Combination Of Electroconvulsive Therapy Research Articles

Safety of Electro-Convulsive Therapy in Combination with Duloxetine in Treatment-resistant Depressive Patients: A Randomized Clinical Trial

Background: There are several strategies in the management of treatment-resistant depression (TRD), including the administration of other antidepressants, augmentation therapy, electro-convulsive therapy (ECT), and a combination of ECT and antidepressants. The safety of ECT combined with any medication must be confirmed. The aim of this study was to assess the safety of duloxetine and ECT combination therapy. Materials and Methods: In this randomized clinical trial, the probable side effects of ECT plus duloxetine were compared with ECT plus sertraline in two groups of admitted TRD patients. Patients with general medical diseases and/or any contraindications to ECT or any of the two drugs were excluded. General side effects, including nausea, vomiting, and headache reported by patients (hours after ECT) as well as cardiotoxicity by electrocardiogram (immediately after any ECT episode), cognitive status by mini-mental state examination (MMSE, one month after the last ECT), and seizure duration were recorded for each patient. Results: No significant differences were observed in nausea, vomiting, headache, and myalgia between ECT+duloxetine and ECT+sertraline groups. Heart rate, QTc interval, ST-T change, and the incidence of arrhythmia were the same between the two arms of the study. Also, no prolonged seizures and status epilepticus were recorded among the studied patients. The MMSE revealed no marked differences in the cognitive status among patients of the two groups. Conclusion: ECT+duloxetine and ECT+sertraline were equally safe in patients with TRD.

Combination of electroconvulsive therapy and repetitive transcranial magnetic stimulation can lead to rapid remission

Combination of electroconvulsive therapy and repetitive transcranial magnetic stimulation can lead to rapid remission

Role of Electroconvulsive Therapy in Treatment-Resistant Schizophrenia in Forensic Psychiatry.

Long-term institutionalization of the forensic psychiatry patient population places a psychological burden on patients and family members as well as a financial burden on the health care system at large. Although electroconvulsive therapy is a well-established tool for patients with treatment-resistant schizophrenia, it is infrequently used in the forensic setting. This review serves to demonstrate an example of electroconvulsive therapy in combination with clozapine as a means of reducing length of hospitalization in a forensic psychiatric patient. Furthermore, this review will discuss factors limiting the prescribing of electroconvulsive therapy to this patient population including ethical considerations and availability.

Evaluation of the effectiveness of electroconvulsive therapy in the treatment of psychosis in a patient with epilepsy. Clinical case

The results of successful treatment of schizophrenic psychosis with persistent catatonic symptoms, refusal to eat in a patient with epilepsy are presented. In view of the progressive course of the disease, the lack of dynamics from the ongoing drug treatment, the method of electroconvulsive therapy was applied. Epileptic seizures and visual signs of brain epileptization were absent with the development of psychosis. As a result of the course of electroconvulsive therapy (9 procedures), the patient's clinical condition improved significantly. This observation illustrates the possibility of using electroconvulsive therapy in combination with antipsychotics and antiepileptic drugs as an alternative method for treating drug-resistant epilepsy.

Longitudinal Neurocognitive Effects of Combined Electroconvulsive Therapy (ECT) and Pharmacotherapy in Major Depressive Disorder in Older Adults: Phase 2 of the PRIDE Study

