Successful Electroconvulsive Therapy Research Articles

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

In old-old patients with major depressive disorder, electroconvulsive therapy (ECT) is relatively safe and more effective than pharmacotherapy. 1 Manly DT Oakley SP Bloch RM Electroconvulsive therapy in old-old patients. Am J Geriatr Psychiatry. 2000; 8: 232-236 Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar , 2 Tharyan P The evidence for electroconvulsive therapy (ECT) in the treatment of severe late-life depression. ECT for depressed elderly: what is the evidence and is the evidence enough?. Int Psychogeriatr. 2007; 19: 19-35 Crossref PubMed Scopus (4) Google Scholar , 3 Burd J Kettl P Incidence of asystole in electroconvulsive therapy in elderly patients. Am J Geriatr Psychiatry. 1998; 6: 203-211 Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar , 4 Salzman C Wong E Wright BC Drug and ECT treatment of depression in the elderly, 1996–2001: a literature review. Biol Psychiatry. 2002; 52: 265-284 Abstract Full Text Full Text PDF PubMed Scopus (70) Google Scholar ECT provokes unique hemodynamic changes. 5 Saito S Anesthesia management for electroconvulsive therapy: hemodynamic and respiratory management. J Anesth. 2005; 19: 142-149 Crossref PubMed Scopus (60) Google Scholar It has been applied successfully in pacemaker patients. During ECT, a pacemaker may be inhibited because of oversensing of ECT-induced myopotentials. This may result in asystole. However, studies have shown that the risks of pacemaker malfunction or cardiac complications during ECT are relatively small. 6 Dolenc TJ Barnes RD Hayes DL Rasmussen KG Electroconvulsive therapy in patients with cardiac pacemakers and implantable cardioverter defibrillators. Pacing Clin Electrophysiol. 2004; 27: 1257-1263 Crossref PubMed Scopus (49) Google Scholar , 7 Giltay EJ Kho KH Keijzer LTM Leijenaar M van Schaick HW Blansjaar BA Electroconvulsive therapy (ECT) in a patient with a dual-chamber sensing, VDDR pacemaker. J ECT. 2005; 21: 35-38 Crossref PubMed Scopus (14) Google Scholar , 8 Suzuki K Takamatsu K Takano T Tanabe Y Matsuoka H Should we convert demand mode to fixed mode when electroconvulsive therapy is administered to patients with pacemakers?. J ECT. 2009; 25: 76 Crossref PubMed Scopus (3) Google Scholar Regarding old-old patients, we found only one report of successful ECT in two patients older than 90 years with DDD and DDDR pacemakers. 6 Dolenc TJ Barnes RD Hayes DL Rasmussen KG Electroconvulsive therapy in patients with cardiac pacemakers and implantable cardioverter defibrillators. Pacing Clin Electrophysiol. 2004; 27: 1257-1263 Crossref PubMed Scopus (49) Google Scholar We present a 95-year-old patient with a VVIR pacemaker.

Successful Electroconvulsive Therapy in a Drug-Refractory Depressed Patient With Idiopathic Intracranial Hypertension

The condition of a 42-year-old woman with drug-refractory major depression, severe headache, and progressive visual impairment was diagnosed as idiopathic intracranial hypertension (IICH). Idiopathic intracranial hypertension is a relative contraindication to electroconvulsive therapy (ECT), chiefly due to the theoretical risk of brain herniation. Although the diagnosis of IICH was unequivocal, the patient's headache was interpreted as being unassociated with IICH. Nine ECT sessions were performed, and both depression and headache improved dramatically. People with IICH are at an increased risk of depression and report more physical complains, including headache. Cases of IICH may be considered for ECT if depression is drug-refractory. In this case, cerebrospinal fluid open pressure should be closely monitored.

Case Report of Electroconvulsive Therapy in a Patient With Parkinson Disease Concomitant With Deep Brain Stimulation

We report on a 56-year-old woman with Parkinson disease who had previously been implanted with bilateral deep brain stimulation (DBS). She was hospitalized after a 2-year course of severe depression with psychotic features and physical as well as mental decline. She underwent 2 rounds of successful electroconvulsive therapy (ECT), improving both her physical and mental health without any adverse effects to the patient or the DBS. This is a fourth reported case of ECT being successfully and safely administered in a patient implanted with DBS. This is the first case report of bitemporal ECT in a patient with bilateral DBS. It is also the first case report using the MECTA device and the first case report of a successful and safe second course of ECT after relapse of this patient's depression.

