Electroconvulsive Therapy in Mania: A Review of 80 Years of Clinical Experience

Elias, Alby; Thomas, Naveen; Sackeïm, Harold A.

doi:10.1176/appi.ajp.2020.20030238

Cited by 45 publications

(46 citation statements)

References 87 publications

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“…In addition, psychiatrists can improve the efficacy of ECT by changing the stimulation power, using different stimulation sites, changing the stimulation mode, etc. [ 22 , 51 ]. Therefore, we hope that when anesthesiologists evaluate patients, they will pay attention to and address these risk factors to further improve the efficacy of ECT.…”

Section: Discussionmentioning

confidence: 99%

Focal points of preanesthesia evaluations for electroconvulsive therapy in patients with depression: a retrospective analysis of clinical characteristics in nonremission

Zou

Chen

et al. 2022

BMC Anesthesiol

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Background This study explored the patient clinical characteristics that may affect electroconvulsive therapy (ECT) efficacy to enable improved focus during evaluations and preparation for ECT. Methods Patients were enrolled for ECT at the Department of Psychiatry and Anesthesiology of the First Affiliated Hospital of Chongqing Medical University from December 2017 to January 2019. The primary outcome in our study was defined as the development of nonremission. A multivariate logistic analysis was performed to identify the risk factors for nonremission. Results In total, 874 depressed patients were included in the study. After the ECT treatment, 255 cases (29.2%) exhibited nonremission. A multivariate logistic regression analysis of the variables was performed, and the results showed that atherosclerosis (OR 8.072, 95% CI 2.442 to 16.675; P = 0.001), COPD (OR 2.919, 95% CI 1.240 to 6.871; P = 0.014), diabetes (OR 2.202, 95% CI 1.115 to 4.348; P = 0.023) and smoking (OR 1.519, 95% CI 1.015 to 2.273; P = 0.042) were independent risk factors for nonremission. Conclusion In the retrospective analysis, we found that atherosclerosis, diabetes, COPD and smoking may be high-risk factors for nonremission.

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Section: Discussionmentioning

confidence: 99%

Focal points of preanesthesia evaluations for electroconvulsive therapy in patients with depression: a retrospective analysis of clinical characteristics in nonremission

Zou

Chen

et al. 2022

BMC Anesthesiol

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“…These remarkable efficacy data of ECT were mainly found in the predominant indication of therapy-resistant depression and have stimulated ECT to be used successfully in a variety of mental and neurological disorders such as first-episode schizophrenia ( Grover et al, 2019 ), acute mania ( Zhang et al, 2021 ), during the early stages of antidepressive treatment ( Haq et al, 2015 ; van Diermen et al, 2018 ), for motor and behavioral symptoms of Parkinson’s disease ( Takamiya et al, 2021 ), and for sustaining mood improvement in geriatric depression ( Kellner et al, 2016 ). Furthermore, ECT is particularly effective in patients with depression, including psychotic features and elderly people with depression ( van Diermen et al, 2018 ), to be beneficial as an augmenting strategy in treatment-resistant schizophrenia ( Grover et al, 2019 ; Sinclair et al, 2019 ; Chiu et al, 2020 ) with maintenance ECT providing an effective form of relapse prevention ( Ward et al, 2018 ), in mania ( Elias et al, 2021 ), catatonia ( Kellner et al, 2020 ), severe agitation ( Grover et al, 2019 ), specific mental disorders in multiple sclerosis ( Yahya and Khawaja, 2021 ), and prepartum and postpartum psychotic states ( Gazdag et al, 2009 ). Even for children and adolescents, no absolute contra indications for ECT have been seen ( Døssing and Pagsberg, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

“…Despite this and other extensive evidence of significant therapeutic effects of ECT in various mental disorders ( Gazdag et al, 2009 ; van Diermen et al, 2018 ; Grover et al, 2019 ; Sinclair et al, 2019 ; Chiu et al, 2020 ; Kellner et al, 2020 ; Elias et al, 2021 ; Yahya and Khawaja, 2021 ), from children ( Døssing and Pagsberg, 2021 ) to the elderly ( Kellner et al, 2016 ; McCall et al, 2018 ), both short and long term ( Ward et al, 2018 ), ECT experts judge that ECT is highly underutilized. Indeed, ECT is mainly used as one of the last treatment options for patients with depression and schizophrenia.…”

Section: Introductionmentioning

confidence: 99%

Risk Assessment of Electroconvulsive Therapy in Clinical Routine: A 3-Year Analysis of Life-Threatening Events in More Than 3,000 Treatment Sessions

Hajak

Hajak²,

Ziegelmayer³

et al. 2021

Front. Psychol.

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Background: Extensive research has reported that electroconvulsive therapy (ECT) can be highly effective in approximately 80% of patients suffering from depression. Its clinical use is mainly limited by historical objections and the concern about unwanted adverse effects (AEs), including serious and potentially life-threatening adverse events (pLTAEs), induced either by ECT or by anesthesia. Objective risk estimation is, therefore, a decisive factor in determining an indication for ECT.Methods: This paper presents a retrospective analysis of 3-year safety protocols and patient files of 157 patients who received a total of 3,106 ECT applications in a psychiatric inpatient setting at a psychiatric community hospital. This patient group comprises 5.3% of inpatients admitted with comparable diagnoses. Adverse events were analyzed from standardized safety protocols and patient files with a focus on pLTAEs.Results: Adverse events were reported for 30 (19.1%) of the 157 participants during 39 (6.1%) of 641 hospital stays. Serious pLTAEs occurred during three electroconvulsive stimulations in three patients, who needed action through the administration of medication or mechanical respiration. No patient suffered permanent damage to health, and no patient died. The incidence of these and other AEs was independent of sex, age, and diagnosis of patients, and anesthesia medication. Minor AEs occurred more often with higher stimulus doses and an increasing number of treatments.Conclusion: The low incidence rate of 0.097% of serious pLTAEs that require medical action may allow the conclusion that ECT is a rather safe treatment when performed in a controlled setting. The beneficial risk profile of ECT performed in the standard care of psychiatric hospitals suggests a more generous indication of this treatment method. We recommend that ECT facilities collect individual safety data to allow a reliable judgment of their institutional ECT risk profile.

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“…Drs. Alby Elias and Naveen Thomas from the University of Melbourne and Dr. Harold Sackeim from Columbia University focus on the use of ECT for treatment-resistant mania by comprehensively reviewing the literature and discussing the optimal ECT parameters for treating mania (1). In another article, Dr. Leanne McCloskey from Northwestern University and her colleagues present a primer on the use of contraceptives in women with psychiatric disorders (2).…”

Section: Pragmatic Issues Important To Clinical Practicementioning

confidence: 99%

Improving Treatment Outcomes Includes Increasing the Diversity of the Psychiatric Workforce

Kalin

2021

AJP

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Electroconvulsive Therapy in Mania: A Review of 80 Years of Clinical Experience

Cited by 45 publications

References 87 publications

Focal points of preanesthesia evaluations for electroconvulsive therapy in patients with depression: a retrospective analysis of clinical characteristics in nonremission

Focal points of preanesthesia evaluations for electroconvulsive therapy in patients with depression: a retrospective analysis of clinical characteristics in nonremission

Risk Assessment of Electroconvulsive Therapy in Clinical Routine: A 3-Year Analysis of Life-Threatening Events in More Than 3,000 Treatment Sessions

Improving Treatment Outcomes Includes Increasing the Diversity of the Psychiatric Workforce

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