1
|
Flint AJ, Banerjee S. Pharmacological treatment of psychotic depression. Lancet Psychiatry 2024; 11:162-164. [PMID: 38360020 DOI: 10.1016/s2215-0366(24)00030-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Alastair J Flint
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Mental Health, University Health Network, Toronto, ON, Canada.
| | - Samprit Banerjee
- Department of Population Health Sciences, Weill Cornell Medicine, New York M5G 2C4, NY, USA
| |
Collapse
|
2
|
Le Droguene E, Bulteau S, Deschamps T, Thomas-Ollivier V, Brichant-Petitjean C, Guitteny M, Laurin A, Sauvaget A. Dynamics of Depressive and Psychomotor Symptoms During Electroconvulsive Therapy in Older Depressive Patients: A Case Series. J ECT 2023; 39:255-262. [PMID: 37310091 DOI: 10.1097/yct.0000000000000934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is an effective treatment for patients experiencing a major depressive episode, especially older ones. Identification of specific responses within early ECT sessions remains an issue of debate, however. Hence, this pilot study prospectively examined the outcome in terms of depressive signs, symptom by symptom, throughout a course of ECT, concentrating particularly on psychomotor retardation symptoms. METHODS Nine patients were clinically evaluated several times during the ECT course, before the first session and then weekly (over 3-6 weeks, according to their evolution), by completing the Montgomery-Åsberg Depression Rating Scale (MADRS), the Mini-Mental State Examination test, and the French Retardation Rating Scale for Depression for assessing the severity of psychomotor retardation. RESULTS Nonparametric Friedman tests showed significant positive changes in mood disorders during ECT in older depressive patients (mean, -27.3% of initial MADRS total score). Fast improvement in French Retardation Rating Scale for Depression score was observed at t1 (ie, after 3-4 ECT sessions), whereas a slightly delayed improvement in the MADRS scores was found at t2 (ie, after 5-6 ECT sessions). Moreover, the scores for items linked to the motor component of psychomotor retardation (eg, gait, postural control, fatigability) were the first to significantly decrease during the first 2 weeks of the ECT course compared with the cognitive component. CONCLUSIONS Interestingly, participants' concentration on daily functional activities, their interest and fatigability, and their reported state of sadness were the first to progress, representing possible precursor signs of positive patient outcomes after ECT.
Collapse
Affiliation(s)
| | - Samuel Bulteau
- Nantes Université, CHU Nantes, INSERM, Methods in Patients-Centered Outcomes and Health Research
| | - Thibault Deschamps
- Nantes Université, CHU Nantes, Movement-Interactions-Performance, Nantes
| | | | | | - Marie Guitteny
- CHU de Nantes, Service d'Addictologie et Psychiatrie de Liaison, Nantes, France
| | - Andrew Laurin
- Nantes Université, CHU Nantes, Movement-Interactions-Performance, Nantes
| | - Anne Sauvaget
- Nantes Université, CHU Nantes, Movement-Interactions-Performance, Nantes
| |
Collapse
|
3
|
Read J, Kirsch I, McGrath L. Electroconvulsive Therapy for Depression: A Review of the Quality of ECT versus Sham ECT Trials and Meta-Analyses. ACTA ACUST UNITED AC 2020. [DOI: 10.1891/ehpp-d-19-00014] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BackgroundElectroconvulsive therapy (ECT) is still being administered to approximately a million people annually. There have been no ECT versus simulated ECT (SECT) studies since 1985. The five meta-analyses of ECT versus SECT studies all claim that ECT is more effective than SECT for its primary target, severe depression. This review assesses the quality of those meta-analyses and of the 11 studies on which they are based.MethodsThe meta-analyses were evaluated primarily in terms of whether they considered the quality of the studies they included, but also in terms of whether they addressed efficacy beyond end of treatment. The methodological rigor of the 11 studies included by one or more of the meta-analyses was assessed using a 24-point Quality scale developed for this review.ResultsThe five meta-analyses include between 1 and 7 of the 11 studies. The meta-analyses pay little or no attention to the multiple limitations of the studies they include. The 11 studies have a mean Quality score of 12.3 out of 24. Eight scored 13 or less. Only four studies describe their processes of randomization and testing the blinding. None convincingly demonstrate that they are double-blind. Five selectively report their findings. Only four report any ratings by patients. None assess Quality of Life. The studies are small, involving an average of 37 people. Four of the 11 found ECT significantly superior to SECT at the end of treatment, five found no significant difference and two found mixed results (including one where the psychiatrists reported a difference but patients did not). Only two higher Quality studies report follow-up data, one produced a near-zero effect size (.065) in the direction of ECT, and the other a small effect size (.299) in favor of SECT.ConclusionsThe quality of most SECT–ECT studies is so poor that the meta-analyses were wrong to conclude anything about efficacy, either during or beyond the treatment period. There is no evidence that ECT is effective for its target demographic—older women, or its target diagnostic group—severely depressed people, or for suicidal people, people who have unsuccessfully tried other treatments first, involuntary patients, or children and adolescents. Given the high risk of permanent memory loss and the small mortality risk, this longstanding failure to determine whether or not ECT works means that its use should be immediately suspended until a series of well designed, randomized, placebo-controlled studies have investigated whether there really are any significant benefits against which the proven significant risks can be weighed.
Collapse
|
4
|
|
5
|
Differences in Speed of Response of Depressive Symptom Dimensions in Older Persons During Electroconvulsive Therapy. J ECT 2019; 35:35-39. [PMID: 29847351 DOI: 10.1097/yct.0000000000000506] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Electroconvulsive therapy (ECT) is an important and effective treatment for depression. However, research on course trajectories of depressive symptoms during ECT is limited. Insight into putative differences in speed of response of depressive symptom dimensions may enable clinicians to optimally inform patients and their relatives. Therefore, we aim to examine course trajectories of depressive symptom dimensions in depressed older persons during ECT. METHODS Data were derived from the Mood Disorders in Elderly treated with Electro Convulsive Therapy study, including 110 persons, aged 55 years or more, with a current diagnosis of major depressive disorder and referred for ECT. Exploratory factor analysis was used to identify symptom dimensions, using the 10 depression items of the Montgomery-Åsberg Depression Rating Scale (MADRS). Differences in course trajectories of symptom dimension during 2 weeks were examined by multilevel analyses. RESULTS Three symptom dimensions were identified: a "mood," "melancholic," and "suicidal" dimension. Mood showed a significantly greater severity decline as compared with melancholic and suicidal at the 1-week follow-up. At the 2-week follow-up, both mood and melancholic demonstrated a significantly greater decline as compared with suicidal. However, because scores on the suicidality item of the Montgomery-Asberg Depression Rating Scale were already lower at baseline compared with the other items, a floor effect cannot be ruled out. DISCUSSION All symptom dimensions of depression showed a rapid response to ECT. Our findings did not support the general assumption that suicidal symptoms may be the first to improve. However, a floor effect on the suicidality item cannot be ruled out.
Collapse
|
6
|
Heijnen WTCJ, Kamperman AM, Tjokrodipo LD, Hoogendijk WJG, van den Broek WW, Birkenhager TK. Influence of age on ECT efficacy in depression and the mediating role of psychomotor retardation and psychotic features. J Psychiatr Res 2019; 109:41-47. [PMID: 30472527 DOI: 10.1016/j.jpsychires.2018.11.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate whether older age predicts a higher efficacy of electroconvulsive therapy (ECT) in severely depressed patients. Also, to analyze whether psychomotor disturbance and/or psychotic features might explain the potential higher efficacy of ECT in older age. METHOD A total of 96 patients with major depressive disorder treated with bilateral ECT were evaluated. The 17-item HAM-D and the MADRS were used to evaluate the efficacy of ECT and time to remission, respectively. Psychomotor disturbance was defined according the HAM-D. RESULTS Middle-aged (MA; 50-70 years) and older-aged (OA; ≥70 years) patients had a non-significant larger symptom reduction compared with young-aged (YA; <50 years) patients. Medium effect size was found in favor of MA (d = 0.44) and small effect size in favor of OA (d = 0.30), when compared to YA. Patients with psychotic features and patients with psychomotor retardation had a significantly larger symptom reduction (p < 0.001 and p = 0.005, respectively; d = 0.88 and d = 0.66, respectively). The association between age and ECT efficacy is mediated by psychomotor retardation (p = 0.049) and in lesser extent by psychotic features (p = 0.071). CONCLUSION The results show that psychomotor retardation and psychotic features are strong predictors of ECT efficacy and explain the association between age and ECT efficacy. Instead of focusing on the age of a patient, clinicians should focus on the presence of psychomotor disturbances and psychotic features of depression, when considering ECT treatment.
