Assessment of Cognitive Status Pre- and Postmodified Electroconvulsive Therapy in Patients with Severe Depression: A Prospective Study

Objective To study the changes in hippocampal morphology and inferior ventricular vein in patients with major depressive disorder (MDD) before and after modified electroconvulsive therapy (MECT) using morphological measurement and susceptibility weighted imaging (SWI). Methods Recruited for this study were 64 MDD patients who had been admitted to the Affiliated Guangji Hospital to Soochow University from February 2016 through March 2017. They were assigned into 2 equal groups. One group was subjected to MECT and the other to simple drug treatment. All the patients were scanned with T1-MR and SWI one day before and after treatment to observe the changes in hippocampal morphology and inferior ventricular vein. The associations between relative parameters and Hamilton Depression Scale (HAMD) were analyzed. The 2 groups were compared in terms of therapeutic efficacy. Results The volumes of the whole hippocampus and the hippocampal body were increased significantly after MECT (P 0.05). Significant increases in the branch number, diameter and length of the inferior ventricular vein were found after MECT (P<0.05). The left and right hippocampal volumes were negatively associated with the HAMD scores (r=-0.442, P=0.011; r=-0.470,P=0.007). Negative correlations were also found between the branch number, diameter and length of the inferior ventricular vein and the HAMD scores (r=-0.419, P=0.017; r=-0.477, P=0.006; r=-0.398, P=0.024). The curative efficacy of the MECT group was significantly higher than that of the drug treatment group (91% versus 72%) (P<0.05). Conclusion Changes in the hippocampal morphology and inferior ventricular vein can be used as one of the objective indicators to evaluate the therapeutic efficacy of MECT in MDD patients. Key words: Modified electroconvulsive therapy; Major depressive disorder; Susceptibility weighted imaging; Hippocampus; Inferior ventricular vein

Anesthesia for electroconvulsive therapy.

Antidepressant effects of ketamine and ECT: A pilot comparison

AimsOur aim was to analyse the trend in the use of new courses of ECT in Northamptonshire Healthcare Trust from 2007 to 2022 and to compare the use of ECT, Modified ECT (MECT), TMS, Ketamine and combined TMS + Ketamine in the Treatment Centre and The Centre for Neuromodulation in Northamptonshire Healthcare Trust from 2013 to 2022.MethodsData for new ECT courses were collected from the Treatment Centre in Northamptonshire Healthcare Trust from 2007 to 2022. These data were then compared with new courses for TMS, MECT, ketamine and combined TMS + Ketamine from various sites across the trust from 2013 to 2022. These data have been represented as two separate graphs the first showing trend of ECT and the second comparison of the trend of ECT, MECT, TMS, Ketamine & combined TMS + Ketamine.ResultsThe data show that there has been a significant decrease in the number of ECT and MECT procedures performed in recent years, with a decrease of over 50% to 70% in new courses of ECT & MECT among various units in the trust. Regarding the data for TMS treatment vs ECT there is a gradual decrease in ECT and increase in TMS over the years, of particular note is the recent period of 2019 to 2022 during which there were 10 times more referrals for TMS compared to ECT at Northamptonshire Healthcare Trust. During this period TMS accounted for 87% of the total new treatments, while ECT accounted for 9% and Ketamine 4%.ConclusionOur findings suggest that TMS is becoming an increasingly popular treatment option for depression and may eventually replace ECT and Modified ECT as the primary treatment in the Northamptonshire Healthcare Trust. This poster provides an overview of the current state of ECT, Modified ECT, TMS, and ketamine as treatments for depression, and highlights the need for further research to better understand the relative effectiveness and safety of these treatments, especially in treatment-resistant depression cases.

Background:It is well known that depression improves faster with electroconvulsive treatment (ECT) than with antidepressant medications. N-methyl-D-aspartate-receptor antagonists (ketamine) have been shown to have rapid antidepressant effects when given as an intravenous infusion. Faster recovery with ECT is likely when used with ketamine as anesthetic.Aim:The aim of the study is to compare the outcome of modified electroconvulsive therapy (MECT) in major depressive disorder patients undergoing MECT with ketamine versus thiopentone anesthesia.Materials and Methods:Sixty hospitalized patients (age: 18–45 years) with major depressive disorder (Diagnostic and Statistical Manual of Mental Disorders-IV Text Revision) were randomly allocated to either of the two MECT groups (30 patients each) receiving ketamine or thiopentone as anesthetic agent. The participants were assessed on a weekly basis on Hamilton Rating Scale for Depression (HAM-D) and Beck Depression Inventory (BDI).Results:Ketamine group required significantly lesser number of MECT sessions for achieving remission and had rapid improvement in HAM-D and BDI scores compared to the thiopentone group. Furthermore, the stimulus intensity required to elicit seizures was significantly less and seizure duration was longer in ketamine group compared to the thiopentone group.Conclusion:The use of ketamine for anesthesia led to rapid recovery from depressive symptoms and seems to be a better option for depressive patients, especially when a rapid response is desired.