There is limited information regarding neurocognitive outcomes of right unilateral ultrabrief pulse width electroconvulsive therapy (RUL-UB ECT) combined with pharmacotherapy in older adults with major depressive disorder. We report longitudinal neurocognitive outcomes from Phase 2 of the Prolonging Remission in Depressed Elderly (PRIDE) study. After achieving remission with RUL-UB ECT and venlafaxine, older adults (≥60 years old) were randomized to receive symptom-titrated, algorithm-based longitudinal ECT (STABLE) plus pharmacotherapy (venlafaxine and lithium) or pharmacotherapy-only. A comprehensive neuropsychological battery was administered at baseline and throughout the 6-month treatment period. Statistical significance was defined as a p-value of less than 0.05 (two-sided test). With the exception of processing speed, there was statistically significant improvement across most neurocognitive measures from baseline to 6-month follow-up. There were no significant differences between the two treatment groups at 6 months on measures of psychomotor processing speed, autobiographical memory consistency, short-term and long-term verbal memory, phonemic fluency, inhibition, and complex visual scanning and cognitive flexibility. To our knowledge, this is the first report of neurocognitive outcomes over a 6-month period of an acute course of RUL-UB ECT followed by one of 2 strategies to prolong remission in older adults with major depression. Neurocognitive outcome did not differ between STABLE plus pharmacotherapy versus pharmacotherapy alone over the 6-month continuation treatment phase. These findings support the safety of RUL-UB ECT in combination with pharmacotherapy in the prolonging of remission in late-life depression.

A prospective multicenter assessor-blinded randomized controlled study to compare the efficacy of short versus long protocols of electroconvulsive therapy as an augmentation strategy to clozapine in patients with ultra-resistant schizophrenia (SURECT study)

BackgroundAlthough clozapine is the most effective antipsychotic drug for treatment-resistant schizophrenia, it leads to a poor or partial response in 40 to 70% of patients. Augmentation of clozapine with electroconvulsive therapy (ECT) is a highly effective and relatively safe treatment for these clozapine-resistant patients. However, parameters are not yet well specified, such as the optimal number of sessions, their frequency, and the relevance of maintenance ECT. Our objective is to compare the efficacy and tolerance between two protocols of combined ECT and clozapine treatment in patients with ultra-resistant schizophrenia (URS): a 6-month protocol (short protocol with 20 ECT sessions) and a 12-month protocol (long protocol with 40 ECT sessions).MethodsSixty-four patients with schizophrenia with persistent psychotic symptoms despite clozapine treatment will be enrolled in a prospective multicentric assessor-blinded randomized controlled trial. Patients will be randomly assigned to the short or the long protocol. The main outcome is the response rate assessed by the Positive and Negative Symptoms Scale (PANSS) 3 months after the end of the treatment in patients following the long protocol compared to those following the short protocol. The response was defined as a 30% reduction on the PANSS baseline. Clinical assessments (PANSS, BPRS, HAMD-21, YMRS, CGI, GAF, Modified Overt Aggression Scale (MOAS), and Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS)) and plasma clozapine concentration will be performed at baseline and at 2, 4, 6, 9, 12, and 15 months. Neuropsychological measures (MMSE, RL/RI-16, Doors test, D2 Test of Attention, Copy of the Rey-Osterrieth complex figure) will be performed at baseline and at 6 and 15 months.DiscussionThe aims of this research are to optimize protocols of combined ECT with clozapine in patients with URS and to offer specific recommendations for these patients’ care.Trial registrationClinicalTrials.gov NCT03542903. Registered on May 31, 2018. Id RCB: 2017-A02657-46

Synergistic effect of electric stimulation and mesenchymal stem cells against Parkinson's disease.

Electroconvulsive therapy (ECT) has known beneficial effects on the core motor symptoms of Parkinson's disease (PD), likely through induction of dopamine release and sensitivity of dopamine receptors. Mesenchymal stem cells (MSCs) can salvage loss of dopamine in PD through their differentiation into dopaminergic neurons. However, it is not known if combined ECT and MSC transplantation may have a synergistic effect against PD. Here, we showed that ECT significantly increased the differentiation of the transplanted MSCs into dopaminergic neurons in a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced mouse model of PD. On the other hand, transplantation of MSCs significantly increased dopamine levels after ECT. Co-application of ECT and MSC transplantation generated a synergistic effect through increases in dopamine and decreases in pro-inflammatory cytokines, resulting in significantly attenuated defect in stepping test and rotational behavior in MPTP-mice. Together, our data suggest that combined ECT and MSC transplantation can be a valuable treatment of PD.

