Clinical Neuroscience of ECT (CNECT)

 Out on PubMed, from authors Down Under, is this paper: Royal Australian and New Zealand College of Psychiatrists professional practice guidelines for the use of ketamine in psychiatric practice. Hussain S, Gale C, Sarma S, Smith J, Bayes A, Loo C. Aust N Z J Psychiatry. 2025 Apr 28:48674251333577. doi: 10.1177/00048674251333577. Online ahead of print. PMID:  40290038 The abstract is copied below: Professional practice guidelines for the use of ketamine in psychiatric practice have been developed by the Royal Australian and New Zealand College of Psychiatrists to provide guidance on the use of ketamine in clinical practice in Australia and Aotearoa New Zealand, based on scientific evidence and supplemented by expert clinical consensus. Articles and information were sourced from existing guidelines and published literature. The findings were then formulated into consensus-based recommendations and guidance by the authors. The guidelines were subjected to rigorous successive con...

 Out on PubMed, from clinicians in Israel, is this LTE: Long-term  electroconvulsive  therapy for psychotic depression in a 9-year-old child: A case report. Walfisch R, Shilton T, Gothelf D, Mosheva M. Asian J Psychiatr. 2025 Apr 21;108:104509. doi: 10.1016/j.ajp.2025.104509. Online ahead of print. PMID:  40286457   The LTE is here , And here: This is an important and well presented case report, adding to the literature about maintenance ECT in children with severe psychiatric syndromes in the context of autism. Unfortunately, the only details about the ECT course are the schedule; while that is important, it would have been nice to know about electrode placement, anesthesia meds and stimulus parameters. Hard to believe this LTE got through the review process without a reviewer requesting these important elements...

 Out on PubMed, from authors in China, is this paper: Age-Dependent Efficacy of Electroconvulsive Therapy in Depression: A Longitudinal Study of Symptom Trajectories and Treatment Predictions. Huang W, Ji Y, Duan N, Zheng H, Qian R, Wang K, Li J, Tian Y. Brain Behav. 2025 Apr;15(4):e70487. doi: 10.1002/brb3.70487. PMID:  40259691   The abstract is copied below: Background: The variability in electroconvulsive therapy (ECT) efficacy for depression has received significant attention, particularly regarding the influence of age on treatment outcomes. However, studies examining the trajectory of ECT efficacy across different age groups remain limited. Methods: This longitudinal study analyzed 1056 intensive longitudinal data measurements from 132 hospitalized patients diagnosed with major depressive episodes, categorized into a young group (<30 years, n = 69) and an older group (≥30 years, n = 63). Depression severity was assessed using the Hamilton Depression Rating Scal...

 Out on PubMed, by me, is this commentary: Electroconvulsive Therapy ( ECT ): Reiterating the Call for Urgent Attention. Kellner CH. Indian J Psychol Med. 2025 Apr 16:02537176251330928. doi: 10.1177/02537176251330928. Online ahead of print. PMID:  40255414   The commentary is here . And here: In writing this commentary I wanted to amplify the important message from Dr. Thirthalli (see blog post of Feb.19th) about ECT's underutilization and the reasons for this.

 Out on PubMed, from authors in Japan, is this case report: A case report of ineffective electroconvulsive therapy for chronic pain. Fukao T, Fujiwara M, Yamada Y, Asada K, Asada T, Ri H, Sakamoto S, Takaki M. PCN Rep. 2025 Apr 21;4(2):e70108. doi: 10.1002/pcn5.70108. eCollection 2025 Jun. PMID:  40265150 The abstract is copied below: Background: Somatic symptom disorder (SSD), which includes chronic pain, is a common mental disorder characterized by significant functional impairment and other psychiatric comorbidities. Electroconvulsive therapy (ECT) has been proposed as a potential treatment for refractory chronic pain. However, evidence supporting its efficacy is limited and/or low quality. We present a case of SSD with chronic pain in which ECT was ineffective. Case presentation: The patient was a 63-year-old man with chronic pain in the lower back, buttocks, thighs, and soles of the feet. The duration of his chronic pain was 3.8 years. He was diagnosed with Bertolotti's s...

 Out on PubMed, from authors in Australia, is this case report: Electroconvulsive  Therapy for Persistent Postural Perceptual Dizziness: A Case Report. Seiler N, McAlary M, Kanaan R, Nair R. Case Rep Psychiatry. 2025 Apr 10;2025:9996688. doi: 10.1155/crps/9996688. eCollection 2025. PMID:  40255647 The abstract is copied below: Persistent postural perceptual dizziness (PPPD) is a functional vestibular disorder that can cause significant distress and impairment. Evidence for effective PPPD treatment is still limited and among suggested treatment regimes there have been mixed findings regarding neurostimulation. We present a case report of electroconvulsive therapy (ECT) for an individual with severe PPPD. The patient was a middle-aged woman admitted for acute suicidal ideation in the setting of peripartum depression and PPPD, following several unsuccessful antidepressant trials and a prior suicide attempt. She provided voluntary consent for ECT during admission, and 10 acu...

I blog about this topic again because it is very likely that ECT is grossly underutilized in the treatment of severe postpartum depression and psychosis. Such patients respond exquisitely well to ECT; I refer to them as "the low-hanging fruit" of ECT responders. Note that in the second query above, ECT is not mentioned.While the numbers are limited, it is likely that appropriate and timely prescription of ECT could save quite a few maternal and fetal lives.

