Clinical Neuroscience of ECT (CNECT)

Out on PubMed, from Belgian colleagues, is this review: [The neuroplastic effects of electroconvulsive therapy]. Belge JB, Constant E. Rev Med Liege. 2022 Sep;77(9):527-531. PMID:  36082600   French. The abstract is copied below: Major depressive disorder is an important cause of disability around the world, with a tremendous psychological burden and extensive socioeconomic consequences. Whilst both psychotherapy and psychopharmacology are effective in treating a depressive episode, often there is a delay of several weeks between the start of treatment and the first beneficial effects. More importantly, approximately 30 % of patients do not remit, even after several treatment attempts. As the oldest biological treatment in psychiatry that is still available, electroconvulsive therapy (ECT) remains the most potent of antidepressant interventions, today achieving a staggering 70-80 % response and a 50-60 % remission rate. In treatment-resistant patients, response rates are even as high a

 Out on PubMed, from authors in Belgium, in JECT, is this paper: Nonremission After Electroconvulsive Therapy in Individuals With Major Depression: Role of Borderline Personality Disorder. Hein M, Mungo A, Loas G. J ECT. 2022 Apr 29. doi: 10.1097/YCT.0000000000000857. Online ahead of print. PMID:  35482914 The abstract is copied below: Objectives: The aim of the present study was to investigate the risk of nonremission following electroconvulsive therapy (ECT), as associated with borderline personality disorder, in individuals with major depression in the context of the contradictory data available in the literature. Methods: We analyzed demographic and clinical data from 210 individuals with major depression who were treated with ECT. Study participants were recruited from the medical records database of the Psychiatry Department at Erasme Hospital. Only individuals with major depression who were in remission, as demonstrated during the systematic psychiatric interview performed at th

Out on PubMed, from investigators in Belgium, is this paper: [Electroconvulsive therapy in the treatment of depression in anorexia nervosa]. van der Lelie K, Sienaert P, Vrieze E. Tijdschr Psychiatr. 2021;63(9):673-678. PMID:  34647306   Dutch. The abstract is copied below: Background: Often anorexia nervosa occurs with other psychiatric comorbidities of which mood disorders are the most frequent. Depressive feelings hamper the chance of a favourable outcome of this persistent disorder. In addition, the underweight makes antidepressants work suboptimal. Electroconvulsive therapy (ECT) offers an important therapeutic value in the treatment of mood disorders. We are investigating whether ECT can be an effective treatment method for patients with anorexia nervosa and major depressive disorder. Aim: Analysis of the literature on the possible effectiveness of electroconvulsive therapy (ECT) in the treatment of major depressive disorder and anorexia nervosa supplemented with a case report. M

Out on PubMed, from researchers in Belgium, is this study: Inflammatory Markers May Inform the Effects of  Electroconvulsive  Therapy on Cognition in Patients with Depression. Belge JB, Diermen LV, Sabbe B, Morrens M, Coppens V, de Timary P, Constant E, Sienaert P, Schrijvers D. Neuropsychobiology. 2021 Apr 28:1-9. doi: 10.1159/000515931. Online ahead of print. PMID:  33910216 The abstract is copied below: Introduction: The neurobiological mechanisms underlying the acute cognitive effects of electroconvulsive therapy (ECT) remain poorly understood. Prior research has shown that proinflammatory cytokines such as IL-6, TNF-α, IL1-β, and IL-10 may interfere with cognitive functioning. Interestingly, immunomodulation is one of the proposed modes of action of ECT. This study investigates whether changes of peripheral levels of IL-6, TNF-α, IL1-β, and IL-10 are related to changes in cognitive functioning following ECT. Methods: In the week before and 1 week after an acute course of ECT, 62 p

Out on PubMed, in JECT, from researchers in Japan and Belgium, is this study: Electroconvulsive Therapy for Patients With Depression Who Lack Capacity for Consent: Doing Good and Doing No Harm. Takamiya A, Bouckaert F, Sienaert P, Uchida T, Kudo S, Yamagata B, Kishimoto T, Mimura M, Hirano J. J ECT. 2021 Apr 9. doi: 10.1097/YCT.0000000000000764. Online ahead of print. PMID:  33840801 The abstract is copied below: Objective : Electroconvulsive therapy (ECT) is provided in real-world clinical settings for patients lacking capacity for consent. The aim of this study was to investigate the clinical characteristics and clinical effectiveness of ECT in this population. Methods : A retrospective chart review was conducted to collect data from patients who received ECT to treat their depressive episodes between April 2012 and March 2019. Differences in clinical characteristics and short-/long-term clinical outcomes between patients who received ECT with their relatives' consent and patient