Collapse
Affiliation(s)
| | - Astrid M Kamperman
- Department of Psychiatry, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Lindsay D Tjokrodipo
- Department of Psychiatry, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Witte J G Hoogendijk
- Department of Psychiatry, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | | | - Tom K Birkenhager
- Department of Psychiatry, Erasmus University Medical Centre, Rotterdam, the Netherlands
| |
Collapse
|
7
|
Coryell W. Impact, Diagnosis, Phenomenology, and Biology. Handb Exp Pharmacol 2019; 250:3-33. [PMID: 31004226 DOI: 10.1007/164_2018_156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This section provides summaries of the epidemiology, phenomenology, nosology, and the suspected biological substrates of the depressive disorders. It particularly emphasizes the historical evolution of the pertinent diagnostic constructs and the prognostic import both of the various diagnostic groupings and of the individual symptoms and symptom clusters.
Collapse
Affiliation(s)
- William Coryell
- Department of Psychiatry, Carver College of Medicine, University of Iowa Health Care, Iowa City, IA, USA.
| |
Collapse
|
8
|
Martínez-Amorós E, Goldberg X, Gálvez V, de Arriba-Arnau A, Soria V, Menchón JM, Palao DJ, Urretavizcaya M, Cardoner N. Early improvement as a predictor of final remission in major depressive disorder: New insights in electroconvulsive therapy. J Affect Disord 2018; 235:169-175. [PMID: 29656263 DOI: 10.1016/j.jad.2018.03.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 02/07/2018] [Accepted: 03/27/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Early improvement to antidepressant drugs predicts remission, but the predictive value of early improvement to electroconvulsive therapy (ECT) is still unclear. The main aim of this study was to determine the optimal definition of early improvement in the treatment of major depressive disorder (MDD) with ECT, by analyzing its value as a predictor of remission. METHODS A naturalistic study was conducted in 87 adult MDD patients treated with acute ECT. ROC curves were generated to identify the best time point (week 1 or 2 of treatment) predicted remission. Sensibility, specificity, and predictive values were calculated for several definitions of early improvement previously proposed in the literature (20%, 25%, 30%, and 35%). Complementary, time to remission was analyzed and a logistic regression model was performed to further characterize the impact of the optimal definition of early improvement on remission while adjusting for other clinically relevant variables. RESULTS A 30% reduction in the HAM-D score after 2 weeks was identified as the optimal definition of early improvement, with acceptable sensitivity (76%), and specificity (67%). Complementary analyses provided further support for this definition showing a shorter time to remission and a significant effect adjusted for the rest of variables. LIMITATIONS Relatively small sample size, ECT restricted to brief bilateral treatment. CONCLUSIONS Early improvement, defined as a 30% of reduction in the HAM-D21 score at week 2, is a good predictor of remission in MDD patients treated with bilateral ECT, with potential clinical impact. Lack of early improvement could indicate a need for further changes in treatment strategies.
Collapse
Affiliation(s)
- Erika Martínez-Amorós
- Mental Health Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain
| | - Ximena Goldberg
- Mental Health Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain
| | - Verònica Gálvez
- School of Psychiatry, University of NSW. Black Dog Institute, Sydney, Randwick, Australia
| | - Aida de Arriba-Arnau
- Department of Psychiatry, Neurosciences Group - Psychiatry and Mental Health, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Virginia Soria
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain; Department of Psychiatry, Neurosciences Group - Psychiatry and Mental Health, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - José M Menchón
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain; Department of Psychiatry, Neurosciences Group - Psychiatry and Mental Health, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Diego J Palao
- Mental Health Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain
| | - Mikel Urretavizcaya
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain; Department of Psychiatry, Neurosciences Group - Psychiatry and Mental Health, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain.
| | - Narcís Cardoner
- Mental Health Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain.
| |
Collapse
|
9
|
Abstract
The first electroconvulsive treatment was administered by Cerletti and Bini in 1938. The event was essentially an experiment, carried out like a military operation (Endler, 1988). The patient was stimulated three times, each time increasing the intensity of the stimulus before a generalised seizure was induced. He had been suffering from an acute psychosis with a poor prognosis, but responded to a course of 11 treatments and was discharged free of symptoms two months later. The first paper on electroconvulsive therapy (ECT) in English was published in theLancet(Kalinowski) in 1939. At that time, somatic treatment alternatives for the severely ill in large mental institutions included lobotomy and insulin coma therapy. In comparison, unmodified ECT (albeit associated with a significant risk of serious physical morbidity) was predictable, efficient, quick and effective. It is understandable why the treatment became widely and fairly indiscriminately adopted before systematic objective evidence of its efficacy was collected.
Collapse
|
10
|
Dols A, Bouckaert F, Sienaert P, Rhebergen D, Vansteelandt K, Ten Kate M, de Winter FL, Comijs HC, Emsell L, Oudega ML, van Exel E, Schouws S, Obbels J, Wattjes M, Barkhof F, Eikelenboom P, Vandenbulcke M, Stek ML. Early- and Late-Onset Depression in Late Life: A Prospective Study on Clinical and Structural Brain Characteristics and Response to Electroconvulsive Therapy. Am J Geriatr Psychiatry 2017; 25:178-189. [PMID: 27771245 DOI: 10.1016/j.jagp.2016.09.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The clinical profile of late-life depression (LLD) is frequently associated with cognitive impairment, aging-related brain changes, and somatic comorbidity. This two-site naturalistic longitudinal study aimed to explore differences in clinical and brain characteristics and response to electroconvulsive therapy (ECT) in early- (EOD) versus late-onset (LOD) late-life depression (respectively onset <55 and ≥55 years). METHODS Between January 2011 and December 2013, 110 patients aged 55 years and older with ECT-treated unipolar depression were included in The Mood Disorders in Elderly treated with ECT study. Clinical profile and somatic health were assessed. Magnetic resonance imaging (MRI) scans were performed before the first ECT and visually rated. RESULTS Response rate was 78.2% and similar between the two sites but significantly higher in LOD compared with EOD (86.9 versus 67.3%). Clinical, somatic, and brain characteristics were not different between EOD and LOD. Response to ECT was associated with late age at onset and presence of psychotic symptoms and not with structural MRI characteristics. In EOD only, the odds for a higher response were associated with a shorter index episode. CONCLUSION The clinical profile, somatic comorbidities, and brain characteristics in LLD were similar in EOD and LOD. Nevertheless, patients with LOD showed a superior response to ECT compared with patients with EOD. Our results indicate that ECT is very effective in LLD, even in vascular burdened patients.
Collapse
Affiliation(s)
- Annemiek Dols
- Department of Old Age Psychiatry, GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands; EMGO+ Institute of Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Filip Bouckaert
- Old-age Psychiatry, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium; Academic Center for ECT and Neuromodulation, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium
| | - Pascal Sienaert
- Academic Center for ECT and Neuromodulation, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium
| | - Didi Rhebergen
- Department of Old Age Psychiatry, GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands; EMGO+ Institute of Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Kristof Vansteelandt
- Department of Psychiatry, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium; Research Group of Quantitative Psychology and Individual Differences, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium
| | - Mara Ten Kate
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Hannie C Comijs
- Department of Old Age Psychiatry, GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands; EMGO+ Institute of Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Louise Emsell
- Old-age Psychiatry, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium; Translational MRI, Department of Imaging and Pathology, KU Leuven & Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Mardien L Oudega
- Department of Old Age Psychiatry, GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands; EMGO+ Institute of Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Eric van Exel
- Department of Old Age Psychiatry, GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands; EMGO+ Institute of Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Sigfried Schouws
- Department of Old Age Psychiatry, GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands; EMGO+ Institute of Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Jasmien Obbels
- Academic Center for ECT and Neuromodulation, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium
| | - Mike Wattjes
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Piet Eikelenboom
- Department of Old Age Psychiatry, GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands
| | - Mathieu Vandenbulcke
- Old-age Psychiatry, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium
| | - Max L Stek
- Department of Old Age Psychiatry, GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands; EMGO+ Institute of Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
11
|
Poulet E, Galvao F, Haffen E, Szekely D, Brault C, Haesebaert F, Brunelin J. Effects of smoking status and MADRS retardation factor on response to low frequency repetitive transcranial magnetic stimulation for depression. Eur Psychiatry 2016; 38:40-44. [PMID: 27657664 DOI: 10.1016/j.eurpsy.2016.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Despite growing evidence supporting the clinical interest of repetitive transcranial magnetic stimulation (rTMS) in treatment-resistant depression (TRD), little is known regarding the effects of clinical and sociodemographic factors on the clinical outcome in patients. METHODS We retrospectively investigated the effects of clinical (using the 3-factor model of the Montgomery-Åsberg depression rating scale [MADRS] encompassing dysphoria, retardation and vegetative symptoms) and sociodemographic characteristics of participants on clinical outcome in a sample of 54 TRD patients receiving low frequency rTMS (1Hz, 360 pulses) applied over the right dorsolateral prefrontal cortex combined with sham venlafaxine. RESULTS Responders (n=29) displayed lower retardation baseline scores (13.6±2.9) than non-responders (15.6±2.9; n=25; P=0.02). We also observed a significant difference between the numbers of ex-smokers in responders and non-responders groups; all ex-smokers (n=8) were responders to rTMS (P=0.005). CONCLUSION Low MADRS retardation factor and ex-smoker status is highly prevalent in responders to low frequency rTMS. Further studies are needed to investigate the predictive value of these factors.
