Safety Of Electroconvulsive Therapy Research Articles

Electroconvulsive therapy in patient with psychotic depression and multiple sclerosis

Safety of electroconvulsive therapy (ECT) in depressive patients with multiple sclerosis (MS) is still discussed and based solely on case reports. This kind of therapy was used in both unipolar depression and depression in bipolar disorder. It was suggested that ECT might cause the deterioration of neurological state (new MS lesions in magnetic resonance imaging). Moreover, there were also data indicating some anesthesiological complications and difficulties in patients with MS. We have presented a case of a patient who was treated with ECT and developed grand mal seizure after 14th electroconvulsive treatment.

Drug Therapy versus Electroconvulsive Therapy for Refractory Schizophrenia: Report of a Case with 14 Years of Follow-up

The long-term efficacy and safety of electroconvulsive therapy (ECT) for refractory schizophrenia is rarely reported. We report the case of a 38-year-old female patient with refractory schizophrenia who was treated with ECT for 14 years (from 24 years of age). Case records of clinical treatment and laboratory tests are described and analyzed. During the first 11 years, the patient was treated with ECT as an adjunct to antipsychotic drugs, but the effectiveness was unstable. For the remaining 3 years she was treated with antipsychotic drugs as an adjunct to ECT and her condition stabilized as she gradually recovered social function. We summarize the clinical characteristics, therapy regimen, long-term effectiveness, and safety of this interesting case.

Safety of Electroconvulsive Therapy in Patients Receiving Dabigatran Therapy

Safety of electroconvulsive therapy (ECT) in patients chronically anticoagulated with warfarin has been established, despite warfarin having a narrow therapeutic range for toxicity and the need for intensive monitoring of the anticoagulant effect. A new anticoagulant medication, dabigatran, is a selective, reversible direct thrombin inhibitor recently approved in 2010 in the United States for thromboprophylaxis in patients with non-valvular atrial fibrillation. It has the potential advantage over warfarin with respect to similar therapeutic efficacy but without the need for frequent hematological monitoring and dose adjustments which are influenced by dietary changes and drug interactions. However, the safety in patients on dabigatran undergoing ECT has not been established. The aim of this case series is to describe the clinical course for two patients who received ECT while on dabigatran, and to assess for any adverse effects related to anticoagulation during the treatment course. We conducted a retrospective review of medical records for two patients who were identified through an electronic search to have received ECT in our psychiatric hospital and concurrently on dabigatran. We collected demographic and clinical information, indications for anticoagulation, pertinent laboratory values, and hemodynamic changes during ECT treatment. We also reviewed the hospital course to determine response and any adverse outcomes related to treatment. Two patients were identified, both males ages 78 and 80 years, and both received ECT for the treatment of major depressive disorder. Each had been prescribed dabigatran for the prevention of stroke and systemic thromboembolism secondary to atrial fibrillation, at the dosage of 150 mg twice daily, and had a creatinine clearance of greater than 30ml/min. They were treated with the recommended dose of 150 mg twice daily in patients with a creatinine clearance greater than 30ml/min. Both patients demonstrated excellent response to an acute course of ECT, receiving 11 and 5 treatments respectively, and achieved remission of depression, with only mild and transient confusion reported as side effects from ECT. They both had multiple medical comorbidities, but there were no reported adverse events related to the risk of increased bleeding due to anticoagulation including no reported cardiac, vascular, neurologic, or hematologic complications. In our review of two cases, no complications related to ECT and dabigatran were identified, and both had excellent response to ECT with remission of depression. To our knowledge, no studies have examined the safety of dabigatran treatment in patients undergoing ECT. Larger studies are needed to further establish its safety in ECT.

