Pretreatment Neurophysiologic Function and ECT Response in Depression

Stubbeman, William F.; Leuchter, Andrew F.; Cook, Ian A.; Shurman, Brett D; Morgan, Melinda; Günay, İbrahim; Gonzalez, Sergio Alejandro Lavandero

doi:10.1097/00124509-200409000-00004

Cited by 13 publications

(15 citation statements)

References 17 publications

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“…Placebo responders are reported to show a significant increase in prefrontal theta cordance, while both medication and placebo non-responders show no change . Similar findings to those for antidepressants have been shown by the UCLA group for electroconvulsive therapy (ECT) treatment (Stubbeman et al, 2004) and by a study from a Czech group regarding response to buproprion in 18 hospitalized depressed patients (Bares et al, 2010). In treatment refractory patients, in a pilot study in 12 depressed patients who had failed at least six weeks of SSRI monotherapy, five out of six responders, compared with two out of six non-responders to augmentation of switches of treatment, showed a decrease in prefrontal theta cordance .…”

Section: Antidepressant Effects On Theta 'Cordance'supporting

confidence: 78%

The use of the EEG in measuring therapeutic drug action: focus on depression and antidepressants

Alhaj

Wiśniewski²,

McAllister-Williams

2010

J Psychopharmacol

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A major issue in proof of concept studies and early clinical trials of novel therapeutic agents is that the active drugs can often have a relatively small additional effect compared with placebo. This is especially the case in psychiatry when we usually have no direct method of measuring the pathology underlying the disorder being studied but, rather, have to rely on the subjective assessment of psychiatric symptoms. The use of the electroencephalogram (EEG) offers two potential major means of addressing this problem. First it is able to provide direct data relating to neural activity that may be abnormal in certain disorders. As such there are opportunities for utilizing the EEG in a variety of ways as an objective outcome measure. Second there is growing evidence that in certain circumstances the EEG can be used to predict which patients are likely to respond to treatment, thus potentially increasing the power of studies by decreasing non-response rates and increasing mean changes in outcome measure. Both of these uses of the EEG are illustrated in reference to the study of mood disorders and in particular depression and its treatment with antidepressants.

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Section: Antidepressant Effects On Theta 'Cordance'supporting

confidence: 78%

The use of the EEG in measuring therapeutic drug action: focus on depression and antidepressants

Alhaj

Wiśniewski²,

McAllister-Williams

2010

J Psychopharmacol

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“…The remaining 1118 citations were screened on the basis of title and abstract; 1085 citations were excluded at this stage. Full‐text review was conducted on the 33 remaining citations, with 14 excluded at this stage: Eight studies did not have head to head comparisons of patients with BDD and/or MDD , three studies did not have measures of ECT efficacy , one study was a letter to the editor citing other included studies , and one study did not define response or remission criteria . Ultimately, 19 studies met our inclusion criteria.…”

Section: Resultsmentioning

confidence: 99%

ECT beyond unipolar major depression: systematic review and meta‐analysis of electroconvulsive therapy in bipolar depression