Collapse
Affiliation(s)
- E Poulet
- Inserm, U1028, CNRS, UMR5292, Lyon neuroscience research center, ΨR2 Team, université de Lyon, 69000 Lyon, France; University Lyon 1, 69000 Villeurbanne, France; Centre hospitalier Le Vinatier, 69678 Bron, France; Service de psychiatrie des urgences, hôpital Édouard-Herriot, CHU de Lyon, 69000 Lyon, France.
| | - F Galvao
- Inserm, U1028, CNRS, UMR5292, Lyon neuroscience research center, ΨR2 Team, université de Lyon, 69000 Lyon, France; University Lyon 1, 69000 Villeurbanne, France; Centre hospitalier Le Vinatier, 69678 Bron, France
| | - E Haffen
- Department of clinical psychiatry, CIC-1431 Inserm, university hospital of Besançon, 25000 Besançon, France; EA-481, université Bourgogne Franche-Comté, université Franche-Comté, 25000 Besançon, France; FondaMental foundation, 94000 Créteil, France
| | - D Szekely
- Princess Grace hospital, department of psychiatry, 98012 Monaco, France
| | - C Brault
- Pôle « information médicale évaluation recherche » (IMER), CHU de Lyon, 62, avenue Lacassagne, bâtiment A, 69424 Lyon cedex 03, France
| | - F Haesebaert
- Inserm, U1028, CNRS, UMR5292, Lyon neuroscience research center, ΨR2 Team, université de Lyon, 69000 Lyon, France; University Lyon 1, 69000 Villeurbanne, France; Centre hospitalier Le Vinatier, 69678 Bron, France
| | - J Brunelin
- Inserm, U1028, CNRS, UMR5292, Lyon neuroscience research center, ΨR2 Team, université de Lyon, 69000 Lyon, France; University Lyon 1, 69000 Villeurbanne, France; Centre hospitalier Le Vinatier, 69678 Bron, France
| |
Collapse
|
12
|
Abstract
PURPOSE OF REVIEW Depression is a presenting symptom of common psychiatric disorders such as major depressive disorder, bipolar disorder, and schizophrenia. Depression can also be the presenting symptom of several neurodegenerative disorders, including Alzheimer disease, dementia with Lewy bodies, frontotemporal dementia, and Parkinson disease. Depression can also cause cognitive impairment and is a risk factor for dementia. As a result of the intimate relationship between depression and dementia, differentiating between a psychiatric and a neurologic cause of depression and dementia can sometimes be very difficult. The purpose of this review is to discuss the diagnosis and treatment of depression and to demonstrate how new diagnostic tools are helping to identify the differential diagnosis of depression. RECENT FINDINGS It is a time of great advancement in the management of depression. Innovative new medications, psychotherapeutic modalities, and new and investigational somatic treatments (eg, transcranial magnetic stimulation, deep brain stimulation) are making it possible to ameliorate and manage symptoms more effectively in more patients. SUMMARY With our greater ability to improve the lives of patients with depression, it is important for neurologists to recognize depression and work with our psychiatric colleagues to help patients access the newest and best treatments.
Collapse
|
13
|
Fink M. What was learned: studies by the consortium for research in ECT (CORE) 1997-2011. Acta Psychiatr Scand 2014; 129:417-26. [PMID: 24571807 DOI: 10.1111/acps.12251] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To review the findings of the four-hospital collaborative studies of electroconvulsive therapy (ECT) in unipolar depressed patients known as CORE between 1997 and 2011. Unipolar depressed patients were treated with bilateral ECT, and on remission were randomly assigned to a fixed schedule continuation ECT or to combined lithium and nortriptyline for 6 months. A second study compared three electrode placements in unipolar and bipolar depressed patients. METHOD Nineteen published reports were reviewed. The findings are compared with those of a parallel multi-hospital study of ECT led by a Columbia University Collaboration (CUC) team that studied right unilateral ECT in a similar population with similar inclusion/exclusion and remission criteria. Successful ECT was followed by placebo, nortriptyline alone, or combined lithium, and nortriptyline. RESULTS Relapse rates after remission were similar with fixed schedule ECT as with medications. Predictors of outcome (psychosis, suicide risk, polarity, melancholia, atypical depression, age) and technical aspects (electrode placement, seizure threshold, speed of response) are discussed, CONCLUSION The findings offer criteria to optimize the selection of patients, the technique, and outcome of ECT for unipolar and bipolar depressed patients. Continuation ECT is an effective alternative to continuation treatment with lithium and nortriptyline. Bilateral electrode placement is more efficient than alternative placements. ECT relieves both bipolar and unipolar depression.
Collapse
Affiliation(s)
- M Fink
- Departments of Psychiatry and Neurology, Stony Brook University, Long Island, NY, USA
| |
Collapse
|
14
|
Psychomotor retardation in depression: a systematic review of diagnostic, pathophysiologic, and therapeutic implications. BIOMED RESEARCH INTERNATIONAL 2013. [PMID: 24286073 DOI: 10.1155/2013/158746.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Psychomotor retardation is a central feature of depression which includes motor and cognitive impairments. Effective management may be useful to improve the classification of depressive subtypes and treatment selection, as well as prediction of outcome in patients with depression. The aim of this paper was to review the current status of knowledge regarding psychomotor retardation in depression, in order to clarify its role in the diagnostic management of mood disorders. Retardation modifies all the actions of the individual, including motility, mental activity, and speech. Objective assessments can highlight the diagnostic importance of psychomotor retardation, especially in melancholic and bipolar depression. Psychomotor retardation is also related to depression severity and therapeutic change and could be considered a good criterion for the prediction of therapeutic effect. The neurobiological process underlying the inhibition of activity includes functional deficits in the prefrontal cortex and abnormalities in dopamine neurotransmission. Future investigations of psychomotor retardation should help improve the understanding of the pathophysiological mechanisms underlying mood disorders and contribute to improving their therapeutic management.
Collapse
|
15
|
Psychomotor retardation in depression: a systematic review of diagnostic, pathophysiologic, and therapeutic implications. BIOMED RESEARCH INTERNATIONAL 2013; 2013:158746. [PMID: 24286073 PMCID: PMC3830759 DOI: 10.1155/2013/158746] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 07/26/2013] [Accepted: 08/26/2013] [Indexed: 11/23/2022]
Abstract
Psychomotor retardation is a central feature of depression which includes motor and cognitive impairments. Effective management may be useful to improve the classification of depressive subtypes and treatment selection, as well as prediction of outcome in patients with depression. The aim of this paper was to review the current status of knowledge regarding psychomotor retardation in depression, in order to clarify its role in the diagnostic management of mood disorders. Retardation modifies all the actions of the individual, including motility, mental activity, and speech. Objective assessments can highlight the diagnostic importance of psychomotor retardation, especially in melancholic and bipolar depression. Psychomotor retardation is also related to depression severity and therapeutic change and could be considered a good criterion for the prediction of therapeutic effect. The neurobiological process underlying the inhibition of activity includes functional deficits in the prefrontal cortex and abnormalities in dopamine neurotransmission. Future investigations of psychomotor retardation should help improve the understanding of the pathophysiological mechanisms underlying mood disorders and contribute to improving their therapeutic management.
Collapse
|
16
|
Abstract
SummaryElectroconvulsive therapy (ECT) is a powerful acute treatment for severe and resistant depression. We review literature related to the efficacy, safety and tolerability of ECT in older people, with an emphasis on research studies and reviews published in the last 25 years. In general ECT has been considered a very effective and safe treatment for depression and other psychiatric and non-psychiatric disorders in older people. Amnesia is commonly attributed to ECT treatment, but studies suggest that the negative effects of ECT on cognition are probably small in older patients. Currently the balance of risks and benefits of ECT justify its use for severe depression in older patients, both with and without dementia.