Successful ECT treatment for medically refractory nonconvulsive status epilepticus in pediatric patient

Status epilepticus is a life threatening condition with a high mortality rate in spite of aggressive treatment. There is little consensus on third and fourth line approaches in refractory cases. While electroconvulsive therapy (ECT) has been employed successfully as a treatment for refractory epilepsy and status epilepticus (SE) after exhausting conventional therapy, its use for pediatric patients is limited. We describe a 7-year-old pediatric case in which ECT was used successfully to treat medically refractory nonconvulsive status epilepticus (NCSE) without complete withdrawal of antiepileptic drugs (AED).

What We Have Learned about Electroconvulsive Therapy and its Relevance for the Practising Psychiatrist

In this narrative review, the current knowledge base on the efficacy and the practice of electroconvulsive therapy (ECT) is reviewed, and its relevance for the practising psychiatrist is appreciated. In the past decade, several large-scale studies have confirmed the significant superiority of ECT in the treatment of severe and refractory psychiatric conditions, such as major depressive disorder and bipolar disorder. However, the efficacy of ECT is not reflected in current treatment algorithms, where ECT is often reserved as a last resort. However, clinical characteristics, such as the presence of psychotic symptoms, suicidality, or catatonic signs, should prompt the clinician to consider ECT earlier in the treatment course. ECT is a safe procedure, without absolute contraindications for its use. Nevertheless, patients' fears and complaints should be acknowledged, and patients should be adequately informed about expected benefits and possible risks, such as memory problems, that are generally transient. Research focusing on further minimizing memory problems, while maintaining a superior efficacy, is ongoing. Adequate continuation treatment, either pharmacotherapy or continuation ECT, after a successful ECT course is of vital importance to maintain the benefits achieved and should be the focus of future research.

Is successful electroconvulsive therapy related to stimulation of the vagal system?

BackgroundElectroconvulsive therapy (ECT) has been shown to exhibit strong beneficial effects in the treatment of major depressive disorder (MDD). While the exact underlying mechanisms are under debate, a role for the sympathetic response upon ECT has been suggested. When assessing patients with MDD for autonomic function, however, a loss of vagal function is prominent. ObjectiveHere, we aimed to assess the immediate effects of ECT on vagal activity and to test the hypothesis that surrogates of the latter correlate with therapeutic outcome. MethodsTwenty patients with MDD who underwent ECT treatment were assessed regarding their vagal function using electrophysiological measures and determination of pancreatic polypeptide (PP), which is known to be released upon vagal stimulation. Parameters were correlated to the improvement of disease severity upon ECT treatment. ResultsPatients showed a significant increase of PP shortly after ECT which correlated with clinical improvement. Furthermore, the described association with the sympathetic phase after ECT could be verified. ConclusionECT increases vagal activity which might be associated with the beneficial effect seen following this treatment. PP elevation after administration of ECT might be a useful parameter to estimate the degree of such vagal stimulation after treatment.

Electroconvulsive Therapy

Cases of memory deficits after electroconvulsive therapy (ECT) have been widely reported particularly short-term memory and to a lesser extent, long-term and autobiographical memory. Explanations for the mechanisms of ECT action have largely been limited to studies of the effect on brain metabolism, neurochemistry, and areas of the brain such as the hippocampus and frontal lobes. However, passing a current of electricity through the brain is clearly a holistic treatment, and consequently, a holistic theory may offer a better understanding of ECT action. Because of its effect on memory systems both positive and negative, it is possible that aspects of memory function could hold the key in explaining how and why successful ECT treatment functions. It will be argued that successful ECT treatment is effective because it facilitates and restores the function of specific memory systems that are deficient in the course of a severe depressive episode. It is these memory systems that link a person to the very essence of their existence and personal identity.