Neurocognitive Effects of Combined Electroconvulsive Therapy (ECT) and Venlafaxine in Geriatric Depression: Phase 1 of the PRIDE Study

ObjectiveThere is limited information regarding the tolerability of electroconvulsive therapy (ECT) combined with pharmacotherapy in elderly adults with major depressive disorder (MDD). Addressing this gap, we report acute neurocognitive outcomes from Phase 1 of the Prolonging Remission in Depressed Elderly (PRIDE) study. MethodsElderly adults (age ≥60) with MDD received an acute course of 6 times seizure threshold right unilateral ultrabrief pulse (RUL-UB) ECT. Venlafaxine was initiated during the first treatment week and continued throughout the study. A comprehensive neurocognitive battery was administered at baseline and 72 hours following the last ECT session. Statistical significance was defined as a two-sided p-value of less than 0.05. ResultsA total of 240 elderly adults were enrolled. Neurocognitive performance acutely declined post ECT on measures of psychomotor and verbal processing speed, autobiographical memory consistency, short-term verbal recall and recognition of learned words, phonemic fluency, and complex visual scanning/cognitive flexibility. The magnitude of change from baseline to end for most neurocognitive measures was modest. ConclusionThis is the first study to characterize the neurocognitive effects of combined RUL-UB ECT and venlafaxine in elderly adults with MDD and provides new evidence for the tolerability of RUL-UB ECT in an elderly sample. Of the cognitive domains assessed, only phonemic fluency, complex visual scanning, and cognitive flexibility qualitatively declined from low average to mildly impaired. While some acute changes in neurocognitive performance were statistically significant, the majority of the indices as based on the effect sizes remained relatively stable.

Combination of electroconvulsive therapy and clozapine in patients with treatment-resistant schizophrenia

Many schizophrenia patients experience residual symptoms even after treatment. Electroconvulsive therapy (ECT) is often used in medication-resistant schizophrenia patients when pharmacologic interventions have failed; however, the mechanism of action is unclear. Brain-derived neurotrophic factor (BDNF) levels are reduced in drug-naive, first-episode schizophrenia and are increased by antipsychotic treatment. We tested the hypothesis that ECT increases serum BDNF levels by measuring BDNF concentrations in schizophrenia patients before and after they received ECT.A total of 160 patients with schizophrenia were examined. The ECT group (n = 80) was treated with antipsychotics and ECT (eight to 10 sessions administered every other day). The drug therapy group (n = 80) received only antipsychotic treatment. A control group (n = 77) was recruited that served as the baseline for comparison.Baseline serum BDNF level in ECT group was lower than in controls (9.7 ± 2.1 vs. 12.4 ± 3.2 ng/ml; P < 0.001), but increased after ECT, such that there was no difference between the two groups (11.9 ± 3.3 vs. 12.4 ± 3.2 ng/ml; P = 0.362). There was no correlation between patients’ Positive and Negative Syndrome Scale (PANSS) score and serum BDNF level before ECT; however, a negative correlation was observed after ECT (total: r = −0.692; P < 0.01). From baseline to remission after ECT, serum BDNF level increased (P < 0.001) and their PANSS score decreased (P < 0.001). Changes in BDNF level (2.21 ± 4.10 ng/ml) and PANSS score (28.69 ± 14.96) were positively correlated in the ECT group (r = 0.630; P < 0.01).BDNF level was lower in schizophrenia patients relative to healthy controls before ECT and medication. BDNF level increased after ECT and medication, and its longitudinal change was associated with changes in patients’ psychotic symptoms. These results indicate that BDNF mediates the antipsychotic effects of ECT.