Collapse
|
17
|
Plakiotis C, Barson F, Vengadasalam B, Haines TP, O'Connor DW. Balance and gait in older electroconvulsive therapy recipients: a pilot study. Neuropsychiatr Dis Treat 2013; 9:805-12. [PMID: 23766650 PMCID: PMC3678917 DOI: 10.2147/ndt.s42628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is commonly used to treat depression in older adults. Despite its efficacy in this regard, an associated increase in the risk of falls in this population is a downside of treatment. ECT research has focused on the incidence of falls, but its effect on balance and gait - intrinsic factors in instability and falls - has not been studied. Our aim was to examine changes in balance and gait among older adults before and after a single ECT session and explore the effect of patient-related and treatment factors on any changes found. METHODS Participants were 21 older adults requiring ECT for depression in public psychiatric services. Patients with clinically overt mobility problems (impairing test participation or increasing the risk of falls) were excluded. Balance and gait testing 1 hour pre-ECT and 1, 2 and 3 hours post-ECT included: (1) steady standing test; (2) perturbation of standing balance by self-initiated movements; (3) perturbation of standing balance by an external perturbation; and (4) timed up and go test. RESULTS No deterioration in test performance was found, using one-way repeated measures analysis of variance. CONCLUSION Balance and gait did not deteriorate immediately after ECT. Exclusion of participants with clinically overt mobility problems and falls being better attributable to factors unrelated to balance and gait (such as post-ECT confusion) may account for our findings. This research does not repudiate the occurrence of ECT-related falls but calls into question the utility of introducing routine balance and gait assessment among older ECT recipients without pre-existing mobility problems as a means of preventing them.
Collapse
Affiliation(s)
- Chris Plakiotis
- School of Psychology and Psychiatry, Monash University, Melbourne, VIC, Australia ; MonashHealth, Melbourne, VIC, Australia
| | | | | | | | | |
Collapse
|
18
|
Plakiotis C, George K, O'Connor DW. Has electroconvulsive therapy use remained stable over time? A decade of electroconvulsive therapy service provision in Victoria, Australia. Aust N Z J Psychiatry 2012; 46:522-31. [PMID: 22375067 DOI: 10.1177/0004867412440190] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Despite the long history of electroconvulsive therapy (ECT) as a psychiatric treatment modality in Australia, existing literature regarding ECT use and practices in Australia is limited. In this unique study, we report ECT provision in Victoria to adults aged 25 years and over from 1998 to 2007, based on complete data from all public and private treatment settings within the State; compare our results to previous literature in the field; and offer possible explanations for these findings as a basis for future research. METHOD Analysis of statutory ECT service provision data collected by the Office of the Chief Psychiatrist of Victoria. RESULTS ECT use declined overall from 2001 onward, followed by a small increase in use in 2007. Eighty per cent of patients received ECT for depression and 14% for psychosis. Sixty-two per cent of ECT recipients were women. Although patients aged 65 years and over were small in number, age adjustment of data was indicative of a higher utilisation rate in this group. With increasing age, the percentage of ECT recipients treated for depression increased, whereas the percentage treated for psychosis decreased. Sixty per cent of patients were treated in the public sector. Public-private sector ECT use did not differ greatly for depression, but more patients were treated in the public sector for psychosis. The majority of patients with depression received treatment voluntarily, but the converse was true for patients with psychosis. Unilateral electrode placement predominated. CONCLUSIONS While utilisation rates gradually declined over the decade studied, patients continued receiving ECT in significant numbers, suggesting its role in treating severe mental illness is far from superceded. The present, population-level research cannot explain the causative factors underlying the patterns observed, but raises interesting questions for further investigation. Ongoing collection of statutory ECT data in a manner making it amenable to research applications is recommended.
Collapse
Affiliation(s)
- Chris Plakiotis
- School of Psychology and Psychiatry, Monash University, Victoria, Australia.
| | | | | |
Collapse
|
19
|
Tominaga K, Okazaki M, Higuchi H, Utagawa I, Nakamura E, Yamaguchi N. Symptom predictors of response to electroconvulsive therapy in older patients with treatment-resistant depression. Int J Gen Med 2011; 4:515-9. [PMID: 21845058 PMCID: PMC3150173 DOI: 10.2147/ijgm.s21029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) has been used for treatment-resistant depression. However, predictors of response to ECT have not been adequately studied using the Montgomery and Åsberg Depression Rating Scale, especially in older patients with treatment-resistant depression. METHODS This study included 18 Japanese patients who fulfilled the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision criteria for a diagnosis of major depressive disorder or bipolar disorder with a current major depressive episode, and met the definition of treatment-resistant depression outlined by Thase and Rush, scoring ≥21 on the Montgomery and Åsberg Depression Rating Scale. The three-factor model of the Montgomery and Åsberg Depression Rating Scale was used for analysis. Factor 1 was defined by three items, factor 2 by four items, and factor 3 by three items, representing dysphoria, retardation, and vegetative symptoms, respectively. ECT was performed twice a week for a total of six sessions using a Thymatron System IV device with the brief pulse technique. Clinical responses were defined on the basis of a ≥50% decrease in total pretreatment Montgomery and Åsberg Depression Rating Scale scores. RESULTS The mean pretreatment factor 2 score for responders (n = 7) was significantly lower than that for nonresponders (n = 11). Furthermore, a significant difference in mean factor 3 score between responders and nonresponders was observed one week after six sessions of ECT, indicating a time lag of response. No significant differences were observed for age, number of previous episodes, and duration of the current episode between responders and nonresponders. CONCLUSION This study suggests that a low pretreatment factor 2 score is a good predictor of response to ECT in older patients with major depression.
Collapse
Affiliation(s)
- Keiichiro Tominaga
- Department of Neuropsychiatry, St Marianna University School of Medicine, Miyamae-ku, Kawasaki City, Kanagawa
| | | | | | | | | | | |
Collapse
|
20
|
Buyukdura JS, McClintock SM, Croarkin PE. Psychomotor retardation in depression: biological underpinnings, measurement, and treatment. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:395-409. [PMID: 21044654 PMCID: PMC3646325 DOI: 10.1016/j.pnpbp.2010.10.019] [Citation(s) in RCA: 217] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 10/05/2010] [Accepted: 10/25/2010] [Indexed: 01/09/2023]
Abstract
Psychomotor retardation is a long established component of depression that can have significant clinical and therapeutic implications for treatment. Due to its negative impact on overall function in depressed patients, we review its biological correlates, optimal methods of measurement, and relevance in the context of therapeutic interventions. The aim of the paper is to provide a synthesis of the literature on psychomotor retardation in depression with the goal of enhanced awareness for clinicians and researchers. Increased knowledge and understanding of psychomotor retardation in major depressive disorder may lead to further research and better informed diagnosis in regards to psychomotor retardation. Manifestations of psychomotor retardation include slowed speech, decreased movement, and impaired cognitive function. It is common in patients with melancholic depression and those with psychotic features. Biological correlates may include abnormalities in the basal ganglia and dopaminergic pathways. Neurophysiologic tools such as neuroimaging and transcranial magnetic stimulation may play a role in the study of this symptom in the future. At present, there are three objective scales to evaluate psychomotor retardation severity. Studies examining the impact of psychomotor retardation on clinical outcome have found differential results. However, available evidence suggests that depressed patients with psychomotor retardation may respond well to electroconvulsive therapy (ECT). Current literature regarding antidepressants is inconclusive, though tricyclic antidepressants may be considered for treatment of patients with psychomotor retardation. Future work examining this objective aspect of major depressive disorder (MDD) is essential. This could further elucidate the biological underpinnings of depression and optimize its treatment.
Collapse
Affiliation(s)
- Jeylan S. Buyukdura
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shawn M. McClintock
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Division of Brain Stimulation and Therapeutic Modulation, Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York, USA
| | - Paul E. Croarkin
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
21
|
O'Connor DW, Gardner B, Eppingstall B, Tofler D. Cognition in elderly patients receiving unilateral and bilateral electroconvulsive therapy: a prospective, naturalistic comparison. J Affect Disord 2010; 124:235-40. [PMID: 20053457 DOI: 10.1016/j.jad.2009.11.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 11/30/2009] [Accepted: 11/30/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND The cognitive side-effects of ECT are minimized by individualized, supra-threshold dosing with brief pulse electrical stimuli. Unilateral ECT is associated with fewer cognitive sequelae but bilateral ECT is possibly more effective. Little is known of the relative effectiveness and tolerability of the two placements in the treatment of elderly, severely depressed inpatients. METHODS Patients of five public aged psychiatry services and a private psychiatric hospital who received right unilateral ECT (n=47) dosed on average at 3 times seizure threshold or bitemporal ECT (n=16) dosed at 1.5 times threshold completed an abbreviated Rey Auditory Verbal Learning Test, a visual memory test and a section of the Autobiographical Memory Inventory as close as possible to 24h after the first or second treatment and again after the fifth or sixth treatment. This design was intended to maximize recruitment of severely depressed patients with a limited ability to consent and cooperate with testing. RESULTS Only 35% of eligible patients completed both assessments, mostly due to refusal or lack of capacity to consent. Moderate dose unilateral and bilateral ECT produced equivalent improvements in mood. There was a tendency for scores on most cognitive tests to decline more with bilateral than unilateral ECT but these differences were statistically significant only for immediate verbal memory and autobiographical memory. CONCLUSIONS Our findings suggest that bilateral ECT is no more effective as an antidepressant than moderately dosed unilateral ECT, at least on a short-term basis, and confers a slightly greater risk of cognitive impairment. This supports the rationale of prescribing unilateral ECT in the first instance in this vulnerable clinical population. LIMITATIONS It proved impossible to recruit most ECT recipients, limiting the capacity to generalize findings to all aged patients. Reports concerning ECT should list recruitment rates to help set findings in context.