Electroconvulsive Therapy Device Classification: Response to FDA Advisory Panel Hearing and Recommendations

Electroconvulsive therapy (ECT) is a safe and highly effective treatment for management of acute episodes of a variety of serious mental disorders, particularly for major depressive episodes that are resistant to multiple interventions with treatment alternatives. As such, the National Network of Depression Centers (NNDC), a consortium of major academic centers with interest and expertise in this area, believes there is an important public health need for ECT to remain available for clinical use. As with all medical devices, ECT is regulated by the US Food and Drug Administration (FDA), which is presently involved in formulating a proposed rule as to how such devices should be classified. Since such classification may have substantial effects on the availability of ECT to patients for whom it is clinically indicated, the NNDC has reviewed the information provided by the FDA to its Advisory Panel, as well as the subsequent deliberations of the Panel itself at a January 2011 public hearing. This review indicates that the FDA may have substantially underestimated the efficacy of ECT as a means to produce large clinical improvements for individuals suffering from severe major depressive disorders and that such an underestimate likely affected the Panel's willingness to recommend reclassification of ECT devices to a less restrictive category. In addition, the NNDC's review generates support for a variety of methods by which the safety of ECT can be ensured, which is an essential requirement for such reclassification.

Catatonia and Neuroleptic Malignant Syndrome

We present the history of four bipolar patients who developed neuroleptic malignant syndrome (NMS) after antipsychotic treatment, focusing on the relationship between NMS and catatonia. In all cases, the administration of antipsychotics has been suspended as soon as fever and autonomic disturbances occurred. A supportive therapy was initiated to stabilize general conditions, then every patient started electroconvulsive therapy (ECT) in combination with benzodiazepines (BDZ). The risk of complications was reduced by the quick adoption of supportive care, whereas the combination of ECT and BDZ was effective in resolving the clinical picture. These cases may provide further support to the hypothesis that catatonia and NMS are disorders pertaining to the same spectrum of illness because the onset or exacerbation of catatonic symptoms coincided with the administration of antipsychotics. Our experience confirms the efficacy and safety of ECT in combination with BDZ as treatment of NMS and residual catatonia.

Use of Electroconvulsive Therapy in Parkinson Disease With Residual Axial Symptoms Partially Unresponsive to L-Dopa

Mental dysfunction and especially gait disorders, such as freezing and postural instability in "on phase," are partially unresponsive to dopaminergic therapy late in the course of Parkinson disease (PD). Some of them have been related to decreased sensitivity of postsynaptic dopaminergic receptors, and it is known that electroconvulsive therapy (ECT) enhances the sensitivity of these receptors. The aim of this study was to determine the efficacy and safety of ECT in patients with advanced Parkinson disease with symptoms partially unresponsive to L-dopa. Neurologic (Parkinson's Disease Questionnaire, Unified Parkinson's Disease Rating Scale, Tinetti Scale, and the Sit-to-Stand test), psychiatric (structured interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and Hamilton Depression Rating Scale) and neuropsychological (Mini Mental State Examination, executive functions, declarative and procedural memory, visual processing, and reaction time) evaluation was performed on 9 patients with a diagnosis of L-dopa-resistant PD by the Movement Disorders Working Group. This evaluation was done before and after 8 sessions of bitemporal ECT. Six patients completed the study. Statistically significant differences were found in the number of steps and freezing episodes in the on phase when they were compared before and after the ECT administration. However, no statistically significant differences were found in the "off" phenomena, motor fluctuations, or dyskinesias before and after ECT administration. No patient showed psychiatric symptoms before, during, or after the ECT. No statistically significant differences were observed in the neuropsychological results between the pretreatment and posttreatment evaluations. All patients showed transient amnesia after the ECT administration, which lasted for 48 hours. Electroconvulsive therapy could be a safe and effective therapeutic option in L-dopa-resistant patients with PD with predominantly axial "on" phenomena; nevertheless, it needs to be confirmed in later studies.

