Antidepressant Efficacy Of Electroconvulsive Therapy Research Articles

The influence of concomitant antidepressant and antipsychotic medication on antidepressant effect and seizure duration of electroconvulsive therapy.

A significant proportion of patients with a depressive disorder show resistance to pharmacological and psychotherapeutic antidepressant treatments. Electroconvulsive therapy (ECT) is still one of the most effective treatment methods, especially in the acute phase. In everyday clinical practice, this usually accompanies pharmacological treatment. It has been shown that pharmacological treatment following acute ECT treatment reduces the rate of relapses. However, the effect of various antidepressants (ADs) and antipsychotics (APs) on the effect during the course of ECT has rarely been investigated. In this retrospective chart review study, the data of 104 depressive patients treated with ECT were examined. We analyzed the influence of concomitant administration of AD and AP or no psychotropic medication on the effect of ECT using the Montgomery-Åsberg Depression Rating Scale (MADRS). We further analyzed the influence of the ADs Bupropion, Venlafaxine, and Sertraline or no AD and the influence of augmentation with Aripiprazole or Quetiapine or Olanzapine. Psychotropic medication did not have an impact on antidepressant efficacy of ECT as measured with the MADRS scores. In addition, the comparison between the antidepressant or antipsychotic medications themselves did not show any significant difference. However, we found a significantly different seizure duration depending on the antidepressant substance that patients received during ECT (p = .008). ECT treatment itself led to a highly significant reduction of 13.3 points in the MADRS (p <.001). Taken together, our study underlines that concomitant psychotropic medication while doing electroconvulsive therapy does not bare the risk of prolonged seizure duration or does it reduce the effectiveness of ECT. To the best of our knowledge, this study is the first to examine the effect of treatment with antidepressants in combination with antipsychotics while doing ECT. In light of our results, this combination therapy is safe and effective. Bearing in mind the delay in onset of antidepressant action of medication and the importance of antidepressant medication for relapse prevention, this study further supports the recommendation that psychotropic medication should be given in adjunction to ECT.

Is Magnetic Seizure Therapy Ready to Round the Corner?

Is Magnetic Seizure Therapy Ready to Round the Corner?

Electro convulsive therapy: Modification of its effect on the autonomic nervous system using anti-cholinergic drugs

The antidepressant efficacy of electroconvulsive therapy (ECT) is correlated to the quality of the seizure as measured by EEG but has also been linked to the magnitude of changes in hemodynamic variables. Muscarinic receptor antagonists are frequently used in the treatment, and are known to affect the hemodynamic response. We hypothesized that atropine and glycopyrrolate alter the hemodynamic and autonomic hormonal response to ECT. In a randomized, cross-over study design 23 patients received either atropine, glycopyrrolate or placebo before ECT. Hemodynamic variable, EEG and EMG, and blood adrenaline, noradrenaline and pancreatic polypeptide was determined. No geriatric patients were included. Hemodynamic changes with ECT can be divided into three phases: Drop in blood pressure and pulse rate in 1st post-stimulus phase was less when using 1 mg atropine. In 2nd post-stimulus phase atropine gave a higher systolic blood pressure. No differences were seen in hormone levels after ECT in the three interventions. A significant longer tonic clonic seizure was seen in the glycopyrrolate group and a tendency of the same was seen with atropine. The study found that the changes in hemodynamic variables induced by ECT can be altered by concomitant administration of muscarinic receptor antagonist.

The Longitudinal Effects of Electroconvulsive Therapy on Ictal Interhemispheric Coherence and Its Associations With Treatment Outcome: A Naturalistic Cohort Study.

Electroconvulsive therapy (ECT) is an effective treatment for severe depression. Electroencephalogram (EEG) measures between ECT sessions seem to be related to the antidepressant efficacy of ECT. In this naturalistic cohort study, we examine longitudinal effects of ECT on interhemispheric EEG coherence measures during seizure activity and its relation to the antidepressant efficacy. This study included 65 patients diagnosed with severe depressive disorder. Depressive symptoms were rated according to the Montgomery-Åsberg Depression Rating Scale before and after the course of ECT. Frequency-specific ictal interhemispheric (fp1-fp2) EEG coherence measures were established during the first and each consecutive sixth treatment session. Linear mixed-effect models were used to determine longitudinal changes in ictal coherence measures during the course of ECT and its relation to treatment efficacy. Ictal interhemispheric coherence in the theta and alpha frequency bands increased over the course of treatment, whereas no significant change was found for the delta and beta frequency bands. A main effect of treatment efficacy on the interhemispheric coherence in the delta and theta band was revealed. However, the longitudinal effects of ECT were not associated with treatment efficacy. The current study suggests that interhemispheric coherence during ECT-induced seizures increases over the course of treatment. Furthermore, these longitudinal effects seem to be unrelated to the antidepressant efficacy of ECT. These findings contribute to the understanding of the mechanism of action of ECT.

