscience of ECT (CNECT)

 Here is another ECT question to OpenEvidence: Here is another example of OpenEvidence getting it right about ECT. I blog about this to encourage readers to use OE as an entry point into the ECT literature.

 Ouit on PubMed, from investigators in Singapore, is this study: Use of Electroconvulsive Therapy Treatment in Adolescents in Singapore. Chen B, Fu Y, Li Z, Tan X, Li J, Herrera MM, Koh DSH, Tor PC. J ECT. 2024 Dec 24. doi: 10.1097/YCT.0000000000001101. Online ahead of print. PMID:  39792650 The abstract is copied below: Background: Electroconvulsive therapy (ECT) is a highly effective treatment for schizophrenia and mood disorders; however, most evidence is derived from the adult population, with less evidence in adolescents. We sought to determine the use of ECT in adolescents in the Institute of Mental Health (IMH) and evaluate the treatment outcome. Methods: We conducted a retrospective naturalistic analysis of ECT registry data of patients aged from 10 to 19 years from March 2017 to March 2023. Descriptive analysis was used to analyze the demographics and clinical characteristics. Paired t tests were used to compare the change in clinical outcome scores, including the Br...

Out on PubMed, from authors in China, is this paper: Suicidal risk is associated with hyper-connections in the frontal-parietal network in patients with depression. Ren Y, Li M, Yang C, Jiang W, Wu H, Pan R, Yang Z, Wang X, Wang W, Wang W, Jin W, Ma X, Liu H, Li R. Transl Psychiatry. 2025 Feb 12;15(1):49. doi: 10.1038/s41398-025-03249-y. PMID:  39939611 The abstract is copied below: Suicide is a complex behavior strongly associated with depression. Despite extensive research, an objective biomarker for evaluating suicide risk precisely and timely is still lacking. Using the precision resting-state fMRI method, we studied 61 depressive patients with suicide ideation (SI) or suicide attempt (SA), and 35 patients without SI to explore functional biomarkers of suicide risk. Among them, 21 participants also completed electroconvulsive therapy (ECT) treatment, allowing the examination of functional changes across different risk states within the same individual. Functional networks were...

 Out on PubMed, from researchers in Germany, is this paper: Machine learning based seizure classification and digital biosignal analysis of ECT seizures. Kayser M, Hurlemann R, Philipsen A, Freundlieb N, Kiebs M. Sci Rep. 2025 Feb 21;15(1):6409. doi: 10.1038/s41598-025-88238-3. PMID:  39984540 The abstract is copied below: While artificial intelligence has received considerable attention in various medical fields, its application in the field of electroconvulsive therapy (ECT) remains rather limited. With the advent of digital seizure collection systems, the development of novel ECT seizure quality metrics and treatment guidance systems in particular will require cutting-edge digital seizure analysis. Using artificial intelligence will offer more analytical degrees of freedom and could play a key role in enhancing the precision of currently available procedures. To this end, we developed the first machine learning (ML) framework that can classify ictal and non-ictal EEG segmen...

   Out on PubMed, from international investigators is this commentary: Electroconvulsive Therapy and Its New Competitors: ECT Remains the Gold Standard. Zilles-Wegner D,  Kellner CH , Sartorius A. J ECT. 2024 Dec 1;40(4):e31-e32. doi: 10.1097/YCT.0000000000001034. Epub 2024 Jul 8. PMID:  38968450   The commentary is here . And here: Thanks to my esteemed German colleagues for the opportunity to collaborate with them on this commentary. We feel it is important to continue to advocate for the fair representation of ECT in studies of comparator experimental and newly approved therapies. It is not that we are Luddites, but prematurely throwing the baby out with the bathwater serves no-one, and is a reckless disservice to our most seriously ill patients. 

Out on PubMed, from investigators in France, in JECT, is this study: Impact of Anesthesia on Electroconvulsive Therapy-Related Impairments in Global Cognitive Function in Patients With Treatment-Resistant Depression. Bernardoff L, Blay M, Thellier D, D'Amato T, Galvao F, Poulet E. J ECT. 2025 Feb 17. doi: 10.1097/YCT.0000000000001119. Online ahead of print. PMID:   39961035   The abstract is copied below: Introduction: Electroconvulsive therapy (ECT) in patients with treatment-resistant depression frequently leads to impairments in global cognitive function. Propofol and etomidate are the 2 most frequently used drugs for anesthetic induction during ECT. However, only few studies compared their differential impact on ECT-related impairments in global cognitive function. Methods: We studied retrospectively 75 patients hospitalized at Centre Hospitalier Le Vinatier (Bron, France) who met the DSM-V criteria for major depressive disorder and were treated with bilateral ECT to compa...