Electroconvulsive therapy increases glial cell-line derived neurotrophic factor (GDNF) serum levels in patients with drug-resistant depression

Electroconvulsive therapy (ECT) can be effective in patients with depression resistant to pharmacologic medication. We report that serum levels of glial cell-line derived neurotrophic factor (GDNF) were increased following ECT of patients with drug-resistant depression. When patients were sub-classified into ECT responders and non-responders, serum GDNF levels were significantly increased (58%) in responsive patients following ECT. No significant increase was seen in non-responders. These results suggest that successful ECT may be associated with elevated serum GDNF levels.

Impacts of Switching Antidepressants After Successful Electroconvulsive Therapy on the Maintenance of Clinical Remission in Patients With Treatment-Resistant Depression

There is no consensus regarding whether a previously prescribed, that is, failed, antidepressant should be continued or switched after a successful electroconvulsive therapy (ECT) for the maintenance of clinical remission in patients with treatment-resistant depression (TRD). In this study, we conducted a chart review to examine impacts of the antidepressant switch after the successful ECT on 1-year outcome in patients with TRD. This retrospective chart review included inpatients with TRD (ie, those who failed to respond to adequate trials of 2 distinctly different classes of antidepressants) who showed clinical remission after ECT. Readmission rate and social functioning 6 months and 1 year after the successful ECT were compared between patients who experienced an antidepressant switch and those who continued prior regimen. Twenty-eight patients (mean age, 59 years; 9 men) were followed-up for 1 year. The patients who changed antidepressants after ECT (n = 7) experienced a readmission significantly less frequent than the others (n = 21) in 1 year (0% vs 43%, P = 0.043). In addition, the former showed significantly better social contacts at 6 months (P = 0.022) and 1 year (P = 0.015). There were no significant differences in baseline characteristics between the 2 groups. The patients who experienced an antidepressant switch after ECT required a readmission less frequently in 1 year than those who were maintained with the same antidepressant. The findings of this preliminary study suggest that a switch to another antidepressant after successful ECT may be encouraged for the maintenance of clinical remission in patients with TRD.

Successful Electroconvulsive Therapy in a Patient With Intellectual Disability and Bipolar Disorder, With Catatonic Features Misdiagnosed as Encephalopathy

We describe the successful use of electroconvulsive therapy (ECT) in a 39-year-old woman with a complex clinical picture including bipolar disorder with catatonic features superimposed on a history of multiple congenital anomalies and intellectual and developmental disabilities. At age 34, the patient presented with marked regression and behavioral disturbance diagnosed as encephalopathy. Multiple medical evaluations were inconclusive, and treatment courses with antibiotics and steroids failed. After psychiatric evaluation, her condition was diagnosed as bipolar disorder with catatonic features. She was treated with ECT with dramatic improvement and resumption of her premorbid level of functioning. We discuss the relevant literature on the use of ECT in patients with intellectual disability.

Four Years of Successful Maintenance Electroconvulsive Therapy

Four Years of Successful Maintenance Electroconvulsive Therapy

Electroconvulsive Therapy in Patients With Vagus Nerve Stimulation

Numerous studies have demonstrated the safety and efficacy of electroconvulsive therapy (ECT) for various psychiatric conditions, and it has been approved by the Food and Drug Administration for the treatment of refractory depression. Recently, the Food and Drug Administration also approved vagus nerve stimulation as a treatment for chronic or recurrent depression. Although electrical stimulation is used for both ECT and vagus nerve stimulation, the mechanisms of their action are very different. The American Psychiatric Association task force identifies no absolute contraindications to the use of ECT. The authors present 2 interesting cases of successful ECT in combination with vagus nerve stimulator.

S13-03 Post- ECT pharmacotherapy: An update

Electroconvulsive therapy (ECT) is a very effective treatment in severe psychiatric disorders. One of the main drawbacks of ECT is the high and early relapse rate in the absence of post- ECT treatment. After a successful ECT- course, pre- ECT pharmacotherapy is often continued. There is, however, no evidence that proves this strategy effective. The research on post- ECT treatments is limited, but promising. The available studies show that relapse rates can be decreased from more than 80% to 40% or less using either imipramine (1), the combination of lithium and nortriptyline (2) or continuation- ECT (3). The question whether or not starting antidepressants during the course of ECT ca further decrease relapse rates remains unanswered. Preliminary data show that starting antidepressants medication during the ECT course has no impact on post- ECT relapse. There is an urgent need for further research on treatment strategies to decrease the unacceptable high relapse rates after recovery from ECT.