The association of electroconvulsive therapy to pharmacological treatment and its influence on cytokines

IntroductionA growing body of evidence shows that disturbances in the immune system are involved in the pathogenesis of depression. Although the immune-modulating effects of antidepressants have been described, few studies have addressed the functioning of the immune system in relation to electroconvulsive therapy (ECT). This study aims to investigate if the addition of ECT to pharmacotherapy is associated with changes in cytokine levels. MethodsAdult inpatients were invited to participate in this study on admission to a psychiatric unit. Those with a diagnosis of depression by Mini-International Neuropsychiatric Interview were included. At treatment discharge, patients were retrospectively divided into those who used combined ECT and pharmacotherapy (31 subjects) and those who used only pharmacotherapy (68 subjects). Pro-inflammatory cytokines IL-2, IL-6, TNF-α, IFN-γ, and IL-17, and anti-inflammatory IL-4 and Il-10, were measured in blood samples collected at admission and discharge. A generalized estimating equation model and the post hoc Bonferroni test were performed for statistical analysis. ResultsThe combination of ECT with pharmacotherapy was associated with a decrease of IL-6 and an increase of TNF-α. Depressive inpatients, as a whole group, had a decrease of IL-6 and an increase of IFN-γ. No significant results were found for IL-2, IL-4, Il-10 and IL-17. ConclusionThis study is clinically relevant because we highlight that, in agreement with the previous literature, IL-6 appears to be a useful marker in depression, and we show for the first time that its reduction is closely related to the use of ECT.

Effectiveness of electroconvulsive therapy in patients with treatment resistant schizophrenia: A retrospective study

This study aimed to evaluate the effectiveness of electroconvulsive therapy (ECT) among patients with treatment resistant schizophrenia (TRS). Records of patients who had received ECT were reviewed to identify patients with TRS who were administered ECT in combination with clozapine. Socio-demographic, clinical data and ECT details were extracted. The most common diagnosis was of paranoid schizophrenia (49%) followed by undifferentiated schizophrenia (36%). A-fifth (22%) of the patients were judged to have poor response to clozapine. The mean number of ECTs given were 13.97 (SD-7.67) and mean clozapine dose was 287.5mgs/day (SD-100.1). About two-thirds (63%) of the patients showed >30% reduction in scores on different symptom-rating scales with combined use of clozapine and ECT. Among clozapine non-responders, approximately 69% responded to the combination. Post-ECT rise in blood pressure was the most common side effect (16.9%) followed by prolonged seizures (7%). Long-term follow-up data was available for 47 out of the 59 patients. More than two-third (N=34; 72%) followed-up for an average of 30 months (SD 32.3; range: 1–120), maintained well with continued clozapine treatment. To conclude, results of this study further endorse the effectiveness, safety and long-term benefits of the clozapine-ECT combination in TRS and clozapine-refractory schizophrenia.

Clinical Practice Guidelines for Management of Schizophrenia.

Clinical Practice Guidelines for Management of Schizophrenia.

Is there a decline in cognitive functions after combined electroconvulsive therapy and antipsychotic therapy in treatment-refractory schizophrenia?

An analysis of literature shows that there is still little evidence concerning the efficacy of electroconvulsive therapy (ECT) combined with antipsychotic therapy in a group of treatment-resistant schizophrenia patients. More precisely, its influence on cognitive functions is still equivocal. The aim of this study was to assess the influence of ECT combined with antipsychotic therapy on working memory, attention, and executive functions in a group of treatment-refractory schizophrenia patients. Twenty-seven patients completed the study: 14 men and 13 women, aged 21 to 55 years (mean age, 32.8 years), diagnosed with treatment-resistant schizophrenia. Each patient underwent a course of ECT sessions and was treated with antipsychotic medications. Before the ECT and within 3 days after the last ECT session, the participants were assessed with the following neuropsychological tests: Trail Making Test (TMT) and Wisconsin Cart Sorting Test (WCST). There were no significant differences in the TMT and WCST results after combined ECT and antipsychotic therapy in treatment-refractory schizophrenia patients. According to the results of the neuropsychological tests, there was no decline in attention, executive functions, or working memory. The current study shows no significant difference in attention, working memory, or executive functions after treatment with a combination of electroconvulsive and antipsychotic therapy. This suggests that combined electroconvulsive therapy may not have a negative influence on the neuropsychological functioning of patients with treatment resistant schizophrenia.

