What was learned: studies by the consortium for research in<scp>ECT</scp>(<scp>CORE</scp>) 1997–2011

Fink, Max

doi:10.1111/acps.12251

Cited by 88 publications

(50 citation statements)

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“…4,33 In conclusion, ECT seems to display similar efficacy for both MDD and BD depression, with few differences in the rapidity of the response and the residual symptoms. These differences might be related to other course characteristics, such as the duration of the episode and interepisodic symptoms, rather than the polarity itself.…”

Section: Ect In Bd Depressionmentioning

confidence: 89%

The Mood-Stabilizing Effects of Electroconvulsive Therapy

Medda¹,

Toni²,

Perugi³

2014

The Journal of ECT

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The "ideal" mood stabilizer has been defined as an agent displaying demonstrated efficacy for the acute treatment and long-term prevention of both mania and depression. On the basis of a selective and an extensive review of the existing literature primarily focused on prospective and controlled studies, we discuss the potential mood-stabilizing effects of electroconvulsive therapy (ECT) and its efficacy for the acute treatment of bipolar depressive and mixed-manic states and the prevention of all types of recurrences of bipolar disorder (BD). We conclude that ECT should be considered an effective acute treatment for the depressive and manic-mixed states of BD, as ECT displays response and remission rates superior to those of other treatment approaches, even in severe and treatment-resistant cases. From this point of view, its clinical mood-stabilizing effects are clearly superior compared with other pharmacological approaches because most treatments that alleviate bipolar depression can cause mania, hypomania, mood instability, or rapid cycling and treatments that can control mania can induce or precipitate depressive symptoms or episodes. The ECT-induced mania is rare, and there are no data suggesting possible long-term mood destabilization, including cycle induction or acceleration. Conversely, several case reports and open trials reported a significant reduction in morbidity among patients experiencing rapid-cycling BD. Regarding relapse prevention, c-ECT and m-ECT are considered as appropriate therapies for treatment-resistant patients exhibiting high rates of depressive or mixed relapse. Further investigation is necessary to identify the frequency and duration of continued treatment after a successful index course of ECT.

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Section: Ect In Bd Depressionmentioning

confidence: 89%

The Mood-Stabilizing Effects of Electroconvulsive Therapy

Medda¹,

Toni²,

Perugi³

2014

The Journal of ECT

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“…Although various studies have found ECT to be effective in the treatment of severe and treatmentresistant depression, [4][5][6][7][8][9] there are many adverse effects that are associated with ECT, such as long-term cognitive deficits; 10 retrograde amnesia, semantic and lexical memory loss; 11 and prolonged seizures 12 or status epilepticus. 13 Although we know that patients with depression who cannot tolerate pharmacotherapy, 5 those who are resistant to drug therapy, 5 or those who have severe depression 6 are good candidates to receive ECT, no study, to our knowledge, has elucidated the independent predictors of the eventual need for ECT.…”

Section: Discussionmentioning

confidence: 99%

Indicators for Electroconvulsive Therapy among Patients Hospitalized for Depression

Suri¹,

Adil²,

Qureshi³

et al. 2015

Psychiatric Annals

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This article compares various characteristics, including demographics, comorbid conditions, hospital status, and outcomes, in patients with major depression who received electroconvulsive therapy (ECT) versus those who did not. It seeks to determine if dyslipidemia is an indicator for ECT among patients hospitalized for depression. Data from all patients admitted to US hospitals between 2009 and 2010 with a primary discharge diagnosis of depression were included. We compared patients with depression who received ECT with those who did not. A logistic regression analysis was used to identify the association between patient and hospital characteristics and odds of receiving ECT. All variables that were significant in the univariate analysis were added as predictor variables to the stepwise logistic regression model. A total of 925,060 patients with depression were included. Of these, 20,251 (2.2%) underwent ECT. In the stepwise logistic regression, female gender (odds ratio [OR] 1.3, 95% confidence interval [CI] 1.2-1.5), white ethnicity (OR 1.8, 95% CI 1.2-2.5), and dyslipidemia (OR 1.3, 95% CI 1.0-1.6) were associated with receiving ECT among the patients with major depression. Large-sized hospitals (OR 1.9, 95% CI 1.2-2.9) and teaching hospitals (OR 3.2, 95% CI 2.1-4.8) were more likely to use ECT.

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“…If no maintenance treatment is offered, the relapse rate is also very high: almost half of all patients relapse, despite receiving pharmacotherapies, with the first 6 months being the period of greatest vulnerability (Jelovac et al 2013, Fink 2014). …”

Section: Ect In Depressionmentioning

confidence: 99%

On electroconvulsive therapy in depression : Clinical, cognitive and neurobiological aspects

Nordanskog¹

2015

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Electroconvulsive therapy (ECT) is used worldwide to treat severe mental disorders. The most common mental disorder, and the third leading cause of disease burden in the world is depression. The clinical efficacy of ECT for severe depression is well-established. However, both the pathophysiology of depression and the mechanism of action of ECT remain elusive. The main aims of this thesis are to address the following issues: 1) the use and practice of ECT in Sweden has not been systematically evaluated since 1975, 2) cognitive side-effects (memory disturbances) are a major concern with ECT and 3) the mechanism of action of ECT remain elusive. The neurobiological aspects of ECT focus on two hypotheses. First, the recent years´ preclinical studies that have provided evidence that ECT induces hippocampal cell proliferation, including neurogenesis. Second, that enhanced functional inhibition of neuronal activity is a key feature. Current use and practice of ECT in Sweden (paper I) is based on data from the national quality register for ECT, the mandatory patient register of the National Board of Health and Welfare and a survey. Treated person rate (TPR) in Sweden 2013 was found to be 41 individuals / 100 000, and thus unchanged since the latest systematic investigation in Sweden 1975. In more than 70% of treatment series the indication was a depressive episode. The selection of patients for ECT and treatment technique in Sweden was similar to that in other western countries, but the consent procedure and the involvement of nurses and nursing assistants in the delivery of ECT differ. Data also shows that there is room for improvement in both the specificity of use and availability of ECT. The second study in this thesis is a longitudinal observational trial where 12 (paper II and III) and 14 (paper IV) patients with depression referred for ECT were investigated. Patients underwent a 3 T MRI structural scanning and DSC-MRI perfusion, a neuropsychological test battery and clinical ratings before ECT, within one to two weeks after ECT and after 6 and 12 months. In line with preclinical findings and the plasticity hypothesis of mechanism of action of ECT, the hippocampal volume increased after ECT in patients with depression. However, this increase was transient and returned to baseline levels within 6 months. No correlation was found between volumetric changes and clinical effect or cognitive outcome. Instead our results suggested an association to the number of treatments, without relation to the side of stimulation. A right-sided decrease in frontal blood flow distinguished remission from non-remission after ECT. There were significant impairments in verbal episodic memory and verbal fluency within one week after ending the ECT course, but these impairments were transient and no persistent cognitive impairments were seen during the follow-up. In summary, this thesis present the first update on the use and practice of ECT in Sweden in the last 40 years as well as a pioneering MRI-study on the hippocampal volume increase...

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What was learned: studies by the consortium for research inECT(CORE) 1997–2011

Cited by 88 publications

References 50 publications

The Mood-Stabilizing Effects of Electroconvulsive Therapy

The Mood-Stabilizing Effects of Electroconvulsive Therapy

Indicators for Electroconvulsive Therapy among Patients Hospitalized for Depression

On electroconvulsive therapy in depression : Clinical, cognitive and neurobiological aspects

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