The effects of electroconvulsive therapy are usually estimated from changes in depression scales from studies with relatively small patient samples. Larger patient samples can be achieved from epidemiological registers, which provide information on other social and clinical predictors, results and risks. To examine whether depression severity predicts the use of electroconvulsive therapy, risk of re-hospitalization, suicidal behaviour and mortality following electroconvulsive therapy in patients with major depression. A cohort of 92,895 patients diagnosed with single or recurrent depression between 2005 and 2016 in the Danish National Patient Registry was followed for electroconvulsive therapy and adverse outcomes. Associations between electroconvulsive therapy and outcomes were analysed using Cox regression. A total of 5004 (5.4%) patients were treated with electroconvulsive therapy. Depression severity was the strongest predictor of electroconvulsive therapy. Electroconvulsive therapy was used more frequently above age 70, in those better educated or married, whereas comorbid alcohol abuse or history of prior stroke at study entry were associated with lower rates. Electroconvulsive therapy was associated with lower mortality. The adjusted hazard ratio for the association between electroconvulsive therapy and suicide in patients with mild depression was 6.99 (3.30-14.43), whereas it was 1.10 (0.55-2.20) in those with severe depression and psychotic symptoms. A similar pattern was seen for emergency contacts and attempted suicide. Electroconvulsive therapy was associated with lower all-cause mortality and the relative risk for re-hospitalization and attempted and committed suicide was lowest in patients with the most severe depression. Electroconvulsive therapy is an important treatment, with significant public health benefits, for patients with severe depression.

Safe and successful treatment of depression with electroconvulsive therapy in a patient with implanted spinal cord stimulators

Successful Electroconvulsive Therapy in a 95-Year-Old Man With a Cardiac Pacemaker—a Case Report

Electroconvulsive Therapy Impact on Memory Performance in Patients With Depression

Electroconvulsive Therapy Impact on Memory Performance in Patients With Depression

The memory-related side-effects rank among the strongest reasons for hostility against Modified Electroconvulsive Therapy (MECT). Most of the studies comparing the Unilateral v/s Bilateral Electrode placements on memory have been conducted on patients with depression while very few studies have been conducted on patients with psychosis in the Indian population. To compare the effects of right unilateral (RU/L) and bilateral (B/L) MECT on the severity of symptoms as well as memory in patients with psychosis after the fourth session and two weeks after the final session of the MECT. One hundred patients having a psychotic illness were randomized into either RU/L or B/L group. Comprehensive psychopathological rating scale (CPRS), clinical global impressions scale (CGI-S), and PGI-memory scale were applied before starting of MECT, after four sessions of MECT and two weeks after the last session of ECT. The results show similar symptomatic improvement in patients receiving RU/L and B/L MECT and the results persisted beyond the therapy sessions. But, in the case of RU/L-MECT group, the deterioration in memory was less as compared to the B/L-MECT group. Both groups had no significant difference in psychopathology and its severity (CPRS and CGI). Both groups were significantly different in memory side effects after the fourth session and two weeks after the last session. Both groups showed a consistent downward trend in psychopathology and its severity. The consistent fall in the total PGI scores remained even after two weeks of the final session in the B/L group (total of six points as compared to baseline) while it came to baseline levels in the RU/L group. Both groups differed significantly in total PGI scores after the fourth session and two weeks after the final session. This study points toward a favorable outcome in the case of therapeutic response with MECT without any significant difference between both types of electrode placements and even after stopping MECT, the improvement appears to be stable over time. Although, there was a side-effect of memory impairment, it appears to be for a shorter duration and it improves with time. The side-effect profile of RU/L electrode placement is lower as compared to bilateral placement. In the post-MECT period, the patients receiving MECT with RU/L electrode placement showed better improvement in memory functions.

