Sex-specifics of ECT outcome

Blanken, M A J T; Oudega, Mardien L.; Hoogendoorn, Adriaan W.; Sonnenberg, C S; Rhebergen, Didi; Klumpers, Ursula; Diermen, Linda van; Birkenhäger, Tom K.; Schrijvers, Didier; Redlich, Ronny; Dannlowski, Udo; Heindel, Walter; Coenjaerts, M; Nordanskog, Pia; Oltedal, Leif; Keßler, Ute; Frid, L M; Takamiya, Akihiro; Kishimoto, Toshifumi; Jørgensen, Martin Balslev; Jørgensen, A.; Bolwig, Tom G.; Emsell, Louise; Sienaert, Pascal; Bouckaert, Filip; Abbott, Christopher; Péran, P; Arbus, Christophe; Yrondi, Antoine; Kiebs, Maximilian; Philipsen, Alexandra; Waarde, Jeroen A. van; Prinsen, E; Verseveld, Mike van; Wingen, Guido van; Doesschate, Freek ten; Camprodon, Joan A.; Kritzer, M; Barbour, Tracy; Cardoner, Narcı́s; Urretavizcaya, Mikel; Soriano‐Mas, Carles; Narr, Katherine L.; Espinoza, Randall; Prudic, Joan; Rowny, Stefan B.; Eijndhoven, Ph van; Tendolkar, Indira; Dols, Annemiek

doi:10.1016/j.jad.2022.12.144

Cited by 11 publications

(8 citation statements)

References 26 publications

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“…The efficacy, safety and applicability of current ECT practices are the result of a series of improvements in treatment delivery, which have focused on preserving and improving efficacy (e.g., by adjusting ECT electrical dose, stimulus parameters and/or electrode placement), while minimizing the potential cognitive side effects (e.g., [ 13 , 14 ]). Moreover, these parameters have to be adjusted by age and sex, since previous studies reported variations in the electrical charge needed to induce an effective convulsion (e.g., [ 15 – 19 ]): for example, women seem to require less charge than men of the same age to induce an optimal seizure, and for both sexes the charge needs to be increased with age (e.g., [ 20 ]). Interestingly, these differences can be modeled in experimental rodents through the induction of electroconvulsive seizures (ECS).…”

Section: Introductionmentioning

confidence: 99%

Comparing the antidepressant-like effects of electroconvulsive seizures in adolescent and adult female rats: an intensity dose–response study

Ledesma-Corvi,

García-Fuster

2023

Biol Sex Differ

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Background The induction of electroconvulsive seizures (ECS) in rodents induces sex- and age-specific disparities in antidepressant-like responses, with females and young age being the most unresponsive ones. Since the electrical charge needed to induce an effective convulsion is also altered by these variables, our aim was to compare different dose-intensities of ECS exclusively in female rats, since there is a lack of preclinical data characterizing this particular sex, while also evaluating efficacy during distinctive age periods of treatment (adolescence vs. adulthood). Methods Adolescent and adult female Sprague–Dawley rats were exposed to an intensity dose–response study (55, 75 or 95 mA; 0.6 s, 100 Hz, 1 session/day, 5 days). The particular characteristics of the induced convulsions (tonic, clonic, recovery times) were monitored during treatment. Antidepressant-like responses were evaluated under the stress of the forced-swim test 1-, 3-, and 7-days post-treatment (i.e., improved immobility time as an indicative of an antidepressant-like response), and brains were collected 24 h later (8 days post-treatment) to evaluate potential changes in hippocampal neurogenesis (Ki-67 and NeuroD) by immunohistochemistry. Results The lowest intensities tested of ECS (55 and 75 mA) induced an antidepressant-like effect in adult female rats, but rendered insufficient in adolescence. The lack of efficacy observed in adolescent rats paralleled differences in the characteristics of the seizures induced by ECS as compared to adulthood. In line with prior results, different dose-intensities of ECS modulated hippocampal neurogenesis in a comparable fashion with age (i.e., increased survival of neural progenitors 8 days post-treatment). Conclusions In conjunction, these results reinforce the importance of fine-tuning the parameters of ECS that might render efficacious while considering sex and age as essential variables for treatment response, and suggest that other molecular mechanisms, beside the partial role of hippocampal neurogenesis, might be participating in the antidepressant-like effects induced by ECS.