Antidepressant efficacy of electroconvulsive therapy is associated with a reduction of the innate cellular immune activity in the cerebrospinal fluid in patients with depression

Objectives: A bidirectional link between the antidepressant effects of electroconvulsive therapy (ECT) and the modulation of the immune system has been proposed. To elucidate the interplay between antidepressant treatment and macrophage/microglia activation in humans, we performed a study on the effects of the antidepressant treatment by ECT on markers of macrophage/microglia activation in patients with depression.Methods: We measured six different markers (IL-6, neopterin, sCD14, sCD163 MIF and MCP1) of macrophage/microglia activation in the cerebrospinal fluid (CSF) and blood of 12 patients with a severe, treatment-resistant depressive episode before and after a course of ECT.Results: Some markers in the CSF of remitters were reduced after the ECT course and differed from non-remitters, but no differences were found before and after ECT independently from the antidepressant efficacy. CSF baseline levels of some markers could predict the reduction of depressive psychopathology during ECT. Higher CSF levels indicating increased macrophage/microglia activation at baseline predicted a better treatment response to ECT.Conclusions: Although the sample size was small, our data suggest that macrophages/microglia are involved in the pathophysiology of major depression and that antidepressant efficacy by ECT might be partly explained by the modulation of the innate immune system within the brain.

Alternating intravenous racemic ketamine and electroconvulsive therapy in treatment resistant depression: A case report

IntroductionTreatment resistant depression (TRD) affecting approximately 10–30% of all depressed patients often remains misdiagnosed and undertreated, leading to a higher risk of relapse and suicide. Electroconvulsive therapy (ECT) and sub-anesthetic ketamine have repeatedly shown to be effective in the TRD population. Administering ketamine as an anesthetic component to augment antidepressant efficacy of ECT has been proven inconclusive, while a combination of alternating ECT and ketamine has not been investigated yet.Case reportWe present a severely depressed and chronically suicidal female inpatient who failed multiple antidepressant treatment attempts, requiring frequent psychiatric admissions. Since available conventional as well as non-conventional antidepressant treatment strategies were nearly exhausted, we employed a combination of ECT (bilateral stimulation up to 150%) 2–3 times/week, while intravenous racemic ketamine (up to 75 mg per infusion) was administered on ECT free days 2–3 times/week. Consequently, robust anti-suicidal and antidepressant effects could be observed already during the first treatment week. The temporarily occurring subjective forgetfulness disappeared after the last ECT. Summarizing, we employed 9 ECT treatments and 7 ketamine infusions leading to a stable psychopathological state even after discharge from psychiatric inpatient care. In order to prevent relapse a maintenance-therapy comprising ECT once monthly and 2 ketamine infusions (up to 100 mg per infusion) administered on the day before and after ECT was established.ConclusionsIn our patient alternating ECT and intravenous racemic ketamine were proven safe and long-term effective after numerous failed antidepressant trials including ECT and ketamine alone. We may hence encourage clinicians to widen their therapeutic armamentarium in severe TRD.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Ketamine Anesthesia, Efficacy of Electroconvulsive Therapy, and Cognitive Functions in Treatment-Resistant Depression.

Electroconvulsive therapy (ECT) is the most effective treatment for drug-resistant depression (DRD). Because a single infusion of ketamine may exert both a rapid antidepressant effect and a quick improvement of cognition, the aim of the present study was to assess whether ketamine, as an anesthetic drug for ECT, can augment the antidepressant activity of the procedure and/or exert a beneficial effect on cognition. A total of 11 male and 34 female patients with DRD, aged 21 to 75 years, were included in the study. Fifteen patients (group 1) received only thiopental anesthesia, 15 patients (group 2) had their second and third ECT sessions with ketamine, and 15 patients (group 3) had ketamine for the second, fourth, sixth, eighth, and tenth sessions. Depression intensity was measured by the 17-item Hamilton Depression Rating Scale. Cognitive functions were measured before and after ECT, assessing visual-spatial abilities, verbal auditory memory, working memory, and executive functions. Before the ECT, the mean (SD) intensity of depression was 32 (6) points on the Hamilton Depression Rating Scale and the mean number of ECT sessions was 10.8 (1.5), with no difference between groups. After the last ECT session, the intensity of depression was significantly lower in group 3, compared with group 1. Cognitive assessments after ECT showed a more marked worsening in verbal memory in patients with added ketamine anesthesia. The addition of ketamine may be connected with better antidepressant efficacy of ECT, compared with only thiopental anesthesia. However, patients with added ketamine had worse results on some of the indices measuring verbal memory.