Collapse
Affiliation(s)
- Daniel W O'Connor
- Aged Mental Health Research Unit, Department of Psychological Medicine, Monash University, Melbourne, Australia.
| | | | | | | |
Collapse
|
22
|
|
23
|
Cinar S, Oude Voshaar RC, Janzing JGE, Birkenhäger TK, Buitelaar JK, van den Broek WW. The course of depressive symptoms in unipolar depressive disorder during electroconvulsive therapy: a latent class analysis. J Affect Disord 2010; 124:141-7. [PMID: 19931917 DOI: 10.1016/j.jad.2009.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2009] [Revised: 11/01/2009] [Accepted: 11/01/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Research examining the course of depressive symptoms during electroconvulsive therapy (ECT) is relatively scarce. OBJECTIVE To classify patients according to the course of their depressive symptoms while receiving ECT. METHODS The sample consisted of 156 consecutive patients receiving ECT for unipolar depressive disorder. Depressive symptoms were measured weekly with the Montgomery-Asberg Depression Rating Scale. Latent class analysis was applied to identify distinct trajectories of symptom improvement. RESULTS We identified five classes of different trajectories (improvement rates) of depressive symptoms, i.e. fast improvement (39 patients), intermediate improvement (47 patients), slow improvement (30 patients), slow improvement with delayed onset (18 patients), and finally a trajectory with no improvement (20 patients). The course of depressive symptoms at the end of the treatment within the trajectories of intermediate improvement, slow improvement and slow improvement with delayed onset, was still improving and did not achieve a plateau. CONCLUSION The different courses of depressive symptoms during ECT probably contribute to mixed results of prediction studies of ECT outcome. Data suggest that for a large group of patients no optimal clinical endpoint can be identified, other than full remission or no improvement at all, to discontinue ECT.
Collapse
Affiliation(s)
- S Cinar
- Radboud University Nijmegen Medical Centre, Nijmegen Centre for Evidence-Based Practice, Department of Psychiatry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | | | | | | | | | | |
Collapse
|
24
|
Predictors of response to electroconvulsive therapy obtained using the three-factor structure of the Montgomery and Asberg Depression Rating Scale for treatment-resistant depressed patients. J ECT 2010; 26:87-90. [PMID: 19710622 DOI: 10.1097/yct.0b013e3181b00f32] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is one of the most effective treatments for refractory major depressive disorder (MDD). Although studies have examined different predictors of a positive response to ECT, predictors based on symptoms listed on a depression rating scale have not been studied. METHODS This study included 24 Japanese patients who fulfilled the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition criteria for MDD or bipolar disorder with current major depressive episode. All subjects had a score of 21 or higher on the Montgomery and Asberg Depression Rating Scale (MADRS). The 3-factor model of MADRS was used for analysis: factor 1 (dysphoria) was defined by 3 items, factor 2 (retardation) was defined by 4 items, and factor 3 (vegetative symptoms) was defined by 3 items. Electroconvulsive therapy was performed 2 times a week for a total of 6 sessions using the Thymatron System IV device (Somatics, Inc., Lake Bluff, Ill) with the brief-pulse technique. A clinical response was defined as a 50% or greater decrease on the pretreatment total MADRS score. RESULTS The mean factor 1 score of responders (n = 17) at pretreatment was significantly higher than that of the nonresponders (n = 7). Furthermore, a significant difference in mean factor 3 scores between responders and nonresponders was observed 1 week after the 6 ECT sessions were complete, indicating a lag in response time. No significant differences were observed in age, number of previous episodes, and duration of current episodes between the responders and nonresponders. CONCLUSIONS This study suggests that a high factor 1 MADRS score at pretreatment was a good predictor of response to ECT in patients with treatment-resistant MDD.
Collapse
|
25
|
D. Lutchman, Tim Stevens, Amir Bash R. Mental health professionals' attitudes towards and knowledge of electroconvulsive therapy. J Ment Health 2009. [DOI: 10.1080/09638230124779] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
26
|
Abstract
This paper reviews concepts of depression, including history and classification. The original broad concept of melancholia included all forms of quiet insanity. The term depression began to appear in the nineteenth century as did the modern concept of affective disorders, with the core disturbance now viewed as one of mood. The 1930s saw the introduction of defined criteria into official diagnostic schemes. The modern separation into unipolar and bipolar disorder was introduced following empirical research by Angst and Perris in the 1960s. The partially overlapping distinctions between psychotic and neurotic depression, and between endogenous and reactive depression, started to generate debate in the 1920s, with considerable multivariate research in the 1960s. The symptom element in endogenous depression currently survives in melancholia or somatic syndrome. Life stress is common in various depressive pictures. Dysthymia, a valuable diagnosis, represents a form of what was regarded earlier as neurotic depression. Other subtypes are also discussed.
Collapse
Affiliation(s)
- Eugene S Paykel
- University of Cambridge, Department of Psychiatry, Cambridge, UK.
| |
Collapse
|
27
|
Brakemeier EL, Luborzewski A, Danker-Hopfe H, Kathmann N, Bajbouj M. Positive predictors for antidepressive response to prefrontal repetitive transcranial magnetic stimulation (rTMS). J Psychiatr Res 2007; 41:395-403. [PMID: 16554071 DOI: 10.1016/j.jpsychires.2006.01.013] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2005] [Revised: 01/04/2006] [Accepted: 01/16/2006] [Indexed: 10/24/2022]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a brain stimulation technique which had recently been investigated as a putative antidepressant intervention. However, there is little agreement about clinically useful predictors of rTMS outcome. Therefore, the objective of the present study was to determine whether specific biographical, clinical, and psychopathological parameters are associated with the antidepressant response to rTMS in a large sample of 70 depressive patients. We performed a logistic regression analysis in 70 patients with major depressive disorder treated with rTMS of the left dorsolateral prefrontal cortex testing the predictive value of various domains of the depression syndrome as well as the variables episode duration, degree of treatment resistance, and CORE criteria. Response was defined as a 50% reduction of the initial Hamilton score (HAMD). After two weeks of treatment, 21% of the patients showed a response to rTMS. The binary logistic regression model correctly assigned 86.7% of the responders and 96.4% of the non-responders to their final response group. In the model, a high level of sleep disturbances was a significant predictor for treatment response to rTMS. Also, a low score of treatment resistance and a short duration of episode were positive predictors. These findings provide new evidence that especially pronounced sleep disturbances may be a significant clinical predictor of a response to rTMS. Prospective rTMS studies are necessary to validate the predictive value of the derived model.
Collapse
Affiliation(s)
- Eva-Lotta Brakemeier
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Eschenallee 3, 14050 Berlin, Germany
| | | | | | | | | |
Collapse
|
28
|
Abstract
Depression is one of the most common mental disorders worldwide. There are a number of depression subtypes, and there has been much debate about how to most accurately capture and organize the features and subtypes of major depression. We review the current state of categorizing unipolar major depression with psychotic features (psychotic major depression, PMD), including clinical, biological, and treatment aspects of the disorder. We then propose some improvements to the current unipolar major depression categorization system. Finally, we identify important issues in need of further research to help elucidate the subtype of unipolar PMD.