Objective: Ministry of Health of Turkey issued a legislation to use only modified electroconvulsive therapy (ECT) in 2005, and this study aimed to assess satisfaction and attitude of bipolar patients regarding modified and unmodified electroconvulsive therapy.Methods: A total of 100 patients (50 treated with modified electroconvulsive therapy (M-ECT) and 50 treated with unmodified ECT (UM-ECT) with a diagnosis of Bipolar Disorder (depressive or manic episode) were invited to participate in this study. Patients with euthymic mood were included. Satisfaction and attitude towards ECT were evaluated with a structured attitude questionnaire, and M-ECT and UM-ECT patients, and their subgroups (depressive vs. manic) were compared.Results: No significant differences were found between M-ECT and UM-ECT groups regarding age, sex, marital status and occupation. The majority of all patients (78%) were satisfied from treatment with ECT and with the outcome (88%), without significant differences between modified and unmodified groups. Forgetfulness (70%) and headaches (57%) occurred in all groups, with the only significant difference in forgetfulness being reported by more manic patients treated with UM-ECT. Depressive and manic patients treated with UM-ECT reported concerns of brain damage and physical harm significantly more frequently. While 86% of patients treated with M-ECT consented to a future treatment, this was significantly less in patients treated with UM-ECT (50%).Conclusions: Bipolar patients report a high degree of satisfaction treated either with modified or unmodified ECT but there was a significant difference in perception of adverse effects and willingness for receiving ECT in future.

The aim of the study was to explore the tendency of modified electroconvulsive therapy (MECT)-related working memory and subjective memory deficits in depressed patients. Sixty patients with unipolar/bipolar depression were prepared and enrolled for MECT and 56 subjects were enrolled as healthy controls (HCs). Their demographics (sex, age, body mass index, years of schooling, etc) and clinical characteristics (dosage and number of MECT, etc) were compared. Depression severity, working memory, and subjective memory were measured using the Hamilton Depression Rating Scale 17 (HAMD17), a Digit Span Backwards (DSB), and self-reported assessments, respectively. Measurements were taken at baseline, within 24 hours after each MECT session, and in every month for a 6-month follow-up period. (a) The patients had poorer performance than the HCs on DSB and HAMD17 at baseline, and the DSB score and HAMD17 total scores were negatively correlated. However, after the second MECT session, the patients' HAMD17 score was significantly improved compared with that at the baseline (P < 0.05), whereas the DSB score showed no significant difference compared with the HCs (P > 0.05). (b) After the first MECT session, 62% of the patients reported subjective memory deficits, which were exacerbated over the subsequent sessions and relieved with antidepressant treatment during the follow-up period. (c) The risk factors for prolonged subjective memory deficits were overweight and the maximum MECT dosage/age (dosage/age = the percentage of output part of total dosage × 100/age, unit: 1/year) ≥ 1.5/year (odds ratio [OR] = 15.36 and 7.98). Depressed patients showed poorer working memory than the HCs. Such memory deficit may be aggravated by MECT, although it may improve with the relief of depression. Although subjective memory deficits can occur after the first MECT session and gradually recover after the treatment, they may last for 6 months or longer. Persistent deficits may be related to being overweight and having a high MECT dosage.

Objective To explore nursing safety management path of patients treat with modified electroconvulsive therapy(MECT) to improve the quality of nursing and reduce the adverse events. Methods According to the theory of Hazard Analysis and Critical Control Point (HACCP) and the SBAR standard communicative model, design and apply nurses handover check list for patients who treat with MECT (the following are referred to as MECT form). The nurses used MECT form to evaluate and manage the risk of patients before and after MECT treatment. This was also help to control the standardization criterion of nursing before and after treatment, meanwhile reduce the risk of treatment. Analyze the data of adverse event before and after applied this MECT form. Results After applied this form for one year, the number of above levle-0 adverse events decreased from 3.51% (191/5 441) to 1.05% (61/5 817) (x2 = 77.856, P<0.05). Conclusion The application of MECT form improves the nursing quality of MECT treatment in psychiatric department and secure the nursing safety. Key words: Modified electroconvulsive therapy; HACCP; SBAR Communication Mode; Checking list; Nursing adverse events

Etomidate enabled electroconvulsive therapy without suppressing adrenocortical function in a case with difficulties in inducing seizures by conventional methods.