The FDA and ECT

McDonald, William M.; Weiner, Richard D.; Fochtmann, Laura J.; McCall, W. Vaughn

doi:10.1097/yct.0000000000000326

Cited by 37 publications

(10 citation statements)

References 15 publications

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“…28 Because of its effectiveness in treating late-life depression, ECT has been considered as the gold standard treatment for older adults with antidepressant-resistant depression. [29][30][31] A recent review found that the response rate to ECT in late-life depression ranged from 60% to 80%, 32 which was considerably lower than the figures (80%-97.5%) found in this systematic review. The reason for this discrepancy is not clear.…”

Section: Discussioncontrasting

confidence: 58%

“…Further, the serum level of brain‐derived neurotrophic factor was significantly lower in depressed patients than in healthy controls, which could increase after ECT . Because of its effectiveness in treating late‐life depression, ECT has been considered as the gold standard treatment for older adults with antidepressant‐resistant depression …”

Section: Discussionmentioning

confidence: 99%

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Electroconvulsive therapy for older adult patients with major depressive disorder: a systematic review of randomized controlled trials

et al. 2018

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Section: Discussioncontrasting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Electroconvulsive therapy for older adult patients with major depressive disorder: a systematic review of randomized controlled trials

et al. 2018

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“…Despite the fact that the FDA mentioned “symptom severity” as well as “treatment‐resistance” (Barton, 2018), as criteria for using ECT, most ECT in western countries is used as a last resort for patients with several pharmacological treatment failures (Dudleston, 2019; McDonald, Weiner, Fochtmann, & McCall, 2016). The underuse of ECT in western countries was recently reviewed (Read, Cunliffe, Jauhar, & McLoughlin, 2019; Sackeim, 2017; Slade, Jahn, Regenold, & Case, 2017), and it was suggested that its underuse may reflect its image as a symbol of coercion, repression or stigma and may contribute to denying some of the most seriously ill depressed patients one of the most effective treatments for their condition (Read et al., 2019).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of electroconvulsive therapy in patients with “less treatment‐resistant” depression by the Maudsley Staging Model

Rosenheck

et al. 2020

Brain and Behavior

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Introduction Electroconvulsive therapy (ECT) is an effective treatment for patients with mood disorders and is most often used for treatment‐resistant cases. This study aimed to examine the effectiveness of ECT in a real‐world treatment sample in a Chinese psychiatric hospital which included both treatment‐resistant and nontreatment‐resistant patients. Methods An observational study of symptom outcomes from admission to the time of discharge was conducted with 37 inpatients diagnosed with unipolar or bipolar depression treated with ECT. Symptom severity was assessed with the 17‐item Hamilton Rating Scales for Depression (HRSD‐17) and treatment‐resistance with the Maudsley Staging Model (MSM). Stratifying at the MSM median admission characteristics and symptom change was compared between patients who were treatment‐resistant ( n = 18) and who were not ( n = 19). The outcome difference between groups was compared using analyses of covariance adjusted for baseline characteristics including symptom severity, followed by linear regression to identify factors associated symptom improvement in the entire sample. Results The sample ( n = 37) showed moderate treatment‐resistance (MSM = 7.30 ± 1.13) at admission and both groups received 8.3 ± 2 ECT sessions. The treatment‐resistant group had a smaller proportion of bipolar patients and more severe symptoms, but showed no significant difference from the nontreatment‐resistant group in HDRS‐17 scores at the time of discharge (adjusted means = 6.23 ± 1.00 vs. 5.94 ± 0.97, Partial η 2 = 0.001, p = .845). Baseline symptom severity was the strongest correlate of reduction in HDRS‐17 scores ( β = 0.891, p < .001). Conclusions Symptom change with ECT in depression did not differ by level of treatment‐resistance but was greatest among those with more severe baseline symptoms. Correlates of ECT effectiveness should be further evaluated in stratified randomized trials.

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“… 17 While the efficacy of ECT has been demonstrated since its early days, some patients still do not achieve remission and may present cognitive complaints, despite the refinement of the technique in terms of effectiveness and safety. 18 - 23 Repetitive transcranial magnetic stimulation is another effective non-invasive technique that has also received U.S. Food and Drug Administration (FDA) approval as a treatment for major depressive disorder. 24 , 25 …”

Section: Introductionmentioning

confidence: 99%

A narrative review on invasive brain stimulation for treatment-resistant depression

Dandekar

Diaz

Rahman

et al. 2022

Braz. J. Psychiatry

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While most patients with depression respond to pharmacotherapy and psychotherapy, about one-third will present treatment resistance to these interventions. For patients with treatment-resistant depression (TRD), invasive neurostimulation therapies such as vagus nerve stimulation, deep brain stimulation, and epidural cortical stimulation may be considered. We performed a narrative review of the published literature to identify papers discussing clinical studies with invasive neurostimulation therapies for TRD. After a database search and title and abstract screening, relevant English-language articles were analyzed. Vagus nerve stimulation, approved by the U.S. Food and Drug Administration as a TRD treatment, may take several months to show therapeutic benefits, and the average response rate varies from 15.2-83%. Deep brain stimulation studies have shown encouraging results, including rapid response rates (> 30%), despite conflicting findings from randomized controlled trials. Several brain regions, such as the subcallosal-cingulate gyrus, nucleus accumbens, ventral capsule/ventral striatum, anterior limb of the internal capsule, medial-forebrain bundle, lateral habenula, inferior-thalamic peduncle, and the bed-nucleus of the stria terminalis have been identified as key targets for TRD management. Epidural cortical stimulation, an invasive intervention with few reported cases, showed positive results (40-60% response), although more extensive trials are needed to confirm its potential in patients with TRD.

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The FDA and ECT

Cited by 37 publications

References 15 publications

Electroconvulsive therapy for older adult patients with major depressive disorder: a systematic review of randomized controlled trials

Electroconvulsive therapy for older adult patients with major depressive disorder: a systematic review of randomized controlled trials

Effectiveness of electroconvulsive therapy in patients with “less treatment‐resistant” depression by the Maudsley Staging Model

A narrative review on invasive brain stimulation for treatment-resistant depression

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