Electroconvulsive Therapy Combined with Pharmacotherapy: Effectiveness and Safety in Treatment-resistant Schizophrenia

Electroconvulsive therapy (ECT) is considered an effective and safe treatment. However, the possibility of cognitive adverse effects has raised a question about neuronal damage. Neuron-specific enolase (NSE) and S100b protein (S100b) were measured to determine whether ECT induces neuronal injury or glial activation. C-reactive protein (CRP), creatine phosphokinase (CPK) and CPK-MB levels were also measured. Present study was conducted in 14 patients with treatment-resistant schizophrenia (29,4±7,7 years old) that underwent combined ECT (10 ECTs on average) and pharmacological treatment. Blood samples were obtained before the beginning of ECT, 24 hours after the third and sixth ECTs. CRP levels indicated the presence of slow inflammatory process. There was no increase in NSE or S100b concentrations that could be associated with the impact of ECT. Significant CPK increases were observed in two patients, maximum at the baseline point; muscle tissue damage was indicated as the cause. Average reduction of PANSS score was 28,8%, and PANSS scores were never significantly correlated with biomarkers’ concentrations. Patients with greater disease duration and more impaired constructive praxis were characterized by higher, though not usually abnormal, levels of NSE after ECT. The results of the present study demonstrate that electroconvulsive therapy combined with pharmacotherapy is safe and effective for the drug treatment resistant group of schizophrenic patients. No significant neuronal damage associated with ECT and cognitive impairment was found. At the same time, increased CRP suggests a presence of chronic inflammation in the vascular wall, which supports a role of inflammatory mechanisms in schizophrenia.

Evaluation of the efficacy of the continuation electroconvulsive therapy in treatment-resistant schizophrenia

Background : Electroconvulsive therapy (ECT) has been reported being a safe and effective treatment in schizophrenia. However, there are a limited number of studies assessing continuation ECT utilization in patients with schizophrenia giving partial response to pharmacological treatment. Objective : The aim of this study is to evaluate the effectiveness of continuation ECT in preventing relapse in patients with treatment-resistant schizophrenia. Methods : In this retrospective analysis, schizophrenia patients (n = 73) were defined in three groups such as patients who received only AP treatment (only AP), patients who received acute ECT only during hospitalization (aECT+AP), patients who received acute ECT and continuation ECT (a-cECT+AP). Three groups were compared according to positive and negative syndrome scale (PANSS) and Brief Psychiatric Rating Scale (BPRS) scores. Results : As per comparison of only AP group, aECT+AP group and a+cECT+AP groups in terms of after discharge PANSS and after discharge BPRS scores for 1st month, 3rd month and 6th month; 3rd and 6th month’s PANSS scores of a+cECT+AP group were statistically significantly lower than other two groups. Discussion : Although this study suffers the limitations of retrospective medical chart analysis, results suggest that, in patients with a diagnosis of schizophrenia who have responded to an acute course of ECT, continuation ECT in combination with antipsychotics is more effective than antipsychotics alone in preventing relapse.

Effectiveness and clinical predictors of response to combined ECT and antipsychotic therapy in patients with treatment-resistant schizophrenia and dominant negative symptoms