Catatonia and neuroleptic malignant syndrome: two disorders on a same spectrum? Three case reports

The authors present the cases of three bipolar patients who developed Neuroleptic Malignant Syndrome (NMS) after antipsychotic treatment, both typical and atypical, focusing on relationship between NMS and catatonia. In all three cases, administration of antipsychotics has been stopped at once, when fever and autonomic disturbances occurred. A supportive therapy (including rehydration, electrolyte restoration and blood pressure aids, together with antipyretics, antibiotics and anticoagulants) was prescribed in order to stabilize general conditions. Every patient started then Electroconvulsive Therapy (ECT) in combination with benzodiazepines. High risk of complications and lethal outcome, associated with NMS, were successfully reduced by the tempestive adoption of a supportive care, while combination between ECT and BDZ was effective in resolution of clinical picture. DISCUSSIONS; These cases may provide further evidences about hypothesis of catatonia and NMS as disorders on the same spectrum. In one patient, NMS occurred overlapping with a previous catatonic state, while two others exhibited catatonic features after resolution of NMS. However, catatonic symptoms arose or worsened with administration of antipsychotics, supporting hypothesis of neuroleptic-induced catatonia as a step of progressive development of NMS. Our experience also confirms efficacy and safety of ECT in combination with BDZ as treatment of NMS and residual catatonia.

Electroconvulsive therapy improves antipsychotic and somnographic responses in adolescents with first-episode psychosis — A case–control study

ObjectivePrevious studies have demonstrated the effectiveness of electroconvulsive therapy (ECT) in pharmacotherapy-resistant neuropsychiatric conditions. This study aimed to evaluate the efficacy and safety of ECT in adolescents with first-episode psychosis. MethodThis case–control study was conducted in inpatients aged 13–20years with first-episode psychosis. Every three similar age and same gender patients consecutively recruited were randomly allocated to control and ECT group at a ratio of 1:2, while they had antipsychotic treatment. ECT treatment was performed for 3 sessions per week with a maximum of 14 sessions. The endpoint was discharge from hospital. Clinical outcomes were measured using hospital stay days, the Positive and Negative Syndrome Scale (PANSS) and response rate. Polysomnography (PSG) was conducted at baseline and at week 2. Safety and tolerability were also evaluated. ResultsBetween March 2004 and November 2009, 112 eligible patients were allocated to control (n=38) and ECT (n=74) group. Additional ECT treatment significantly reduced hospital stay compared to controls (23.2±8.2days versus 27.3±9.3days, mean±SD, P=0.018). Survival analysis revealed that the ECT-treated group had a significantly higher cumulative response rate than controls (74.3% versus 50%, relative risk (RR)=1.961, P=0.001). Additional ECT also produced significantly greater improvement in sleep efficiency, rapid eye movement (REM) latency and density than control condition. The PSG improvement significantly correlated with reduction in scores on overall PANSS, positive symptoms, and general psychopathology. No patients discontinued ECT treatment regimen during hospital stay. The incidence of most adverse events was not different in the two groups, but ECT-treated group had more complaints of transient headache and dizziness than controls. ConclusionsECT is an effective and safe intervention used in adolescents with first-episode psychosis. Its antipsychotic effects are associated with improved PSG variables. ECT can be considered as an early psychosis intervention.

Antiparkinsonian Mechanism of Electroconvulsive Therapy in MPTP-Lesioned Non-Human Primates