Bahji

Hawken

Sepehry

et al. 2018

Acta Psychiatr Scand

111

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ECT beyond unipolar major depression: systematic review and metaanalysis of electroconvulsive therapy in bipolar depression.Objective: In this systematic review and meta-analysis, the response, remission, and speed of response in adults with major depressive disorder (MDD) and bipolar disorder in depressive episode (BDD) receiving an acute course of electroconvulsive therapy (ECT) were quantitatively analyzed. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, 1660 citations were identified through five electronic databases. Nineteen articles met final inclusion criteria for meta-analysis. Results: The pooled response and remission rates with ECT in MDD were 74.2% (n = 1246/1680) and 52.3% (n = 850/1626), respectively. In BDD, they were 77.1% (n = 437/567) and 52.3% (n = 275/377), respectively. Although response rates to ECT were statistically higher in BDD (OR = 0.73, 95% CI: 0.56-0.95, P = 0.02), remission rates were similar (OR = 0.91, 95% CI: 0.65-1.26, P = 0.56). Individuals with BDD vs. MDD required fewer number of ECT sessions to achieve response (SMD = À0.23, 95% CI: À0.44 to À0.023, P = 0.03). There were no significant moderator effects identified. Conclusion: Response rates and speed of response are higher in individuals with BDD; however, remission rates are equivalent. These findings support increased utilization of ECT in individuals with treatment-refractory BDD. Summations• Electroconvulsive therapy is more effective for treating individuals with bipolar vs. unipolar major depression in terms of clinical response, but it was found to be equally effective for achieving remission. Moreover, a smaller number of ECT sessions was needed to achieve clinical response in BDD vs. MDD patients. Considerations• Studies reporting on remission rates were generally heterogeneous in assessing clinical outcomes. A variety of rating scales were applied for measuring response and remission rates. As well, there was a lack of data on outpatients. Furthermore, this meta-analysis synthesized non-randomized study designs rather than randomized controlled trials.

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“…Cordance is a continuous numerical measure of regional brain activity, described in a series of publications from our group and other independent, international researchers (e.g., Leuchter et al, 1999, 2002, 2004; Cook and Leuchter 2001; Cook et al, 2002, 2005; Stubbeman et al, 2004; Hunter et al, 2005, 2006, 2008; Bareš et al, 2007, 2008; Kopeček 2006, 2007, 2008; Morgan et al, 2007); it combines complementary information from absolute and relative power EEG spectral measures to yield a metric which had a stronger correlation with regional cerebral perfusion than either component alone (Leuchter et al, 1999), providing a physiologic framework for the interpretation of findings. These earlier studies examined an empirically-predefined region of interest (ROI) that included prefrontal EEG channels bilaterally and at the midline (FP1, FP2, and FPZ electrodes, figure 1a).…”

Section: Introductionmentioning

confidence: 99%

Midline and right frontal brain function as a physiologic biomarker of remission in major depression

Cook¹,

Hunter²,

Abrams³

et al. 2009

Psychiatry Research: Neuroimaging

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Prior investigations have reported that changes in the prefrontal electroencephalogram (EEG) precede symptom improvement from antidepressant medications, and could serve as a biomarker of treatment outcome in major depressive disorder (MDD). A new physiologically-defined region of interest, overlying the midline and right frontal (MRF) cortical area, was examined here for a relationship between early decreases in theta-band cordance and remission. Subjects were 72 adults with unipolar MDD who had completed placebo-controlled antidepressant treatment trials, with 37 randomized to medication and 35 to placebo. We assessed changes in cordance and absolute and relative power in the MRF region at 48 hours, 1 week, and 2 weeks after start of drug, as potential predictors of remission (final Ham-D 17 ≤5). Eleven of 37 medication subjects (30%) remitted vs 6 of 35 placebo subjects (17%). Change in MRF cordance one and two weeks after start of drug was significantly associated with remission in medication subjects (P=0.02 at 1 week), with Receiver Operating Characteristic (ROC) analysis yielding 0.76 area under the curve. Decreases in MRF cordance at 1 week predicted remission with medication with 69% overall accuracy (90% sensitivity; 60% specificity). MRF cordance changes were not associated with remission with placebo. Absolute and relative power did not differentiate groups. These results suggest that remission may be predictable from physiologic measurements after 1 week of treatment, and that this region merits further investigation in the neurobiology of treatment response.

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Pretreatment Neurophysiologic Function and ECT Response in Depression

Abstract: Depressed subjects with higher pretreatment central cordance appear to be more likely to experience therapeutic benefits of ECT. The location of central electrodes over the cingulate cortex may indicate that pretreatment cingulate activity is associated with response to ECT.

Cited by 13 publications

References 17 publications

The use of the EEG in measuring therapeutic drug action: focus on depression and antidepressants

The use of the EEG in measuring therapeutic drug action: focus on depression and antidepressants

ECT beyond unipolar major depression: systematic review and meta‐analysis of electroconvulsive therapy in bipolar depression

Midline and right frontal brain function as a physiologic biomarker of remission in major depression

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