Collapse
Affiliation(s)
- Jennifer Keller
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5723, USA.
| | | | | |
Collapse
|
29
|
|
30
|
DeBattista C, Belanoff J, Glass S, Khan A, Horne RL, Blasey C, Carpenter LL, Alva G. Mifepristone versus placebo in the treatment of psychosis in patients with psychotic major depression. Biol Psychiatry 2006; 60:1343-9. [PMID: 16889757 DOI: 10.1016/j.biopsych.2006.05.034] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2005] [Revised: 05/03/2006] [Accepted: 05/25/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND Abnormalities in the hypothalamic pituitary adrenal axis have been implicated in the pathophysiology of psychotic major depression (PMD). Recent studies have suggested that the antiglucocorticoid, mifepristone might have a role in the treatment of PMD. The current study tested the efficacy of mifepristone treatment of the psychotic symptoms of PMD. METHODS 221 patients, aged 19 to 75 years, who met DSM-IV and SCID criteria for PMD and were not receiving antidepressants or antipsychotics, participated in a double blind, randomized, placebo controlled study. Patients were randomly assigned to either 7 days of mifepristone (n = 105) or placebo (n = 116) followed by 21 days of usual treatment. RESULTS Patients treated with mifepristone were significantly more likely to achieve response, defined as a 30% reduction in the Brief Psychiatric Rating Scale (BPRS). In addition, mifepristone treated patients were significantly more likely to achieve a 50% reduction in the BPRS Positive Symptom Scale (PSS). No significant differences were observed on measures of depression. CONCLUSION A seven day course of mifepristone followed by usual treatment appears to be effective and well tolerated in the treatment of psychosis in PMD. This study suggests that the antiglucocorticoid, mifepristone, might represent an alternative to traditional treatments of psychosis in psychotic depression.
Collapse
|
31
|
Pluijms EM, Birkenhäger TK, Mulder PG, van den Broek WW. Influence of episode duration of major depressive disorder on response to electroconvulsive therapy. J Affect Disord 2006; 90:233-7. [PMID: 16376432 DOI: 10.1016/j.jad.2005.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2005] [Revised: 11/03/2005] [Accepted: 11/03/2005] [Indexed: 11/15/2022]
Abstract
BACKGROUND Longer duration of major depressive episode is supposed to decrease response to electroconvulsive therapy (ECT). Most studies on the subject are dated and their population differs from ours, therefore their results may not be applicable to our population of severely depressed inpatients. METHODS We reviewed the records of 56 consecutive inpatients with major depressive disorder according to DSM-III-R criteria and assessed each patient's episode duration. We examined whether episode duration has an effect on response to ECT. RESULTS Episode duration has no significant effect on response to ECT, according to both a reduction on the Hamilton Rating Scale for Depression (HRSD) of at least 50% and a post-treatment HRSD score <or=7 as outcome criteria. Concerning each patient's absolute change in HRSD score pre-treatment compared to post-treatment, again episode duration has no significant effect. LIMITATIONS The present study has a limited sample size and concerns a rather homogeneous population of severely depressed inpatients. Episode duration was established retrospectively. CONCLUSIONS ECT is an effective treatment for severely depressed inpatients, independent of episode duration.
Collapse
Affiliation(s)
- Esther M Pluijms
- Department of Psychiatry, Erasmus Medical Center, University of Rotterdam, The Netherlands.
| | | | | | | |
Collapse
|
32
|
Birkenhäger TK, van den Broek WW, Mulder PGH, de Lely A. One-year outcome of psychotic depression after successful electroconvulsive therapy. J ECT 2005; 21:221-6. [PMID: 16301881 DOI: 10.1097/01.yct.0000183269.62735.89] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Psychotic depression is thought to have a higher relapse frequency after electroconvulsive therapy (ECT) compared with nonpsychotic depression, although this observation is contradicted by previous studies that have found the opposite. In this study, the 1-year risk of relapse after successful ECT was determined prospectively in patients with psychotic depression and compared with the risk of relapse observed for depressed patients without psychotic features. METHOD Fifty-nine responders to ECT (a decrease in Hamilton Rating Scale for Depression [HAM-D] score > or = 50%) were followed for 1 year: 29 with and 30 without psychotic features. Relapse was defined as meeting DSM-IV criteria for major depressive disorder and a HAM-D score > or = 16. The frequency of relapse after 4 and 12 months was compared between both samples, adjusted for the co-variables duration of the index episode and type of post-ECT pharmacotherapy. RESULTS : At both 4 and 12 months after ECT, instances of relapse were significantly lower in patients with psychotic depression compared with nonpsychotic patients: 3/28 (11%) versus 16/27 (59%) and 4/27 (15%) versus 19/28 (68%), respectively. CONCLUSIONS The main finding of the present study is the favorable 1-year outcome for patients with psychotic depression after response to ECT with a trend toward the same result at 4 months. The 1-year outcome of the total sample is also more favorable than expected.
Collapse
Affiliation(s)
- Tom K Birkenhäger
- Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands.
| | | | | | | |
Collapse
|
33
|
Abstract
BACKGROUND Regarding the pharmacological treatment of psychotic depression there is uncertainty about the effectiveness of an antidepressant alone compared to the combination of an antidepressant and an antipsychotic. OBJECTIVES To compare the clinical effectiveness of pharmacological treatments for patients with a psychotic depression: antidepressant monotherapy, antipsychotic monotherapy, and the combination of an antidepressant and an antipsychotic, compared with each other and/or with placebo. SEARCH STRATEGY (1) The Cochrane Central Register of Controlled Trials (CENTRAL) was screened with the terms depressive disorder and drug treatment (April 2004). (2) MEDLINE (1966 to April 2004) and EMBASE (1980 to April 2004) were searched using terms with regard to treatment of unipolar psychotic depression.(3) Reference lists of related reviews and reference lists of all identified studies were searched.(4) Personal communications. SELECTION CRITERIA All randomised controlled trials (RCTs) with patients with major depression with psychotic features as well as RCTs with patients with major depression with or without psychotic features which reported on the subgroup of patients with psychotic features separately. DATA COLLECTION AND ANALYSIS Two reviewers assessed the methodological quality of the included studies, according to the Cochrane Handbook criteria. Data were entered into RevMan 4.2.5. We used intention-to-treat data. For dichotomous efficacy outcomes, the relative risk with 95% confidence intervals (CI) was calculated. For continuously distributed outcomes, it was not possible to extract data from the RCTs. Regarding the primary harm outcome, only overall drop-out rates were available for all studies. MAIN RESULTS The search identified 3333 abstracts, but only 10 RCTs with a total of 548 patients could be included in the review. Due to clinical heterogeneity, few meta-analyses were possible. We found no conclusive evidence that the combination of an antidepressant and an antipsychotic is more effective than an antidepressant alone (two RCTs; RR 1.44, 95% CI 0.86 to 2.41), but a combination is more effective than an antipsychotic alone (three RCTs; RR 1.92, 95% CI 1.32 to 2.80). There were no statistically significant differences in the overall drop-out rates between any of the treatments, neither in individual studies nor after pooling of studies. AUTHORS' CONCLUSIONS Treatment with an antipsychotic alone is not a good option. Starting with an antidepressant alone and adding an antipsychotic if the patient does not respond or starting with the combination of an antidepressant and an antipsychotic both appear appropriate options for patients with psychotic depression. In clinical practice the balance between risks and benefits suggests that initial antidepressive monotherapy and adding an antipsychotic if there is inadequate response should be the preferred treatment strategy for many patients. The general lack of available data limits confidence in the conclusions drawn.
Collapse
|
34
|
Tsuchiyama K, Nagayama H, Yamada K, Isogawa K, Katsuragi S, Kiyota A. Predicting efficacy of electroconvulsive therapy in major depressive disorder. Psychiatry Clin Neurosci 2005; 59:546-50. [PMID: 16194256 DOI: 10.1111/j.1440-1819.2005.01412.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this study was to investigate methods for predicting the efficacy of electroconvulsive therapy (ECT) in patients with major depressive disorder. Subjects comprised 24 inpatients with major depressive disorder diagnosed according to DSM-IV criteria who were resistant to antidepressant therapy or who, due to adverse reactions, could not undergo pharmacotherapy at adequate doses for sufficient durations. ECT was generally performed 12 times using a sinusoidal-wave device. Efficacy of ECT was evaluated using the 17-item Hamilton Rating Scale for Depression (HRSD). Multiple regression analysis was performed, using the final rate of improvement with ECT as the dependent variable, and improvement rate at completion of three ECT sessions and adequacy of pharmacotherapy before ECT as independent variables. Significant positive correlations were seen between final improvement rate with ECT and improvement rate at completion of three ECT sessions (partial correlation coefficient, 0.50, P<0.02), and significant negative correlations were seen between final improvement rate and adequacy of pharmacotherapy before ECT (partial correlation coefficient, -0.51, P<0.02). No significant differences were identified between responders and non-responders with respect to age, sex, duration of index episode, number of previous depressive episodes, whether depression was melancholia-type, whether depression was accompanied by psychotic features, total HRSD score immediately before ECT, and HRSD retardation or agitation scores. These results suggest that history of pharmacotherapy prior to ECT and improvement rate at completion of three ECT sessions may offer predictors for the final rate of improvement with ECT.