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Section: Introductionmentioning

confidence: 99%

Comparing the antidepressant-like effects of electroconvulsive seizures in adolescent and adult female rats: an intensity dose–response study

Ledesma-Corvi,

García-Fuster

2023

Biol Sex Differ

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“…The community-based ECT study of Prudic et al revealed an average age of 57 years, with 63% female patients ( Prudic et al, 2004 ). Clinical data from 20 independent international sites also showed an average age of 55 years and 59% women ( Blanken et al, 2023 ). Typically, depression is more prevalent in women, resulting in women constituting about two-thirds of ECT recipients as seen by previously reported studies ( Slade et al, 2017 ; Wilkinson et al, 2018 ; Luccarelli et al, 2020 ; Kaster et al, 2021 ).…”

Section: Populationmentioning

confidence: 98%

“…Furthermore, patient characteristics, such as gender distribution and average age, offer valuable insights into cohort representativeness, regardless of their direct impact on the outcome. Notably, ECT appears equally effective in both genders and more effective in older individuals ( Zorumski et al, 1986 ; O’Connor et al, 2001 ; Brus et al, 2017 ; Ekstrand et al, 2022 ; Blanken et al, 2023 ). The community-based ECT study of Prudic et al revealed an average age of 57 years, with 63% female patients ( Prudic et al, 2004 ).…”

Section: Populationmentioning

confidence: 99%

Ketamine or ECT? What Have We Learned From the KetECT and ELEKT-D Trials?

Ekstrand,

Takamiya,

Nordenskjold

et al. 2023

International Journal of Neuropsychopharmacology

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Two recent clinical trials, KetECT and ELEKT-D, compared the effectiveness of ketamine and electroconvulsive therapy (ECT) for major depressive disorder. Notably, these trials reported marked differences in ECT’s clinical outcomes of, with remission rates of 63% for KetECT and a strikingly lower rate of 22% for ELEKT-D, while the remission rates for ketamine were 46% and 38%, respectively. Considering that the primary objective of both trials was to compare the standard treatment (ECT) with an experimental intervention (ketamine), it is crucial to highlight the pronounced disparities in ECT’s clinical outcomes. This article offers a comprehensive comparison of these trials while also exploring how patient characteristics, treatment protocols, and study designs may contribute to such pronounced outcome discrepancies. These differences highlight the heterogeneous nature of depression and underscore the need for personalized treatments. These studies also provide valuable insights into identifying the most suitable candidates for ketamine and ECT.

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“… 11 With regard to non-pharmacological treatments, sex-specific research on TRD treatment effectiveness remains limited. While one study found that electroconvulsive therapy (ECT) for MDD yielded equally effective outcomes in both sexes, 20 another study identified interleukin-6 as a significant predictor of antidepressant effects for females but not males with TRD. 16 …”

Section: Introductionmentioning

confidence: 99%

Sex Differences in the Antidepressant and Neurocognitive Effects of Nonconvulsive Electrotherapy in Patients with Treatment-Refractory Depression

Zhang,

Wei,

et al. 2024

ALPHA PSYCHIATRY

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Objective: The objective of this study was to examine sex differences in the antidepressant and neurocognitive effects of adjunctive nonconvulsive electrotherapy (NET) in patients with treatment-refractory depression (TRD), which has not yet been thoroughly investigated. Methods: The study enrolled 20 patients with TRD, comprising 11 males and 9 females, who underwent a series of 6 NET sessions. The 17-item Hamilton Depression Rating Scale (HAMD-17) was used to assess depressive symptoms, response, and remission at baseline and after the first, third, and sixth NET sessions. The Wisconsin Card Sorting Test (WCST) was used to assess neurocognitive function at baseline and after the sixth NET session. Results: After completing 6 NET sessions, female patients experiencing TRD exhibited a higher inclination toward achieving an antidepressant response (77.8% vs. 45.5%, P = .197) and antidepressant remission (22.2% vs. 0%, P = .189) when compared to their male counterparts. No significant differences were observed in changes in the HAMD-17 and WCST subscale scores (all P > .05), including completing classification number, total error number, persistent error number, and random error number between males and females. Additionally, no significant correlations were observed between baseline WCST subscale scores and changes in HAMD-17 scores or endpoint scores, irrespective of sex (all P > .05). Conclusion: These pilot findings suggest that female patients with TRD exhibited increased rates of achieving antidepressant response and remission after undergoing NET. However, further studies should be conducted to confirm these findings.

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Sex-specifics of ECT outcome

Cited by 11 publications

References 26 publications

Comparing the antidepressant-like effects of electroconvulsive seizures in adolescent and adult female rats: an intensity dose–response study

Comparing the antidepressant-like effects of electroconvulsive seizures in adolescent and adult female rats: an intensity dose–response study

Ketamine or ECT? What Have We Learned From the KetECT and ELEKT-D Trials?

Sex Differences in the Antidepressant and Neurocognitive Effects of Nonconvulsive Electrotherapy in Patients with Treatment-Refractory Depression

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