Background: Electroconvulsive therapy (ECT), an effective treatment for depression, also improves motor symptomatology in Parkinson’s disease (PD). We have previously demonstrated that ECT stimulates dopamine (DA) function in the striatum of healthy non-human primates, suggesting that DA may contribute to antidepressant effects. Objective: We investigated the potential role of DA mechanisms in the amelioration of PD symptoms following a clinical course of ECT. Methods: We treated non-human primates rendered mildly bilaterally or unilaterally parkinsonian with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), with a course of 6 ECT treatments. Using positron emission tomography, animals were scanned at baseline and at various time points after ECT with tracers of the DA system. Data were analyzed using the Logan reference tissue model and statistics were performed using orthogonal polynomial contrasts. Results: There was no change in binding of the DA transporter tracer in the lesioned striata after ECT as opposed to what we measured in the striatum of healthy animals. Raclopride binding to the D_2/3 receptors was unaffected in all groups. However, there were increases in vesicular monoamine transporter type 2 and D₁ receptor binding in the MPTP-lesioned striata after ECT, returning towards baseline by 6 weeks. Conclusion: We suggest that the effects of ECT in PD may proceed from a mechanism similar to that in healthy animals but with a blunted dopaminergic response, likely due to the significant loss of striatal DA terminals. The safety of ECT, its mild side effects and its stimulatory effects of the DA system may thus make it an attractive adjunct to antiparkinsonian treatment.

The Safety of Electroconvulsive Therapy in Patients With Severe Aortic Stenosis

The Safety of Electroconvulsive Therapy in Patients With Severe Aortic Stenosis

Safety of Electroconvulsive Therapy in Patients With a History of Heart Failure and Decreased Left Ventricular Systolic Heart Function

Patients with heart failure may experience psychiatric disorders for which electroconvulsive therapy (ECT) is indicated. Little is known, however, about the safety of ECT in these patients. We assessed the safety of ECT in patients with a history of heart failure and decreased left ventricular systolic heart function. We conducted a retrospective review of the medical records of 35 patients with a history of heart failure and reduced left ventricular systolic heart function who underwent ECT at Mayo Clinic in Rochester, Minnesota, between January 1995 and December 2009. Of the 35 patients, 18 (51%) were women. The median age was 77 years (range, 54-92 years). The median left ventricular ejection fraction was 30% (range, 15%-40%). The 35 patients underwent 513 ECT sessions (median number of sessions per patient, 10; range, 1-44). The 35 patients tolerated ECT well. No patient died or experienced decompensated heart failure, myocardial ischemia, or myocardial infarction during or within 24 hours after an ECT session. Prophylactic intravenous β-blockers were given to patients who, during previous ECT sessions, had marked hypertension (eg, systolic blood pressure >180-200 mm Hg) or a heart rate greater than 100 beats per minute; overall, this prophylaxis was used in 26 patients during 413 ECT sessions (80% of the total number of ECT sessions). Three patients experienced temporary, non-life-threatening cardiac arrhythmias. Electroconvulsive therapy was safe in 35 patients with a history of heart failure and decreased left ventricular systolic heart function treated at our institution.

The Safety of Electroconvulsive Therapy in Patients With Prolonged QTc Intervals on the Electrocardiogram

Prolonged QTc intervals have been associated with increased cardiac morbidity and mortality. We investigated whether pretreatment prolongation of the QTc interval was associated with increased cardiac-related events (CREs) in electroconvulsive therapy (ECT) treatment of psychiatric disorders. The charts of 1437 ECT patients were reviewed for the presence of baseline QTc prolongation. Broadly defined CREs during the course of treatment were abstracted from patient charts. Presence of baseline QTc prolongation was not independent of increased risk of CREs during ECT. Careful consideration should be given to patients who have QTc prolongation on an electrocardiogram and are undergoing ECT treatment, but this should not definitively exclude patients from receiving ECT treatment.