 Out on PubMed, from researchers in The Lowcountries, is this paper: The pattern of inflammatory markers during  electroconvulsive  therapy in older depressed patients. Carlier A, Rhebergen D, Schilder F, Bouckaert F, Sienaert P, Veerhuis R, Hoogendoorn AW, Eikelenboom P, Stek ML, Dols A, van Exel E. World J Biol Psychiatry. 2021 Apr 6:1-24. doi: 10.1080/15622975.2021.1907718. Online ahead of print. PMID:  33821774 The abstract is copied below: Objectives: An association is found between changes in cytokine levels and antidepressant treatment outcome. Also, a proinflammatory profile is associated with a favourable electroconvulsive therapy (ECT) outcome. This paper investigates the pattern of inflammatory markers during a course of ECT in older depressed patients and whether this pattern is associated with ECT outcome. We hypothesized that ECT has an anti-inflammatory effect. Methods: The pattern of CRP, IL-6, IL-10, and TNF-α during a course of ECT was examined using longitudinal mixe

Out on PubMed, from researchers in Belgium, is this paper:  The Leuven late life depression (L3D) study: PET-MRI biomarkers of pathological brain ageing in late-life depression: study protocol. Emsell L, Laroy M, Van Cauwenberge M, Vande Casteele T, Vansteelandt K, Van Laere K, Sunaert S, Van den Stock J, Bouckaert F, Vandenbulcke M. BMC Psychiatry. 2021 Jan 28;21(1):64. doi: 10.1186/s12888-021-03063-y. PMID:  33509135 The abstract is copied below: Background: Major depressive disorders rank in the top ten causes of ill health in all but four countries worldwide and are the leading cause of years lived with disability in Europe (WHO). Recent research suggests that neurodegenerative pathology may contribute to the development of late-life depression (LLD) in a sub-group of patients and represent a target for prevention and early diagnosis. In parallel, electroconvulsive therapy (ECT), which is the most effective treatment for severe LLD, has been associated with significant brain struct

Out on PubMed, from researchers in Belgium and The Netherlands, is this paper: Cognitive remediation following  electroconvulsive  therapy in patients with treatment resistant depression: randomized controlled trial of an intervention for relapse prevention - study protocol. Van de Velde N, Kappen M, Koster EHW, Hoorelbeke K, Tandt H, Verslype P, Baeken C, De Raedt R, Lemmens G, Vanderhasselt MA. BMC Psychiatry. 2020 Sep 16;20(1):453. doi: 10.1186/s12888-020-02856-x. PMID:  32938410 The abstract is copied below: Background:  Major depressive episode (MDE) is worldwide one of the most prevalent and disabling mental health conditions. In cases of persistent non-response to treatment, electroconvulsive therapy (ECT) is a safe and effective treatment strategy with high response rates. Unfortunately, longitudinal data show low sustained response rates with 6-month relapse rates as high as 50% using existing relapse prevention strategies. Cognitive side effects of ECT, even though transient,

Out on PubMed recently is this review article (in French) in the Revue Médicale de Liège: [Innovative therapeutic approaches in psychiatry : neuromodulation. For whom, why and how ?]. Scantamburlo G, Salado AL. Rev Med Liege. 2020 May;75(5-6):426-431. PMID:  32496692   The pdf is here . While this review article is not just about ECT,  it does  give ECT pride  of place , with a short, but  accurate summary of the treatment. Most importantly, it emphasizes the role of ECT for the treatment  of severe and urgent illness, in contradistinction to rTMS, which the authors note is only indicated for milder illness. While that difference is clear to ECT practitioners, it is often obscured, with rTMS  suggested as an alternative to ECT. The authors cite a quote about ECT, referring to it  as "an old therapy of the future."

Out on PubMed today from colleagues in Belgium and the Netherlands is this new study: Understanding  ECT -related anxiety: a prospective study. Obbels J, Vansteelandt K, Verwijk E, Lambrichts S, Bouckaert F, Sienaert P. Acta Psychiatr Scand. 2020 May 31. doi: 10.1111/acps.13198. Online ahead of print. PMID:  32474903 The abstract is available from the above link, and the conclusions are copied below: There are individual differences in ECT‐related anxiety trajectories during ECT. Both female patients and patients with psychotic depression experienced more ECT‐related anxiety before the start of ECT. The severity of ECT‐related anxiety decreased significantly in patients with a psychotic depression, but remained stable in patients without a psychotic depression during ECT. In addition, patients who showed a stronger decrease in depression‐severity also showed a stronger decrease in ECT‐related anxiety. A better understanding of ECT‐related anxiety‐trajectories can help in desig

Out on Pubmed today is this commentary in the American Journal of Geriatric Psychiatry, by Pascal Sienaert and Belgian colleagues: Electroconvulsive Therapy During COVID-19-Times: Our Patients Cannot Wait. Sienaert P, Lambrichts S, Popleu L, Van Gerven E, Buggenhout S, Bouckaert F. Am J Geriatr Psychiatry . 2020 Apr 22. pii: S1064-7481(20)30297-9. doi: 10.1016/j.jagp.2020.04.013. [Epub ahead of print] No abstract available.  PMID:   32345550 The pdf is here . The authors describe the adaptations made in Belgium to ECT service provision during the COVID-19 pandemic crisis. They discuss patient management strategies and infection control in the treatment suite. Most importantly, they make the case that ECT is a vital treatment that cannot be considered elective.