 Out on PubMed, from authors in the Netherlands, Belgium, and Germany, is this study: Raised Intracranial Pressure in Seizures Induced by  Electroconvulsive  Therapy. Spoor JKH, Hollestelle RVA, Birkenhager TK, De Wit MY, Haitsma IK, Mathijssen IMJ, van Veelen MC, Kamp MA, Pluijms E, Klimek M, Neuteboom R, Maissan I, Dibué M. Eur J Neurol. 2025 Apr;32(4):e70149. doi: 10.1111/ene.70149. PMID:  40237234 The abstract is copied below: Background: Increased intracranial pressure (ICP) can be observed immediately upon seizure activity in craniotomized patients in neurosurgical practice. However, it is not commonly included in models of pathomechanisms contributing to morbidity and mortality in epilepsy. A main contributor to this may be the fact that measuring ICP noninvasively during a seizure is technically challenging. T he optic nerve sheath diameter (ONSD) represents a promising, noninvasive option to monitor relative ICP changes. We therefore measured ONSD in patient...

  The pdf is here . The link is here: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2832320

 Out on PubMed,  from authors at Yale University, is this paper: Ketamine Versus  Electroconvulsive   Therapy for the Treatment of Depression: A Guide for Clinicians. Elliott SI, B Katz R, B Ostroff R, Ansari M, Holmes SE, Sanacora G. Focus (Am Psychiatr Publ). 2025 Apr;23(2):195-205. doi: 10.1176/appi.focus.20240040. Epub 2025 Apr 15. PMID:  40235610 The paper is here . And from the text: There is little information to suggest that ECT could increase risk of substance use disorder.   Huh? Adverse effects such as prolonged apnea or prolonged paralysis, caused by the muscle relaxants given during ECT, and seizure-related adverse effects such as prolonged seizures and tardive seizures are more serious but rare. Because of the muscle contractions induced during ECT, severe osteoporosis could be a risk factor for fractures during treatment, and ketamine might be a safer treatment if adequate paralysis cannot be achieved   Sure. True, but why even bring up ...

 Out on PubMed, from authors in Louisiana, in JECT, is this case report: The Lysing of Catatonia With Intravenous Ketamine Prior to Definitive Treatment With Electroconvulsive Therapy. Conrad EJ, Stielper ZF, Mermilliod IV, Eng MR. J ECT. 2025 Apr 15. doi: 10.1097/YCT.0000000000001151. Online ahead of print. PMID:  40232233 The abstract is copied below: The presence of catatonia refractory to routine pharmacologic management is often subsequently managed by electroconvulsive therapy. However, legal obstacles that delay the initiation of electroconvulsive therapy in a timely fashion may be present. This may lead to prolonged risks associated with immobility and result in other procedures such as percutaneous endoscopic gastrostomy (PEG) tube placement. We present a case of successful lysing of catatonia with intravenous ketamine that allowed a patient to avoid potential complications and other procedures prior to definitive treatment with electroconvulsive therapy. Further res...

Out on PubMed, from authors in Turkiye, is this case report: Electroconvulsive therapy ameliorates treatment-resistant depression in patient with Lewy body dementia. Akgul YSS, Gultekin M, Demirel Ozsoy S. Neurocase. 2025 Apr 12:1-5. doi: 10.1080/13554794.2025.2490785. Online ahead of print. PMID:  40220014 The abstract is copied below: Lewy body dementia (LBD), the second most common degenerative dementia after Alzheimer's disease, is frequently associated with neuropsychiatric symptoms such as depression, anxiety, and apathy. These symptoms may precede cognitive decline, often resulting in misdiagnosis and inappropriate treatment. Electroconvulsive therapy (ECT) has emerged as a promising option for treatment-resistant depression in LBD. This report describes a 68-year-old female patient with LBD who received multiple ECT sessions for persistent severe depression and suicidal ideation. ECT led to marked symptom improvement across several hospitalizations . This case underscores t...

Out on PubMed, from authors in Ireland and England, is this paper: Why is electroconvulsive therapy for depression more effective in older age? A causal mediation analysis. Jelovac A, Landau S, Beeley P, McCaffrey C, Finnegan M, Gusciute G, Whooley E, McDonogh S, Thompson S, Igoe A, McDonagh K, McLoughlin DM. Psychol Med. 2025 Apr 10;55:e110. doi: 10.1017/S0033291725000807. PMID:   40207565   The abstract is copied below: Background: Older people with depression exhibit better response to electroconvulsive therapy (ECT). We aimed to measure the total effect of age on ECT response and investigate whether this effect is mediated by psychotic features, psychomotor retardation, psychomotor agitation, age of onset, and episode duration. Methods: We pooled data from four prospective Irish studies where ECT was administered for a major depressive episode (unipolar or bipolar) with baseline score ≥21 on the 24-item Hamilton Depression Rating Scale (HAM-D). The primary outcome was chan...

 Out on PubMed, from authors in France, is this paper: Hippocampal microstructural changes following electroconvulsive therapy in severe depression. Le Berre A, Attali D, Uszynski I, Debacker C, Lui M, Charron S, Moyal M, Ramon F, Henensal A, Benzakoun J, Mekaoui L, Gorwood P, Poupon C, Cachia A, Oppenheim C, Plaze M. Mol Psychiatry. 2025 Apr 8. doi: 10.1038/s41380-025-03016-x. Online ahead of print. PMID:  40199994 The abstract is copied below: Electroconvulsive therapy (ECT) induces hippocampal volume increases in depressed patients, potentially reflecting neuroplasticity. We hypothesized that Neurite Orientation Dispersion and Density Imaging (NODDI) could provide in vivo evidence of hippocampal neuroplasticity following ECT. This longitudinal study evaluated 43 depressed patients undergoing ECT and 24 controls. MRI and clinical assessments were performed at baseline (V1), after 5 sessions (V2), and post-treatment (V3). Evaluations included a 3 T MR-scan with 3DT1-weighted ...