Unilateral ultra-brief pulse electroconvulsive therapy for depression in Parkinson's disease

Williams, Nolan; Bentzley, Brandon S.; Sahlem, Gregory L.; Pannu, Jaspreet; Korte, Jeffrey E.; Revuelta, Gonzalo J.; Short, E. Baron; George, Mark S.

doi:10.1111/ane.12614

Cited by 20 publications

(18 citation statements)

References 33 publications

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“…Improvement in general cognitive functioning, assessed using MMSE, was also reported in an elderly depressed cohort 37,38 . Some studies reported disorientation and confusion in patients with PD directly after ECT, 23,24,27,33 but these side effects were transient. Moreover, recent methodological advancement in ECT, such as adjustments for electrode placement 40,41 and pulse width, 42 can reduce cognitive side effects.…”

Section: Discussionmentioning

confidence: 83%

“…The literature search yielded 1219 articles. Of these, 117 were fully inspected, 103 were removed, and 14 studies [22][23][24][25][26][27][28][29][30][31][32][33][34][35] met the inclusion criteria for our analysis. The complete details of the search results, including the reasons for exclusion, are shown in Supplementary Figure S1.…”

Section: Resultsmentioning

confidence: 99%

“…Indeed, one study included in our metaanalysis used right unilateral ultra-brief pulse ECT, and it reported on ECT's efficacy on motor and non-motor symptoms with no cognitive side effects. 34…”

Section: Effect Of Ect On Cognitive Functionmentioning

confidence: 99%

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Electroconvulsive Therapy for Parkinson's Disease: A Systematic Review and Meta‐Analysis

et al. 2020

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Background Electroconvulsive therapy (ECT) is a well‐established treatment for psychiatric disorders, including depression and psychosis. ECT has been reported to be effective in treating such psychiatric symptoms in patients with Parkinson's disease (PD) and has been also reported to be effective in treating motor symptoms. The aim of the study is to summarize previous clinical studies investigating the efficacy of ECT for symptoms in patients with PD. Methods A systematic review and meta‐analysis of any study designs assessing motor and/or non‐motor symptoms in patients with PD before and after ECT. Co‐primary outcomes were set as motor manifestations assessed using the Unified Parkinson's Disease Rating Scale or other rating scales, and non‐motor symptoms included depression and psychosis. Secondary outcomes were wearing‐off phenomenon and cognitive function. The impact of ECT on those symptoms was examined by comparing the severity of the symptoms before and after ECT using a random effect model and was expressed in standardized mean difference. Results Of 1219 identified citations, 14 studies (n = 129; 1 randomized controlled study, 9 prospective observational studies, and 4 retrospective studies) were analyzed. The findings were as follows: ECT significantly improved motor manifestations in patients with PD, and the improvement was significant in the subpopulation without psychiatric symptoms; ECT significantly improved depression and psychosis; and ECT significantly relieved wearing‐off phenomenon and did not worsen cognitive functioning. Conclusion The current meta‐analysis suggests the potential benefit of ECT on motor and non‐motor symptoms in presumably complicated and difficult‐to‐treat subgroups. © 2020 International Parkinson and Movement Disorder Society

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Section: Discussionmentioning

confidence: 83%

Section: Resultsmentioning

confidence: 99%

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Electroconvulsive Therapy for Parkinson's Disease: A Systematic Review and Meta‐Analysis

et al. 2020

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“…Conventional repetitive transcranial magnetic stimulation (rTMS) has been used to investigate functional connectivity changes that occur with remission (7); however, conventional rTMS also requires several weeks to induce remission with less than half of patients remitting (8). Electroconvulsive therapy (ECT) has greater efficacy and more rapid onset of action than antidepressant medications; however, mean onset is still >2 weeks (9), open-label remission rates occur in only 50-65% of patients (5), and there are numerous significant off-target effects, including cognitive disturbances (10) and effects on the motor system (11), making it difficult to determine which network changes are specific to remission from depression. Ketamine induces brief remission rapidly but only in a third of patients (12,13) and with significant off-target effects (14,15).…”

