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Bahji A. The Rise, Fall, and Resurgence of Electroconvulsive Therapy. J Psychiatr Pract 2022; 28:440-444. [PMID: 36355582 DOI: 10.1097/pra.0000000000000666] [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: 11/12/2022]
Abstract
Electroconvulsive therapy (ECT) is one of the most effective treatments for depression. However, significant stigma from the media and the antipsychiatry movement has biased the public toward ECT, leading to underutilization, particularly among those most in need. This report reviews some of the key historical events in the rise, fall, and resurgence of ECT and how modern ECT knowledge and practice are more refined, including an improved understanding of its mechanisms of action and optimal treatment parameters.
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Affiliation(s)
- Anees Bahji
- BAHJI: Department of Psychiatry and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Sun S, Yang P, Chen H, Shao X, Ji S, Li X, Li G, Hu B. Electroconvulsive Therapy-Induced Changes in Functional Brain Network of Major Depressive Disorder Patients: A Longitudinal Resting-State Electroencephalography Study. Front Hum Neurosci 2022; 16:852657. [PMID: 35664348 PMCID: PMC9158117 DOI: 10.3389/fnhum.2022.852657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesSeveral studies have shown abnormal network topology in patients with major depressive disorder (MDD). However, changes in functional brain networks associated with electroconvulsive therapy (ECT) remission based on electroencephalography (EEG) signals have yet to be investigated.MethodsNineteen-channel resting-state eyes-closed EEG signals were collected from 24 MDD patients pre- and post-ECT treatment. Functional brain networks were constructed by using various coupling methods and binarization techniques. Changes in functional connectivity and network metrics after ECT treatment and relationships between network metrics and clinical symptoms were explored.ResultsECT significantly increased global efficiency, edge betweenness centrality, local efficiency, and mean degree of alpha band after ECT treatment, and an increase in these network metrics had significant correlations with decreased depressive symptoms in repeated measures correlation. In addition, ECT regulated the distribution of hubs in frontal and occipital lobes.ConclusionECT modulated the brain’s global and local information-processing patterns. In addition, an ECT-induced increase in network metrics was associated with clinical remission.SignificanceThese findings might present the evidence for us to understand how ECT regulated the topology organization in functional brain networks of clinically remitted depressive patients.
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Affiliation(s)
- Shuting Sun
- Brain Health Engineering Laboratory, School of Medical Technology, Beijing Institute of Technology, Beijing, China
| | - Peng Yang
- Shandong Daizhuang Hospital, Jining, China
| | - Huayu Chen
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, China
| | - Xuexiao Shao
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, China
| | - Shanling Ji
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, China
| | - Xiaowei Li
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, China
- Shandong Academy of Intelligent Computing Technology, Jinan, China
- *Correspondence: Xiaowei Li,
| | - Gongying Li
- Department of Psychiatry, Huai’an Third People’s Hospital, Huai’an, China
- Gongying Li,
| | - Bin Hu
- Brain Health Engineering Laboratory, School of Medical Technology, Beijing Institute of Technology, Beijing, China
- Chinese Academy of Sciences Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
- Joint Research Center for Cognitive Neurosensor Technology of Lanzhou University and Institute of Semiconductors, Chinese Academy of Sciences, Lanzhou, China
- Open Source Software and Real-Time System, Lanzhou University, Ministry of Education, Lanzhou, China
- Bin Hu,
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Tan XW, Oon LK, Tsang YYT, Ong HS, Tor PC. A Pilot Study of Switching Electroconvulsive Therapy for Patients With Treatment Resistant Schizophrenia or Mood Disorder. J ECT 2021; 37:202-206. [PMID: 33625174 DOI: 10.1097/yct.0000000000000747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Switching of ECT electrode modality is commonly done in clinical practice but outcomes are unclear. We aimed to compare the clinical outcomes between ECT modality switchers and nonswitchers in a large tertiary psychiatric institution over 1 year. METHODS Brief Psychiatric Rating Scale (BPRS), Montgomery-Åsberg Depression Rating Scale (MADRS) and Montreal Cognitive Assessment (MoCA) were used to assess symptoms and cognition. General linear regression was utilized to compare the change of BPRS or MADRS and MoCA score among switchers vs nonswitchers. RESULTS 21.5% of 209 patients switched ECT. Baseline BPRS scores were lower among nonswitchers. Response rate in schizophrenia, depression and mania were higher for nonswitchers (69.6%, 81.35% and 84.8% respectively / 9.2 (SD 3.3) sessions) compared to switchers (53.8%, 0% and 66.7% respectively / 10.6 (SD 4.5) sessions). Most common ECT switches were Bifrontal (BF) to Bitemporal (BT) (schizophrenia), UB RUL (ultrabrief right unilateral) to BT (depression), and UB RUL to BT / BF (mania). There was no significant difference in the change of BPRS and MoCA scores between nonswitchers and switchers. However, there was significantly more improvement of MADRS scores among nonswitchers [adjusted mean ± SE: (-26.4 ± 2.8)] compared with switchers (-10.6) ±6.6). CONCLUSIONS ECT switching was commonly done and may result in better or worse outcomes than not switching depending on diagnosis. Controlled trials are required to address this urgent clinical issue.