Collapse
Affiliation(s)
- Kounosuke Tsuchiyama
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-machi, Oita, Japan.
| | | | | | | | | | | |
Collapse
|
35
|
Abstract
This study analyzed the efficacy of electroconvulsive therapy (ECT) in depression by means a meta-analytic review of randomized controlled trials that compared ECT with simulated ECT or placebo or antidepressant drugs and by a complementary meta-analytic review of nonrandomized controlled trials that compared ECT with antidepressants drugs. The review revealed a significant superiority of ECT in all comparisons: ECT versus simulated ECT, ECT versus placebo, ECT versus antidepressants in general, ECT versus TCAs and ECT versus MAOIs. The nonrandomized controlled trials also revealed a significant statistical difference in favor of ECT when confronted with antidepressants drugs. Data analyzed suggest that ECT is a valid therapeutic tool for treatment of depression, including severe and resistant forms.
Collapse
Affiliation(s)
- Daniel Pagnin
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology. University of Pisa, Italy.
| | | | | | | |
Collapse
|
36
|
Abstract
Recently published controlled studies comparing electroconvulsive therapy (ECT) with other treatments for depression offer the opportunity to perform a meta-analysis of ECT in depression. Fifteen studies were identified which fulfilled the inclusion criteria. From these controlled trials, 20 effect sizes of ECT were calculated. The speed of action during the course and the efficacy after a full course of ECT were explored. The efficacy of sine wave and brief pulse machines were compared. The comparison between ECT and four other comparative treatments was made. Predictive variables were explored using homogeneity tests. ECT was shown to be superior after a full course. The funnel plot showed the absence of publication bias. There was no exaggeration of effect size in the lower quality trials. No evidence was found for a superior speed of action of ECT or for a difference in efficacy between sine wave and brief pulse stimulation. ECT was shown to be superior to medication and simulated ECT. Some evidence was found that psychosis predicted better response to ECT.
Collapse
Affiliation(s)
- King Han Kho
- GGZ Delfland, Locatie St Jorisweg, 2 Delft, The Netherlands.
| | | | | | | |
Collapse
|
37
|
Pluijms EM, Birkenhäger TK, Huijbrechts IPAM, Moleman P. Influence of resistance to antidepressant pharmacotherapy on short-term response to electroconvulsive therapy. J Affect Disord 2002; 69:93-9. [PMID: 12103456 DOI: 10.1016/s0165-0327(00)00378-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Few studies assessing the influence of resistance to antidepressant pharmacotherapy on the response to subsequent electroconvulsive therapy (ECT) are found in the literature. Results are somewhat conflicting and may not be applicable to the population of depressed patients in The Netherlands. The aim of this study is to assess the influence of medication resistance on the short-term response to ECT in a population of severely depressed inpatients in The Netherlands, where ECT is an exceptional treatment, often used as a final treatment option. METHODS We reviewed the records of 41 consecutive inpatients with major depression according to DSM-III-R criteria and rated each patients' antidepressant pharmacotherapy prior to ECT. We examined the extent to which medication resistance was related to short-term response to ECT. RESULTS When a reduction of at least 50% on the Hamilton Rating Scale for Depression (HRSD) post-ECT compared to pre-ECT (partial remission) is used as response criterion, medication resistant patients and patients without established medication resistance were equally likely to respond to subsequent ECT. When a post-ECT HRSD score < or = 7 (full remission) is used as response criterion, medication resistant patients were less likely to respond to subsequent ECT (8/29=27.6%) than patients who did not receive adequate antidepressant pharmacotherapy prior to ECT (6/12=50.0%), although the difference in response rate was not statistically significant. LIMITATIONS This study has a retrospective nature and a relatively small sample size. CONCLUSION Antidepressant medication resistance does not seem to have an influence on the short-term response to subsequent ECT. However, when the number of patients achieving full remission is concerned, a substantial percentage of antidepressant medication resistant patients respond to ECT, although their response rate was nearly half compared to that of patients without prior adequate treatment with antidepressants. This difference in response rate was not statistically significant. ECT seems to be an effective treatment for both patients with and without prior adequate treatment with antidepressants in this Dutch population.
Collapse
Affiliation(s)
- Esther M Pluijms
- Department of Biological Psychiatry, Parnassia Psychomedical Centre, P.O. Box 53002, 2505 AA The Hague, The Netherlands
| | | | | | | |
Collapse
|
38
|
Daly JJ, Prudic J, Devanand DP, Nobler MS, Lisanby SH, Peyser S, Roose SP, Sackeim HA. ECT in bipolar and unipolar depression: differences in speed of response. Bipolar Disord 2001; 3:95-104. [PMID: 11333069 DOI: 10.1034/j.1399-5618.2001.030208.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES There is sparse evidence for differences in response to electroconvulsive therapy (ECT) between patients with bipolar or unipolar major depression, with virtually no information on speed of response. We contrasted a large sample of bipolar (BP) and unipolar (UP) depressed patients in likelihood and rapidity of clinical improvement with ECT. METHODS Over three double-blind treatment protocols, 228 patients met Research Diagnostic Criteria for UP (n = 162) or BP depression (n = 66). Other than lorazepam PRN (3 mg/day), patients were withdrawn from psychotropics prior to the ECT course and until after post-ECT assessments. Patients were randomized to ECT conditions that differed in electrode placement and stimulus intensity. Symptomatic change was evaluated at least twice weekly by a blinded evaluation team, which also determined treatment length. RESULTS Patients with BP and UP depression did not differ in rates of response or remission following the ECT course, or in response to unilateral or bilateral ECT. Degree of improvement in Hamilton Rating Scale for Depression scores following completion of ECT was also comparable. However, BP patients received significantly fewer ECT treatments than UP patients, and this effect was especially marked among bipolar ECT responders. Both BP I and BP II patients showed especially rapid response to ECT. CONCLUSIONS The BP/UP distinction had no predictive value in determining ECT outcome. In contrast, there was a large effect for BP patients to show more rapid clinical improvement and require fewer treatments than unipolar patients. The reasons for this difference are unknown, but could reflect a more rapid build up of anticonvulsant effects in BP patients.
Collapse
Affiliation(s)
- J J Daly
- Department of Biological Psychiatry, New York State Psychiatric Institute, NY 10032, USA.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
BACKGROUND This study examined the relationship between age and outcome of electroconvulsive therapy (ECT). METHOD This was a naturalistic, prospective follow-up of 81 consecutive in-patients with primary major depression. ECT outcome was compared for three age groups - under 65, 65-74 and 75 years and over - on the Hamilton Rating Scale for Depression (HRSD), Global Assessment of Functioning scale (GAF) and clinical outcome rating scale. Assessments were performed pre-ECT, immediately post-ECT, 1-3 years later and, for patients suspected of having dementia, 5 years later. RESULTS At post-ECT and follow-up, improvement on HRSD and clinical outcome ratings were comparable for patients in the three age groups. Improvements on GAF were also comparable post-ECT, but not between post-ECT and follow-up. At follow-up, 35.7% of the oldest group had dementia. Importantly, patients who did and did not develop dementia were clinically indistinguishable prior to ECT. The number and severity of common adverse events were similar pre- and post-ECT and were not associated with age. CONCLUSIONS Depressive outcome and adverse effects of ECT are largely independent of age. Older patients receiving ECT appear to have a higher risk of developing dementia, possibly underpinned by cerebrovascular disease.
Collapse
Affiliation(s)
- H Brodaty
- School of Psychiatry, University of New South Wales, Sydney, Australia.
| | | | | | | |
Collapse
|
40
|
Abstract
BACKGROUND Motor retardation is a common feature of major depressive disorder having potential prognostic and etiopathological significance. According to DSM-IV, depressed patients who meet criteria for psychomotor retardation, must exhibit motor slowing of sufficient severity to be observed by others. However, overt presentations of motor slowing cannot distinguish slowness due to cognitive factors from slowness due to neuromotor disturbances. METHODS We examined cognitive and neuromotor aspects of motor slowing in 36 depressed patients to test the hypothesis that a significant proportion of patients exhibit motor programming disturbances in addition to psychomotor impairment. A novel instrumental technique was used to assess motor programming in terms of the subject's ability to program movement velocity as a function of movement distance. A traditional psychomotor battery was combined with an instrumental measure of reaction time to assess the cognitive aspects of motor retardation. RESULTS The depressed patients exhibited significant impairment on the velocity scaling measure and longer reaction times compared with nondepressed controls. Approximately 40% of the patients demonstrated abnormal psychomotor function as measured by the traditional battery; whereas over 60% exhibited some form of motor slowing as measured by the instruments. Approximately 40% of the patients exhibited parkinsonian-like motor programming deficits. A five-factor model consisting of motor measures predicted diagnosis among bipolar and unipolar depressed patients with 100% accuracy. LIMITATIONS The ability of motor measures to discriminate bipolar from unipolar patients must be viewed with caution considering the relatively small sample size of bipolar patients. CONCLUSIONS These findings suggest that a subgroup of depressed patients exhibit motor retardation that is behaviorally similar to parkinsonian bradykinesia and may stem from a similar disruption within the basal ganglia.