Section: Introductionmentioning

confidence: 99%

Functional connectivity changes with rapid remission from moderate-to-severe major depressive disorder

Xiao

Bentzley

Cole

et al. 2019

Preprint

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NRW and KDS have filed intellectual property on the methodology discussed in this manuscript.Major depressive disorder is common and debilitating. It has been difficult to study the brain changes associated with recovery from depression, because treatments take weeks-to-months to become effective, and symptoms fail to resolve in many people. We recently developed a type of magnetic brain stimulation called SAINT. SAINT leads to full remission from depression in 90% of people within 5 days. We used SAINT and functional magnetic resonance imaging to determine how the brain changes with rapid remission from depression. We found changes in areas of the brain associated with emotion regulation. This provides a significantly clearer picture of how the non-depressed brain differs from the depressed brain, which can be used to develop rapid and effective treatments for depression.

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“…ECT has been tested in numerous populations including MS, PD, various endocrinological disorders and renal failure, demonstrating similar efficacy compared to the general population. It may be particularly beneficial for PD with comorbid MDD, as ECT is effective to treat depressive symptoms as well as the core symptoms and functional outcomes of PD (Borisovskaya et al, 2016;Williams et al, 2017). While there are no absolute contraindications for ECT, caution should be exercised with a history of stroke or MI in the past 6 months or with pre-morbid significant cognitive impairment.…”

Section: Brain Stimulation and Convulsive Therapies In The Medically Illmentioning

confidence: 99%

Depression in the medically ill

Rosenblat

Kurdyak

Cosci

et al. 2019

Aust N Z J Psychiatry

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Background: Depressive disorders are significantly more common in the medically ill compared to the general population. Depression is associated with worsening of physical symptoms, greater healthcare utilization and poorer treatment adherence. The present paper provides a critical review on the assessment and management of depression in the medically ill. Methods: Relevant articles pertaining to depression in the medically ill were identified, reviewed and synthesized qualitatively. A systematic review was not performed due to the large breadth of this topic, making a meaningful summary of all published and unpublished studies not feasible. Notable studies were reviewed and synthesized by a diverse set of experts to provide a balanced summary. Results: Depression is frequently under-recognized in medical settings. Differential diagnoses include delirium, personality disorders and depressive disorders secondary to substances, medications or another medical condition. Depressive symptoms in the context of an adjustment disorder should be initially managed by supportive psychological approaches. Once a mild to moderate major depressive episode is identified, a stepped care approach should be implemented, starting with general psychoeducation, psychosocial interventions and ongoing monitoring. For moderate to severe symptoms, or mild symptoms that are not responding to low-intensity interventions, the use of antidepressants or higher intensity psychotherapeutic interventions should be considered. Psychotherapeutic interventions have demonstrated benefits with small to moderate effect sizes. Antidepressant medications have also demonstrated benefits with moderate effect sizes; however, special caution is needed in evaluating side effects, drug–drug interactions as well as dose adjustments due to impairment in hepatic metabolism and/or renal clearance. Novel interventions for the treatment of depression and other illness-related psychological symptoms (e.g. death anxiety, loss of dignity) are under investigation. Limitations: Non-systematic review of the literature. Conclusion: Replicated evidence has demonstrated a bidirectional interaction between depression and medical illness. Screening and stepped care using pharmacological and non-pharmacological interventions is merited.

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Unilateral ultra-brief pulse electroconvulsive therapy for depression in Parkinson's disease

Cited by 20 publications

References 33 publications

Electroconvulsive Therapy for Parkinson's Disease: A Systematic Review and Meta‐Analysis

Electroconvulsive Therapy for Parkinson's Disease: A Systematic Review and Meta‐Analysis

Functional connectivity changes with rapid remission from moderate-to-severe major depressive disorder

Depression in the medically ill

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