 Out on PubMed, from a noted Indian ECT scholar, is this editorial: Underutilization of  Electroconvulsive  Therapy (ECT): A Call for Urgent Attention. Thirthalli J. Indian J Psychol Med. 2025 Feb 12:02537176251317677. doi: 10.1177/02537176251317677. Online ahead of print. PMID:  39957794 The editorial is here . And here: The case report that begins this editorial is one of the most compelling you will ever read. The ECT advocacy message of this editorial, likewise, is extremely well presented. Recognition that ECT education and training are woefully inadequate in India and around the world should be a wake up call. I recommend a full and careful read of this piece by all ECT health professionals. Kudos to Dr. Thirthalli for this impactful contribution to the ECT literature. (Please see also yesterday's blog post for a very similar message.)

 Out on PubMed, from international authors, is this LTE: Recasting the role of electroconvulsive therapy and the electroconvulsive therapy practitioner: For severe illness, not necessarily treatment-resistant depression. Espinoza RT,  Kellner CH , Sartorius A, Nordenskjöld A. J Psychopharmacol. 2025 Feb 16:2698811251319469. doi: 10.1177/02698811251319469. Online ahead of print. PMID:  39956784 The LTE is here . And here: In this LTE my colleagues and I make the case for ECT as a treatment for a range of severe and urgent psychiatric illnesses. I am so glad we got to say this in this way, particularly the part about ECT practitioners being specialists in severe illness. For the sake of responsible and rational patient care, it is important to fairly represent ECT and not to prematurely hype supposed replacements.

 Out on PubMed, from researchers in China, is this basic science study: Esketamine alleviates cognitive impairment signs induced by modified electroconvulsive therapy in a depression rat model via the KLF4/p38 MAPK pathway. Zhou X, Zhang L, Gao W, Li H, Guo Q, Dai J, Gao F, Wang L. J Affect Disord. 2025 Feb 10:S0165-0327(25)00200-9. doi: 10.1016/j.jad.2025.02.012. Online ahead of print. PMID:  39938694 The abstract is copied below: Background: Depression is a common and serious psychiatric disorder with significant impacts on individuals. Modified electroconvulsive therapy (MECT) is an established treatment for severe and treatment-resistant depression, but its cognitive side effects, particularly memory impairments, limit its use. Esketamine (ESK), an FDA-approved antidepressant, has shown neuroprotective effects. However, its role in mitigating MECT-induced cognitive deficits remains unexplored. This study investigates whether ESK could alleviate MECT-induced signs of cognit...

 Out on PubMed, from authors in New Mexico, is this paper: Electroconvulsive  Therapy (ECT) Referral Workshop for Depression: Assessing Patients and Addressing Stigma. Haynes W, Miller J, Weidner P, Abbott C. MedEdPORTAL. 2025 Feb 11;21:11497. doi: 10.15766/mep_2374-8265.11497. eCollection 2025. PMID:  39935971   The abstract is copied below: Introduction: Electroconvulsive therapy (ECT) is an important somatic treatment in psychiatry with well-defined indications, strong evidence for a quick response, and established efficacy. Despite the benefits of ECT, it is underutilized and inequitably accessed by patients in the United States. Patient and provider lack of knowledge, misinformation, and negative attitudes perpetuated by bias and stigma towards ECT can be significant barriers to patients receiving ECT. Methods: We created a workshop to address these issues with Kern's six-step approach, using the affective context learning theory as a conceptual framework. Based...

Out on PubMed, from investigators in Scotland, is this paper: Electroconvulsive Therapy: A Scotland-Wide Naturalistic Study of 4826 Treatment Episodes. Martin JL, Strawbridge RJ, Christmas D, Fleming M, Kelly S, Varveris D, Martin D. Biol Psychiatry Glob Open Sci. 2024 Dec 16;5(2):100434. doi: 10.1016/j.bpsgos.2024.100434. eCollection 2025 Mar. PMID:  39926701  The abstract is copied below: Background: Electroconvulsive therapy (ECT) is an effective treatment option for several psychiatric disorders, including treatment-resistant depression, but there are concerns about potential adverse effects, particularly on cognition. This study describes ECT response and side effects in the Scottish ECT Audit Network. Methods: Data collected from 4826 treatment episodes includes pre-ECT and post-ECT illness severity scores (Clinical Global Impression-Severity [CGI-S] and Montgomery-Åsberg Depression Rating Scale [MADRS]), diagnosis, age, sex, consent status, treatment year, treatment fre...

 I queried OE on "Why is ECT controversial?" I blog about this to continue  to remind readers to try out OpenEvidence regarding ECT topics. I think this is pretty good and somewhat nuanced. I worry a bit about the "ethical considerations" section, given that the ethical issues are not at all controversial, IMO. If there is, in fact, sloppiness in the informed consent process, then that should be improved. But generally, ECT is the most scrutinized and informed consented procedure in all of medicine; the new APA Task Force Report has a 13-page chapter (Chapter 10) devoted to consent.

 Soon to be out on PubMed, are these two LTEs in Anesthesiology: The letters and reply are also  here . These two LTEs applaud the collaboration between the specialties of anesthesiology and psychiatry, both clinically and in research. Various ketamine issues are also addressed, trying to keep the clinical realities versus the research and theoretical exuberance in responsible balance. It is always helpful when ECT topics can be placed in the anesthesiology literature, in order to expand the base of medical professionals who are informed about modern ECT practice.