Effects of Stimulus Intensity and Electrode Placement on the Efficacy and Cognitive Effects of Electroconvulsive Therapy

Sackeïm, Harold A.; Prudic, Joan; Devanand, D. P.; Kiersky, Judith E.; Fitzsimons, Linda; Moody, Bobba J.; McElhiney, Martin; Coleman, Eliza; Settembrino, Joy M.

doi:10.1056/nejm199303253281204

Cited by 855 publications

(496 citation statements)

References 26 publications

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“…While we agree with most of their findings, we would like to add an important interpretation of their results, as it relates to clinical practice: while the group data suggest an equivalent overall antidepressant efficacy rate for the two techniques, at the individual patient level, the approximately half of all patients who do not remit with right unilateral electrode placement should be crossed over to bilateral (Sackeim et al 1993. While the randomized trial data for this assertion are few, crossover to bilateral electrode placement is a nearly ubiquitous clinical practice that has been employed successfully for many thousands of patients worldwide (Lapidus & Kellner, 2011).…”

supporting

confidence: 75%

Letter to the Editor: Electrode placement in electroconvulsive therapy – bilateral is still the ‘gold standard’ for some patients

Kellner

Çiçek²,

Ables

2017

Psychol. Med.

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supporting

confidence: 75%

Letter to the Editor: Electrode placement in electroconvulsive therapy – bilateral is still the ‘gold standard’ for some patients

Kellner

Çiçek²,

Ables

2017

Psychol. Med.

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“…A description of the battery and the derived outcome measures are presented in Table 1. The modified MiniMental State exam (mMMS) (Stern et al, 1987), a measure of global cognitive status and an expanded version (range 0-57) of the original MMS (Folstein et al, 1975), has shown sensitivity to variation in ECT technique (Sackeim et al, 1993. Psychomotor function was assessed with three measures of reaction time (RT): Simple (SRT) (Benton, 1977), Choice (CRT) (Benton and Blackburn, 1957), and Stroop RT (MacLeod, 1991).…”

Section: Study Measuresmentioning

confidence: 99%

“…Randomized-controlled trials have shown more severe short-term memory deficits with sine wave compared to brief pulse stimulation (Valentine et al, 1968;Weiner et al, 1986), bilateral (BL) compared to right unilateral (RUL) electrode placement (Lancaster et al, 1958;Sackeim et al, 1986;Sackeim et al, 1993;Sackeim et al, 2000), and higher electrical dosage (McCall et al, 2000;Ottosson, 1960;Sackeim et al, 1993). These adverse effects are reduced by the use of RUL ECT with brief or ultrabrief pulse stimulation and electrical dosage titrated to the needs of the individual patient (Sackeim, 2004b).…”

Section: Introductionmentioning

confidence: 99%

The Cognitive Effects of Electroconvulsive Therapy in Community Settings

Sackeïm

Prudic

Fuller

et al. 2006

Neuropsychopharmacol

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488

370

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Despite ongoing controversy, there has never been a large-scale, prospective study of the cognitive effects of electroconvulsive therapy (ECT). We conducted a prospective, naturalistic, longitudinal study of clinical and cognitive outcomes in patients with major depression treated at seven facilities in the New York City metropolitan area. Of 751 patients referred for ECT with a provisional diagnosis of a depressive disorder, 347 patients were eligible and participated in at least one post-ECT outcome evaluation. The primary outcome measures, Modified Mini-Mental State exam scores, delayed recall scores from the Buschke Selective Reminding Test, and retrograde amnesia scores from the Columbia University Autobiographical Memory Interview-SF (AMI-SF), were evaluated shortly following the ECT course and 6 months later. A substantial number of secondary cognitive measures were also administered. The seven sites differed significantly in cognitive outcomes both immediately and 6 months following ECT, even when controlling for patient characteristics. Electrical waveform and electrode placement had marked cognitive effects. Sine wave stimulation resulted in pronounced slowing of reaction time, both immediately and 6 months following ECT. Bilateral (BL) ECT resulted in more severe and persisting retrograde amnesia than right unilateral ECT. Advancing age, lower premorbid intellectual function, and female gender were associated with greater cognitive deficits. Thus, adverse cognitive effects were detected 6 months following the acute treatment course. Cognitive outcomes varied across treatment facilities and differences in ECT technique largely accounted for these differences. Sine wave stimulation and BL electrode placement resulted in more severe and persistent deficits.

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“…In contrast to functional imaging studies of conventional antidepressant medications, pramipexole did not alter metabolism in the amygdala but did increase activity in the premotor cortex, hippocampus, posterior cingulate cortex, and superior temporal gyrus. 112 For electroconvulsive therapy (ECT), the most effective acute depression treatment to date, good clinical response is associated with electrode placement over the PFC 113 and with relatively decreased activity after treatment in the PFC, anterior cingulate, and temporal and parietal cortices. 39,114 Cognitive behavioral therapy (CBT) and interpersonal therapy (IPT), two forms of psychotherapy studied for efficacy in the treatment of depression, have effects on affective circuitry that are distinct from those of antidepressant medication.…”

Section: Presumptive Mood Disorder Circuitsmentioning

confidence: 99%

Neural circuitry and neuroplasticity in mood disorders: Insights for novel therapeutic targets

Carlson¹,

Singh²,

Zarate³

et al. 2006

NeuroRX

136

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Summary:Major depressive disorder and bipolar disorder are severe mood disorders that affect the lives and functioning of millions each year. The majority of previous neurobiological research and standard pharmacotherapy regimens have approached these illnesses as purely neurochemical disorders, with particular focus on the monoaminergic neurotransmitter systems. Not altogether surprisingly, these treatments are inadequate for many individuals afflicted with these devastating illnesses. Recent advances in functional brain imaging have identified critical neural circuits involving the amygdala and other limbic structures, prefrontal cortical regions, thalamus, and basal ganglia that modulate emotional behavior and are disturbed in primary and secondary mood disorders. Growing evidence suggests that mechanisms of neural plasticity and cellular resilience, including impairments of neurotrophic signaling cascades as well as altered glutamatergic and glucocorticoid signaling, underlie the dysregulation in these circuits. The increasing ability to monitor and modulate activity in these circuits is beginning to yield greater insight into the neurobiological basis of mood disorders. Modulation of dysregulated activity in these affective circuits via pharmacological agents that enhance neuronal resilience and plasticity, and possibly via emerging nonpharmacologic, circuitry-based modalities (for example, deep brain stimulation, magnetic stimulation, or vagus nerve stimulation) offers promising targets for novel experimental therapeutics in the treatment of mood disorders.

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Effects of Stimulus Intensity and Electrode Placement on the Efficacy and Cognitive Effects of Electroconvulsive Therapy

Cited by 855 publications

References 26 publications

Letter to the Editor: Electrode placement in electroconvulsive therapy – bilateral is still the ‘gold standard’ for some patients

Letter to the Editor: Electrode placement in electroconvulsive therapy – bilateral is still the ‘gold standard’ for some patients

The Cognitive Effects of Electroconvulsive Therapy in Community Settings

Neural circuitry and neuroplasticity in mood disorders: Insights for novel therapeutic targets

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