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Affiliation(s)
- Xiao Wei Tan
- From the Departments of Mood Disorder and Anxiety
| | - Li Keat Oon
- Developmental Psychiatry, Institute of Mental Health
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Landry M, Moreno A, Patry S, Potvin S, Lemasson M. Current Practices of Electroconvulsive Therapy in Mental Disorders: A Systematic Review and Meta-Analysis of Short and Long-Term Cognitive Effects. J ECT 2021; 37:119-127. [PMID: 33009218 DOI: 10.1097/yct.0000000000000723] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Electroconvulsive therapy (ECT) remains one of the most effective treatments for major depressive disorder, but uncertainties persist regarding the cognitive tests to include in ECT follow-up. The current study is a systematic review and meta-analysis of the most frequent cognitive side effects after ECT. We also discuss the most common cognitive tests in ECT follow-up. We searched studies published from 2000 to 2017 in English and French language in Pubmed, EBM Reviews, EMBASE, and PsycINFO. Standardized cognitive tests were separated into 11 cognitive domains. Comparisons between cognitive measures included pre-ECT baseline with post-ECT measures at 3 times: PO1, immediately post-ECT (within 24 hours after last ECT); PO2, short term (1-28 days); and PO3, long term (more than 1 month). A total of 91 studies were included, with an aggregated sample of 3762 individuals. We found no significant changes in global cognition with Mini-Mental State Examination at PO1. Hedges g revealed small to medium effect sizes at PO2, with individuals presenting a decrease in autobiographical memory, verbal fluency, and verbal memory. Verbal fluency problems showed an inverse correlation with age, with younger adults showing greater deficits. At PO3, there is an improvement on almost all cognitive domains, including verbal fluency and verbal memory. There is a lack of standardization in the choice of cognitive tests and optimal cognitive timing. The Mini-Mental State Examination is the most common screening test used in ECT, but its clinical utility is extremely limited to track post-ECT cognitive changes. Cognitive assessment for ECT purposes should include autobiographical memory, verbal fluency, and verbal memory.
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Ward HB, Szabo ST, Rakesh G. Maintenance ECT in schizophrenia: A systematic review. Psychiatry Res 2018; 264:131-142. [PMID: 29631245 DOI: 10.1016/j.psychres.2018.03.033] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 03/09/2018] [Accepted: 03/09/2018] [Indexed: 12/15/2022]
Abstract
Relapse after discontinuation of ECT is significant in patients with schizophrenia. The purpose of this systematic review was to examine use of M-ECT in schizophrenia to guide clinical decision making for relapse prevention in schizophrenia. We reviewed studies examining the role of continuation (C-ECT) and maintenance electroconvulsive therapy (M-ECT) in schizophrenia. Following PRISMA guidelines, we included randomized controlled trials, open label trials, retrospective chart reviews, case reports, and case series in this review. We evaluated adjunctive pharmacological regimens; ECT treatment parameters, including frequency, duration of continued treatment, electrode placement; clinical outcomes including cognitive side effects and relapse rates from included studies. Our findings suggest M-ECT could provide an effective form of relapse prevention in these patients and persistent cognitive side effects are minimal.
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Affiliation(s)
- Heather Burrell Ward
- Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Duke University School of Medicine, Durham, NC, USA.
| | - Steven T Szabo
- Veterans Affairs Medical Center, Durham, NC, USA; Department of Psychiatry, Duke University Medical Center, Durham, NC, USA
| | - Gopalkumar Rakesh
- Department of Psychiatry, Duke University Medical Center, Durham, NC, USA
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Abstract
OBJECTIVE There is a dearth of up-to-date literature regarding electroconvulsive therapy (ECT) in adolescents, and the question of when to pronounce course failure has not been properly addressed. The current study aims to evaluate trajectories of clinical status throughout ECT courses in adolescent patients. METHODS We retrieved detailed data of 36 patients who received ECT in our treatment center. Clinical records were retrospectively assessed and evaluated every 6 ECT sessions to quantify Clinical Global Impressions-Improvement (CGI-I) scores. RESULTS The mean number of sessions per course was 24.4 ± 14.2. The mean CGI-I score at the conclusion of the ECT courses was 2.47 ± 1.19. At the end of the acute treatment stage, 26 patients (72.2%) were much or very much improved, based on CGI-I scores. Only 5 patients exhibited a significant response after 6 sessions or fewer, whereas 21 patients (56.6%) improved after 12 sessions. Pearson correlations between CGI-I scores throughout the course of ECT showed no significant correlation between CGI-I scores after 6 sessions and the final CGI-I scores. However, a significant correlation was found between CGI-I scores after 12 sessions and the final CGI-I score. CONCLUSIONS An improvement in the clinical status of adolescents treated by ECT might occur only after a substantial number of sessions. An early lack of response does not necessarily predict a failed ECT course.