Change in Seizure Threshold During Electroconvulsive Therapy

The seizure threshold (ST) is a measure of the minimum electrical energy necessary to induce a grand mal seizure. Dose titration of the ST has been suggested to optimize stimulus dosing in electroconvulsive therapy (ECT). The change in ST with remission is examined in a large sample of unipolar depressed patients. In a study of continuation treatments after successful ECT, the ST was determined at the first treatment and again 1 week after remission using a conventional ST measurement protocol. Patients were treated with bilateral electrode placement at 150% above the measured ST. In 80 subjects, the ST measured the same in 70%, increased in 21%, and decreased in 9% at remission. In a study of bilateral ECT, the ST did not rise conclusively with remission.

Resolution of Catatonia by Successful Seizure Induction Via Electroconvulsive Therapy With Electrodes Applied Bilaterally to the Parietotemporal Region

Electroconvulsive therapy (ECT) has been shown to be effective in cases of medically intractable mood disorder and schizophrenia. However, some patients receiving ECT have only a short electroencephalographic seizure or no seizure at the maximum stimulus intensity and thus fail to obtain a therapeutic effect. A new treatment option is needed to induce therapeutic seizures in such patients. We report a case of catatonic schizophrenia that was resolved by successful seizure induction by means of ECT with electrodes applied bilaterally to the parietotemporal region after bifrontotemporal ECT failed to induce adequate seizure. We note that parietotemporal ECT can induce therapeutic seizures in patients with a high seizure threshold because more current penetrates the brain due to a decrease in shunted current.

Long-term Follow-up After Successful Electroconvulsive Therapy for Depression

A long-term follow-up of depressed patients responsive to electroconvulsive therapy (ECT) with intensive pre-ECT pharmacotherapy treatment failure who also participated in a 6-month trial directly post-ECT in which imipramine was compared with placebo for relapse prevention. A total of 26 patients responsive to ECT who participated in the 6-month continuation trial were invited 4 to 8 years later to assess their follow-up status. The groups with and without relapse within 6 months were compared with regard to recurrence of depression up to 8 years later. Recurrence was defined as a new episode of depression that needed antidepressant medication and/or readmission in hospital and/or a new ECT course. At the time of follow-up (mean duration, 6.8 years), the recurrence rate of depression for the total sample was 42.3%. There was no significant difference in the recurrence rates and number of recurrences between the nonrelapse and relapse groups. The small study population limits generalization of the results; the design of the study is naturalistic and retrospective. In our small sample of depressed patients with pharmacotherapy treatment failure, recurrence is not influenced by relapse after terminating ECT. Continuation of medication started immediately after ECT seems to be an important factor in preventing recurrence.

Depression and the causal role of specific memory system degenerations: Link may be supported by reported therapeutic benefits of Omega 3 fatty acids

It is well documented that depressed patients, as a result of their illness, often experience some difficulties with their memory. This hypothesis suggests a vice-versa; that it is a gradual impairment and ultimate failure of specific memory systems that may underpin the onset and continuation of a depressive illness. So particular memory systems of the brain may have a greater role to play in clinical depression and associated anxiety than is generally recognised. A common feature of electroconvulsive therapy (ECT) is that it affects patients' short-term memory adversely. However, in line with the hypothesis, it is suggested that the mechanism of action of successful ECT treatment is that it facilitates the repair and reactivation of particular memory systems. One link that has some bearing on this hypothesis is that of Omega 3 fish oil. It has in some cases been observed to aid recovery of depression and possibly prevent relapse. It has been shown to improve memory.