Electroconvulsive Therapy and Cochlear Implantation

Objective: Electroconvulsive therapy (ECT), used for recalcitrant psychiatric illnesses, is contraindicated in patients with cochlear implants (CI) because of potential risk of damage to the CI and/or the patient. With increasing numbers of CI recipients, ECT in this population warrants further study. Herein, we present a cadaveric study of such. Method: Ten functional CIs were unilaterally implanted in fresh cadaveric heads. Each head then received 12 ECT treatments replicating a standard clinical treatment protocol. CI impedance testing was performed prior to and immediately after CI insertion, and then after the 1st, 3rd, 5th, 7th, 9th, and 12th ECT treatments. Results: Twelve rounds of ECT (800 mA per treatment) were performed on each of the implanted heads by a staff psychiatrist. Measured responses were typical to those encountered clinically. Impedance measurements after each ECT treatment did not show any increases. No open circuits developed because of ECT. After the first ECT treatment there was a trend toward decreased impedance measurements, which were sustained throughout the rest of the testing. Regarding ipsilateral vs contralateral application of ECT therapy, no statistically significant differences (all P > .5) in impedance measurements were noted. Conclusion: ECT does not cause any electrically measureable damage to CIs via either ipsilateral or contralateral therapy. Coupled with case reports on the safety of ECT in patients with CIs and similar technology (ie, deep brainstimulators), this study suggests that ECT can be safely used in patients with CIs.

Efficacy and Safety of Electroconvulsive Therapy in the Treatment of Bipolar Disorder

: To evaluate the efficacy and safety of electroconvulsive therapy (ECT) in bipolar disorder (BPD). : Clinical trials on the treatment of BPD with ECT were systematically reviewed. A comprehensive search of MEDLINE, PsycINFO, and ISI Web of Science databases was conducted in March 2010. : A total of 51 articles met our selection criteria. Only 3 controlled or comparative prospective trials addressed the treatment of mania with ECT. In these studies, which had small samples, ECT was superior to simulated ECT, lithium, or the combination of lithium and haloperidol. We did not find any controlled or comparative prospective trial on the efficacy of ECT in bipolar depression. In the 4 retrospective studies that compared ECT with antidepressants, no difference was observed between them. In 9 of 10 trials that compared bipolar with unipolar depressed patients, ECT was equally efficacious for both groups of patients. Of the 6 studies of patients with BPD that performed a comparison between pre-ECT versus post-ECT, only 1 study showed a worsening in cognition after the treatment. : There are no studies with adequate methodology on the treatment of BPD with ECT. The lack of scientific evidence contrasts with broad anecdotal clinical experience that suggests that ECT is an important tool in the treatment of BPD, especially in more severe or refractory cases. The marked stigma associated with ECT and the lack of large financial support may account for the paucity of ECT research.

Temporary Interruption of Deep Brain Stimulation for Parkinson's Disease During Outpatient Electroconvulsive Therapy for Major Depression: A Novel Treatment Strategy

The safety of electroconvulsive therapy (ECT) in patients with deep brain stimulation (DBS) has not been established. Cases reported had no adverse events, but DBS was withheld throughout the weeks of the ECT course. The authors report the first case of temporary interruption of DBS only during the minutes of each outpatient ECT.

Temporary Interruption of Deep Brain Stimulation for Parkinson's Disease During Outpatient Electroconvulsive Therapy for Major Depression: A Novel Treatment Strategy

The safety of electroconvulsive therapy (ECT) in patients with deep brain stimulation (DBS) has not been established. Cases reported had no adverse events, but DBS was withheld throughout the weeks of the ECT course. The authors report the first case of temporary interruption of DBS only during the minutes of each outpatient ECT.

Acoustic Neuroma Identified After Electroconvulsive Therapy in a Patient With Recurrent Major Depression and Undifferentiated Somatoform Disorder

Little is known about the safety of electroconvulsive therapy (ECT) in patients with brain tumors, especially in patients with acoustic neuroma, which is difficult to diagnose early. For patients with somatoform disorder, physicians may alter the sensitivity to the somatic complaints, making it even more difficult to make an early diagnosis of "silent" brain tumors. This report describes a rare case involving treatment of refractory major depression and somatoform disorder that developed into increased intracranial pressure after ECT, possibly due to an undiagnosed acoustic neuroma. It is suggested that for patients with refractory major depression with somatoform disorders, the threshold of suspicion for silent tumors should be lowered and pre-ECT brain imaging study should be performed, specifically when the pattern of symptoms of the central nervous system-related somatoform syndrome changes.