Collapse
Affiliation(s)
- M P Caligiuri
- Department of Psychiatry (0603), Movement Disorders Laboratory, University of California at San Diego, La Jolla, CA 92093, USA.
| | | |
Collapse
|
41
|
Hughes CW, Emslie GJ, Crismon ML, Wagner KD, Birmaher B, Geller B, Pliszka SR, Ryan ND, Strober M, Trivedi MH, Toprac MG, Sedillo A, Llana ME, Lopez M, Rush AJ. The Texas Children's Medication Algorithm Project: report of the Texas Consensus Conference Panel on Medication Treatment of Childhood Major Depressive Disorder. J Am Acad Child Adolesc Psychiatry 1999; 38:1442-54. [PMID: 10560232 DOI: 10.1097/00004583-199911000-00020] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To develop consensus guidelines for medication treatment algorithms for childhood major depressive disorder (MDD) based on scientific evidence and clinical opinion when science is lacking. The ultimate goal of this approach is to synthesize research and clinical experience for the practitioner and to increase the uniformity of preferred treatment for childhood MDD. A final goal is to develop an approach that can be tested as to whether it improves clinical outcomes for children and adolescents with MDD. METHOD A consensus conference was held. Participants included academic clinicians and researchers, practicing clinicians, administrators, consumers, and families. The focus was to review and use clinical evidence to recommend specific pharmacological approaches for treatment of MDD in children and adolescents. After a series of presentations of current research evidence and panel discussion, the consensus panel met, agreed on assumptions, and drafted the algorithms. The process initially addressed strategies of treatment and then tactics to implement the strategies. RESULTS Consensually agreed-upon algorithms for major depressions (with and without psychosis) and comorbid attention deficit disorders were developed. Treatment strategies emphasized the use of selective serotonin reuptake inhibitors. The algorithm consists of systematic strategies for treatment interventions and recommended tactics for implementation of the strategies, including medication augmentation and medication combinations. Participants recommended prospective evaluation of the algorithms in various public sector settings, and many volunteered as sites for such an evaluation. CONCLUSIONS Using scientific and clinical experience, consensus-derived algorithms for children and adolescents with MDD can be developed.
Collapse
Affiliation(s)
- C W Hughes
- University of Texas Southwestern Medical Center, Dallas, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
WHO estimate that by the beginning of the next century major unipolar depression will be one of the most important causes of ill health overall. Whereas the cause of depression is still obscure, it is becoming clear that a number of diverse factors are likely to be implicated, both genetic and environmental. Effective treatment of depression similarly involves a variety of methods, from electro-convulsive therapy to inter-personal psychotherapy. The pathophysiology of depression is gradually becoming accessible through research strategies, such as functional neuroimaging paired with mood altering interventions.
Collapse
Affiliation(s)
- A Doris
- Department of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Morningside Park, UK
| | | | | |
Collapse
|
43
|
Abstract
AbstractObjectives: To compare the electroconvulsive therapy response of a sample of depressed elderly patients as a function of the presence or absence of psychosis.Method: Retrospective study of patients over age 65 treated with ECT at three psychiatric hospitals over a three year period.Results: One hundred and eighty-nine ECT courses were administered to 135 patients. Almost 8 5% of patients made a marked or moderately good response to treatment. There was no difference in ECT response between psychotic and non-psychotic depressed patients.Conclusions: ECT should be considered as a treatment option for severe depressive illness, regardless of depressive subtype.
Collapse
|
44
|
Strober M, Rao U, DeAntonio M, Liston E, State M, Amaya-Jackson L, Latz S. Effects of electroconvulsive therapy in adolescents with severe endogenous depression resistant to pharmacotherapy. Biol Psychiatry 1998; 43:335-8. [PMID: 9513748 DOI: 10.1016/s0006-3223(97)00205-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND This open, prospective study examined the effects of electroconvulsive therapy (ECT) in 10 adolescents with primary, endogenous, psychotic depression who were resistant to antidepressant pharmacotherapy. METHODS Change in symptom severity from baseline was assessed weekly with Hamilton Depression Rating Scale (HDRS) ratings, and outcome was measured additionally at 1 month, and again at 1 year, post-ECT. RESULTS All but 1 patient demonstrated dramatic improvement, with statistically significant decreases in mean HDRS score detected after the first week of treatment. All responders maintained the benefits of their treatment. CONCLUSIONS The results provide evidence of the clinical effectiveness of ECT in adolescents with phenomenological characteristics shown to be predictive of ECT response in adults.
Collapse
Affiliation(s)
- M Strober
- Department of Psychiatry & Biobehavioral Sciences, Neuropsychiatric Institute & Hospital, School of Medicine, University of California at Los Angeles 90024-1759, USA
| | | | | | | | | | | | | |
Collapse
|
45
|
Shen H, Awata S, Konno M, Sato M. A lasting change in trazodone response after non-convulsive electroshock therapy for medication-resistant senile depression. Psychiatry Clin Neurosci 1998; 52:111-3. [PMID: 9682943 DOI: 10.1111/j.1440-1819.1998.tb00982.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A senile patient showed a dramatic recovery from medication-resistant depression after non-convulsive electroshock therapy (nc-EST), with a lasting change in response to trazodone, which mainly acts as a serotonin re-uptake inhibitor. This result suggests that a change in the serotonin reuptake mechanism may be involved in the effect of nc-EST on depression.
Collapse
Affiliation(s)
- H Shen
- Department of Psychiatry, Tohoko University School of Medicine, Sendai, Japan
| | | | | | | |
Collapse
|
46
|
|
47
|
Sobin C, Prudic J, Devanand DP, Nobler MS, Sackeim HA. Who responds to electroconvulsive therapy? A comparison of effective and ineffective forms of treatment. Br J Psychiatry 1996; 169:322-8. [PMID: 8879718 DOI: 10.1192/bjp.169.3.322] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND It has been reported that real ECT is more effective than simulated treatment among depressed patients with delusions and/or retardation, and that ECT is not effective among depressed patients who lack these features. METHOD In two randomised, double-blind studies, 143 patients with major depression were subtyped regarding psychosis, retardation and agitation. In both studies, low dosage, right unilateral ECT was ineffective compared with other forms of ECT. This report examined whether the depressive subtypes differed in clinical response to the ineffective and effective forms of ECT. RESULTS The therapeutic advantage of effective forms of ECT was similar across the depression subtypes. Patients who lacked both psychosis and retardation showed this pattern. CONCLUSIONS The findings cast doubt on the utility of these depression subtypes in predicting ECT response. ECT is a viable treatment option for patients with major depression regardless of the presence or absence of psychosis, retardation and/or agitation.
Collapse
Affiliation(s)
- C Sobin
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, USA
| | | | | | | | | |
Collapse
|
48
|
Hickie I, Mason C, Parker G, Brodaty H. Prediction of ECT response: validation of a refined sign-based (CORE) system for defining melancholia. Br J Psychiatry 1996; 169:68-74. [PMID: 8818371 DOI: 10.1192/bjp.169.1.68] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The clinical validity of melancholia has been argued on the basis of its capacity to predict response to electroconvulsive therapy (ECT). We have argued that a sign-based (CORE) rating system of psychomotor disturbance can identify patients with melancholia. Therefore, the clinical validity of the CORE system was tested here in terms of its capacity to predict response to ECT. METHOD The response of 81 patients with primary affective disorders to an individualised course of ECT was investigated. CORE scores and other clinical predictors were evaluated in terms of their capacity to predict effect size changes in symptoms and disability. RESULTS CORE scores predicted ECT response, as did the presence of psychotic features. The combination of marked psychomotor change (high CORE scores) and psychotic features predicted the best response to ECT. CONCLUSION This study supports the clinical validity of the CORE system for diagnosing melancholia.
Collapse
Affiliation(s)
- I Hickie
- Academic Department of Psychiatry, St George Hospital, Kogarah, New South Wales, Australia
| | | | | | | |
Collapse
|
49
|
Abstract
The Nottingham electroconvulsive therapy (ECT) trial was designed with a simulated treatment group to test prospectively the power of delusions or agitation to predict response. The response of patients without retardation and without delusions was examined retrospectively as well because of doubts over the usefulness of ECT for this subgroup. Deluded/nondeluded and agitated/nonagitated subtypes responded significantly to real treatment. Neither delusions nor agitation predicted greater treatment response. Patients without retardation, with or without delusions responded to real ECT, supporting the continuing prescription of ECT for these patients as well.
Collapse
Affiliation(s)
- D O'Leary
- Department of Psychiatry, Trinity College, Dublin, Ireland
| | | | | | | |
Collapse
|
50
|
|