Imipramine Is Effective in Preventing Relapse in Electroconvulsive Therapy-Responsive Depressed Inpatients With Prior Pharmacotherapy Treatment Failure

To compare the efficacy of imipramine versus placebo in preventing relapse after successful electroconvulsive therapy (ECT) in depressive inpatients with pharmacotherapy treatment failure prior to ECT. During a 6-month period, the incidence of relapse was assessed. Two centers, both inpatient units for treatment of depressed patients, participated in this trial. Patients with DSM-IV-diagnosed major depressive disorder resistant to an anti-depressant and subsequent lithium addition and/or a monoamine oxidase inhibitor were included. Patients were randomly assigned to double-blind treatment with imipramine with adequate plasma levels (N=12) or placebo (N=15) after successful ECT. The mean imipramine dosage was 209 mg/day (standard deviation: 91.7, range: 75-325 mg/day). The main outcome measure was relapse defined as at least "moderately worse" compared with baseline score on the Clinical Global Impressions-Improvement scale. Treatments were compared with survival analysis using the Cox proportional hazards model, including psychotic features and the score on the Hamilton Rating Scale for Depression (HAM-D) at baseline as prespecified covariables. Patients were enrolled in the study from April 1997 to July 2001. In the placebo group, 80% (12/15) of the patients relapsed compared with 18% (2/11) in the imipramine group. The Cox regression analysis showed a significant reduction in the risk of relapse of 85.6% with imipramine compared to placebo (p=.007; 95% confidence interval [CI]=24.6% to 97.2%) adjusted for the covariables. There was an 18% increase in the relapse rate (p=.032; 95% CI=2% to 36%) per unit increase in HAM-D score before the start of the trial; psychotic features had no significant effect (p=.794). Depressed patients with pharmacotherapy treatment failure may benefit from the prophylactic effect of the same class of drug during maintenance therapy after response to ECT.

Time course of cerebral blood flow changes following electroconvulsive therapy in depressive patients-measured at 3 time points using single photon emission computed tomography

Although electroconvulsive therapy (ECT) has been employed for treating depression for more than 60 years, its mechanisms of action are yet unknown. To clarify the ECT effects on brain function, we examined cerebral blood flow (CBF) using single photon emission computed tomography at 3 time points--few days before an ECT course (Pre) and approximately 5 days (Post 1) and 1 month (Post 2) after the last ECT session. Eight depressive patients completed the study. In all the patients, the depressive symptoms improved after the ECT course, and major cognitive impairment was not observed at any time point. At Pre, the regional CBF (rCBF) in the widespread areas in the frontal lobe and limbic regions including cingulate cortex and parahippocampal gyrus was lower in the patients than in the normal controls. At Post 1 and Post 2, the rCBF in the frontal and limbic regions continued to be lower in the patients than in the controls although the successive recovery of decreased rCBF in the frontal region was observed. Regarding the time course among the patients, the rCBF in the right medial frontal region significantly increased (toward normal) at Post 2, not at Post 1. These findings suggest that depressive patients have decreased CBF in the frontal and limbic regions, and the medial frontal region plays a crucial role in ECT and recovery from depression. Further, patients who have undergone ECT treatment for depression should be carefully observed because brain functions continue to change even after a successful ECT course.

One-Year Outcome of Psychotic Depression After Successful Electroconvulsive Therapy

Psychotic depression is thought to have a higher relapse frequency after electroconvulsive therapy (ECT) compared with nonpsychotic depression, although this observation is contradicted by previous studies that have found the opposite. In this study, the 1-year risk of relapse after successful ECT was determined prospectively in patients with psychotic depression and compared with the risk of relapse observed for depressed patients without psychotic features. Fifty-nine responders to ECT (a decrease in Hamilton Rating Scale for Depression [HAM-D] score > or = 50%) were followed for 1 year: 29 with and 30 without psychotic features. Relapse was defined as meeting DSM-IV criteria for major depressive disorder and a HAM-D score > or = 16. The frequency of relapse after 4 and 12 months was compared between both samples, adjusted for the co-variables duration of the index episode and type of post-ECT pharmacotherapy. : At both 4 and 12 months after ECT, instances of relapse were significantly lower in patients with psychotic depression compared with nonpsychotic patients: 3/28 (11%) versus 16/27 (59%) and 4/27 (15%) versus 19/28 (68%), respectively. The main finding of the present study is the favorable 1-year outcome for patients with psychotic depression after response to ECT with a trend toward the same result at 4 months. The 1-year outcome of the total sample is also more favorable than expected.