The effectiveness and predictors of response to electroconvulsive therapy (ECT) combined with antipsychotics (AP) in treatment-resistant schizophrenia patients with the dominance of negative symptoms (TRS-NS) have not been studied systematically so far. 29 patients aged 21–55 years diagnosed with TRS-NS underwent ECT combined with antipsychotics (ECT+AP). Prior to the ECT, the symptom profile and severity were evaluated using Positive and Negative Syndrome Scale (PANSS). Demographic and medical data was collected; ECT parameters and pharmacotherapy results were evaluated. After the combined ECT+AP therapy a significant decrease in symptom severity was found. A response to treatment was achieved by 60% of patients. The greatest reductions were obtained in general and positive PANSS subscale (median change: 11 and 7 pts.) and the smallest, but still significant, ones in negative symptoms subscale (median: 3.5 pts.). Patients who responded to ECT+AP demonstrated a significantly shorter duration of the current episode in comparison with patients who did not experience at least a 25% reduction in symptom severity (median: 4 vs. 8 months). A combination of ECT and antipsychotic therapy can provide a useful treatment option for patients with TRS-NS. The only significant predictor of response to treatment was a shorter duration of the current episode.

Influence of valproate on the required dose of propofol for anesthesia during electroconvulsive therapy of bipolar affective disorder patients

BackgroundPropofol is often used as an anesthetic agent for electroconvulsive therapy (ECT). In recent studies, propofol was shown to possess significant seizure-shortening properties during ECT. “Valproate” is a mood stabilizer used mainly in the treatment of bipolar affective disorder. It is reported that valproate, being an anticonvulsant, raises the seizure threshold, thus decreases the efficacy of ECT treatment.AimThe purpose of our study was to compare the dose of propofol in valproate-using patients and valproate-free patients.MethodsIn an open design, 17 patients with bipolar affective disorder manic episodes who were to be treated with valproate and ECT in combination, were compared with 16 manic-episode patients who were to be treated with ECT but not valproate. The two groups were compared on the basis of electroencephalography-registered seizure duration and the propofol dosage required to induce anesthesia.ResultsValproate, compared with no valproate treatment, results in a decrease in the propofol dose required to induce anesthesia. In the valproate group of study participants, seizure duration was significantly shorter than in the valproate-free group.ConclusionThe results suggest that valproate reduces the dose of propofol required for anesthesia during ECT treatment in patients with bipolar affective disorder manic episodes. Although propofol is a safe and efficacious anesthetic for ECT treatment, lower doses of propofol should be used to induce anesthesia for patients under valproate treatment. When the clinician needs to prolong seizure duration in patients treated with valproate, interruption of the valproate treatment or an anesthetic agent other than propofol should be considered.

Transient serotonin toxicity evoked by combination of electroconvulsive therapy and fluoxetine.

The serotonin syndrome has been described only in rare instances for electroconvulsive therapy combined with an antidepressant medication. We describe a case of serotonin toxicity induced by electroconvulsive therapy in combination with fluoxetine.

P.1.g.087 Hyperammonemic encephalopathy caused by combined electroconvulsive therapy and valproate use

P.1.g.087 Hyperammonemic encephalopathy caused by combined electroconvulsive therapy and valproate use

Effective Treatment of Catatonia by Combination of Benzodiazepine and Electroconvulsive Therapy

Catatonia, a motor dysregulation syndrome, can emerge in numerous psychiatric disorders, mainly in schizophrenia and mood disorders, and metabolic and endocrine disorders such as infections, toxic states, epilepsy, and traumatic brain injury. In our study, we aimed to investigate demographic, clinical, and treatment-related characteristics of catatonic patients managed in our inpatient clinic. The medical records of 57 patients diagnosed to have catatonia according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, criteria who were admitted to the inpatient psychiatry clinic of the Gaziantep University School of Medicine between 1 January, 2003, and 31 December, 2011, were retrospectively reviewed. In patients with catatonia, mood disorders (63.2%) were found to be the most common underlying or primary disease, whereas mutism (47.4%) was found to be the most common catatonic symptom. There was a comorbid medical condition in 9 patients (15.8%). Patients underwent an average of 9.00 electroconvulsive therapy (ECT) sessions. Among 57 patients with catatonia, catatonic symptoms were resolved in 57 patients (100%) by benzodiazepine and ECT. In our study, full recovery was achieved in catatonia by benzodiazepine plus ECT combination. As a result, we recommend combined ECT and benzodiazepine for catatonia.