La terapia elettroconvulsivante nel trattamento della depressione maggiore resistente

Introduction The efficacy of electroconvulsive therapy (ECT) in treating depressive symptoms has been established by different studies. This paper reviews the current knowledge of ECT in the treatment of major depressive disorder and its implications in clinical practice. Materials and methods In this review we analyzed studies on the efficacy and safety of ECT, quality of life, and factors predictive of response. A search of the literature was conducted in PubMed using the terms “electroconvulsive therapy”, “major depressive disorder”, “efficacy”, “tolerability”, “cognitive impairment”, “meta-analysis”, “quality of life”, “predictive response factors”, “maintenance treatment”. Results In a high percentage of patients ECT is associated with remission of symptoms and improvement of the quality of life. Factors predicting especially good ECT responses in depressed patients include psychomotor retardation, psychosis, and advanced age. Cognitive side-effects are the main limitation of ECT although efficacy and tolerability vary according to the used ECT technique. Conclusions ECT is one of the most powerful treatments available. Thanks to the improvements in technique, ECT has become even safer and more useful for treatment of acute phase of depression and for the prevention of new depressive episodes.

Clinical Experience Using Electroconvulsive Therapy in Adolescents with Schizophrenia Spectrum Disorders

The aim of this study was to evaluate the effectiveness and safety of electroconvulsive therapy (ECT) in adolescent patients diagnosed with schizophrenia spectrum disorders (SSD). All patients diagnosed with SSD who received ECT in the Child and Adolescent Psychiatry and Psychology Department in a general hospital in Barcelona, Spain, from January, 2003, to December, 2007, were identified retrospectively. As part of the usual evaluation protocol, Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impression (CGI) scales were administered before ECT, after the acute ECT phase (CGI), and at 6 months from baseline. Data related to characteristics of these patients such as demographics, pharmacological treatment, ECT parameters, and side effects were registered. Thirteen cases, ages 13-17 (mean age, 16.6 +/- 1.2 years), were included. Compared to pre-ECT scores, mean PANSS decreased significantly at 6-month assessment (t = 3.58, p = 0.004). Clinical response (20% or greater reduction in PANSS total scores at the 6-month end point) was achieved in 54% of patients. A significant improvement of mean CGI score was observed after the acute ECT phase (t = 11.88, p < 0.001) and at 6-month assessment (t = 12.48, p < 0.001). There were no severe incidents related to any session during the acute ECT phase, although 1 patient experienced a tardive seizure during the continuation ECT. Our clinical experience supports the assertion that ECT is a safe and effective treatment for SSD in adolescent patients.

The influence of anaesthetic medication on safety, tolerability and clinical effectiveness of electroconvulsive therapy

Background: Electroconvulsive therapy (ECT) is still considered the most effective biological treatment strategy in psychiatric disorders. However, the clinical efficacy of ECT may be affected by stimulus variables and the concomitant use of psychopharmacological medication. Furthermore, most anaesthetics have anticonvulsant properties and therefore might additionally influence the efficacy of ECT. Method: In order to explore whether different anaesthetics might alter the effectiveness or safety of ECT we retrospectively analyzed 5482 ECT treatments in 455 patients. Anaesthetics were chosen according to clinical reasons and comprised thiopental, methohexital, propofol and etomidate. Results: Seizure duration was significantly affected by the anaesthetic medication with longest seizure activity during thiopental anaesthesia. In addition, postictal suppression, a further prospective parameter of ECT effectiveness, was significantly higher during propofol and thiopental anaesthesia. The clinical effectiveness was significantly better during propofol and thiopental anaesthesia. In contrast, the overall safety did not differ between the anaesthetic groups. Conclusion: Our study supports the hypothesis that inducting anaesthetic agents have a different impact on seizure duration, ictal and postictal electrophysiological indices and clinical efficacy of ECT. Compared to thiopental, which has been established as a standard anaesthetic during ECT, also the modern anaesthetic propofol is a suitable inducting agent.