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Müller HHO, Reike M, Grosse-Holz S, Röther M, Lücke C, Philipsen A, Kornhuber J, Grömer TW. Electroconvulsive Therapy Hasn't Negative Effects on Short-Term Memory Function, as Assessed Using a Bedside Hand-Held Device. Ment Illn 2017; 9:7093. [PMID: 28748058 PMCID: PMC5509960 DOI: 10.4081/mi.2017.7093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/31/2017] [Accepted: 03/31/2017] [Indexed: 11/23/2022] Open
Abstract
Electroconvulsive therapy (ECT) is effective in the treatment of treatment-resistant major depression. The fear of cognitive impairment after ECT often deters patients from choosing this treatment option. There is little reliable information regarding the effects of ECT on overall cognitive performance, while short-term memory deficits are well known but not easy to measure within clinical routines. In this pilot study, we examined ECT recipients' pre- and post-treatment performances on a digital ascending number tapping test. We found that cognitive performance measures exhibited good reproducibility in individual patients and that ECT did not significantly alter cognitive performance up to 2 hours after this therapy was applied. Our results can help patients and physicians make decisions regarding the administration of ECT. Digital measurements are recommended, especially when screening for the most common side effects on cognitive performance and short-term memory.
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Affiliation(s)
- Helge H O Müller
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen.,Department of Psychiatry and Psychotherapy, Medical Campus University of Oldenburg, School of Medicine and Health Sciences, University Hospital Karl-Jaspers-Klinik, Bad Zwischenahn, Germany
| | - Mareen Reike
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen
| | - Simon Grosse-Holz
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen
| | - Mareike Röther
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen
| | - Caroline Lücke
- Department of Psychiatry and Psychotherapy, Medical Campus University of Oldenburg, School of Medicine and Health Sciences, University Hospital Karl-Jaspers-Klinik, Bad Zwischenahn, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, Medical Campus University of Oldenburg, School of Medicine and Health Sciences, University Hospital Karl-Jaspers-Klinik, Bad Zwischenahn, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen
| | - Teja W Grömer
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen
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Sanz-Fuentenebro FJ. Stimulus characteristics in electroconvulsive therapy. A pragmatic review. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2016; 11:36-47. [PMID: 27569402 DOI: 10.1016/j.rpsm.2016.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 06/07/2016] [Accepted: 06/30/2016] [Indexed: 12/28/2022]
Abstract
The process of normalization electroconvulsive therapy (ECT) requires, among other actions, disseminating the latest information on this technique. One of the most complex aspects is the electrical stimulus, whose knowledge should be spread and put into practice. In this paper we review the available information about frequency and number of ECT sessions, and efficacy of each electrode placement. We also present two approaches to determine the ECT charge: stimulus titration versus age-based method; and the limitations of the summary metrics of charge, being necessary to expand our knowledge of the parameters that configure the stimulus: duration, current amplitude frequency and pulse width.
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Affiliation(s)
- Francisco Javier Sanz-Fuentenebro
- Hospital Universitario-Instituto de Investigación Hospital 12 de Octubre, Madrid, España; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), España.
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Abstract
This paper reviews recent research on the use of electroconvulsive therapy (ECT) in elderly depressed patients. The PubMed database was searched for literature published within the past 4 years, using the search terms: "electroconvulsive elderly," "electroconvulsive geriatric," "ECT and elderly," and "ECT elderly cognition." The studies in this review indicate excellent efficacy for ECT in geriatric patients. Adverse cognitive effects of ECT in this population are usually transient and not typically severe. In addition, continuation/maintenance ECT (C/M-ECT) may be a favorable strategy for relapse prevention in the elderly after a successful acute course of ECT. ECT is an important treatment option for depressed geriatric patients with severe and/or treatment-resistant illness. New data add to the evidence demonstrating that ECT is a highly effective, safe, and well-tolerated antidepressant treatment option for geriatric patients.
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Affiliation(s)
- Emma T Geduldig
- The Icahn School of Medicine at Mount Sinai, Department of Psychiatry, One Gustave L. Levy Place, Box 1230, New York, NY, 10029, USA.
| | - Charles H Kellner
- The Icahn School of Medicine at Mount Sinai, Department of Psychiatry, One Gustave L. Levy Place, Box 1230, New York, NY, 10029, USA.
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