Repetitive Transcranial Magnetic Stimulation Versus Electroconvulsive Therapy for the Treatment of Major Depressive Disorder, A Randomized Controlled Clinical Trial

Studies comparing the antidepressant effects of electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) have reported mixed results. This study compared the efficacy of rTMS and ECT in adult patients with refractory major depressive disorder (MDD). This randomized, ECT-controlled, parallel-group clinical trial analyzed the antidepressant effects of ECT and rTMS in 73 patients with MDD diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. The Beck Depression Inventory and Hamilton Depression Rating Scale were used to measure depression. Both ECT and rTMS significantly improved depression and suicidal behavior scores. However, ECT reduced depression and suicidal behavior scores more than rTMS. There were no significant adverse effects in the rTMS group. Both ECT and rTMS improved MDD in the short term, but the antidepressant efficacy of ECT was greater than rTMS. Moreover, ECT led to greater reductions in suicidal behavior than rTMS. Until strong evidence for the safety and efficacy of rTMS is available, further studies are needed to compare ECT and rTMS in terms of the long-term relapse rate and quality of life.

Comparison of repetitive transcranial magnetic stimulation and electroconvulsive therapy in unipolar non-psychotic refractory depression: a randomized, single-blind study

Repetitive transcranial magnetic stimulation (rTMS) can induce significant antidepressant effects and, for some patients, might be an alternative to electroconvulsive therapy (ECT). The results of studies comparing the efficacy of rTMS and ECT are mixed and, therefore, comparison of these two therapies needs to be further explored. Forty-two patients aged between 18 and 65 yr, referred to ECT due to unipolar non-psychotic depression refractoriness entered the trial. They were randomly assigned to receive either rTMS or ECT. Depressive symptom changes were blindly measured by Hamilton Depression Rating Scale, Visual Analogue Scale and Clinical Global Impression at baseline, after 2 wk and after 4 wk of treatment. There was no difference in the antidepressant efficacy of ECT and rTMS. Response rates were relatively low in both groups (40% and 50% respectively), with no significant difference between them (p=0.55). Remission rates were also low for both groups (20% and 10% respectively), also with no significant difference (p=0.631). There was no significant difference in the neuropsychological test performance after either one of these therapies. Both treatments were associated with a degree of improvement in refractory depression and therefore add to the literature that rTMS can be an effective option to ECT as it is a less costly treatment and is not associated with anaesthetic and other ECT risks.

Ictal and interictal EEG markers or seizure inhibition predict and index antidepressant efficacy of electroconvulsive therapy

Ictal and interictal EEG markers or seizure inhibition predict and index antidepressant efficacy of electroconvulsive therapy

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AnaesthesiaVolume 44, Issue 2 p. 168-168 Free Access A reply E.C. Rouse, E.C. Rouse Glan Clwyd Hospital, Clwyd LL18 5UJSearch for more papers by this author E.C. Rouse, E.C. Rouse Glan Clwyd Hospital, Clwyd LL18 5UJSearch for more papers by this author First published: February 1989 https://doi.org/10.1111/j.1365-2044.1989.tb11187.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1 Sackeim HA, Decina P, Prohovnic I, Portnoy S, Kanzler M, Malitz S. Dosage, seizure threshhold, and the antidepressant efficacy of electroconvulsive therapy. Annals of the New York Academy of Sciences 1986; 462: 398– 410. 2 Fink M, Johnson L. Monitoring the duration of electroconvulsive therapy seizures. Cuff and EEG methods compared. Archives of General Psychiatry 1982; 39: 1189– 91. 3 Sackeim H, Decina P, Prohovnik I, Malitz S. Seizure threshold in electroconvulsive therapy. Effects of sex, age, electrode placement and number of treatments. Archives of General Psychiatry 1987; 44: 355– 60. 4 Simpson KH, Halsall PJ, Carr Cme, Stewart KG. Seizure duration after methohexitone or propofol for induction of anaesthesia for electroconvulsive therapy (ECT). British Journal of Anaesthesia 1987; 59: 1323p– 4p. Volume44, Issue2February 1989Pages 168-168 ReferencesRelatedInformation