It's been a while since my last post on this blog about transcranial magnetic stimulation (TMS). Myself 'm not impressed by it's efficacy for treatment resistant depression. Especially in treatment resistant depression, whatever that may be, rTMS is probably best avoided for more evidence based form of treatments with proven efficacy. The reason for this post about TMS is a recent publication in the Journal of Clinical Psychiatry. FDA approval for rTMS was based on a large, industry-sponsored, multicenter, double-blind, monotherapy study with 325 patients with "moderately treatment resistant depression" also discussed on this blog here. My opinion on this trial was This .....read more »

From all the newspapers in the last seven years in British national newspapers about 348 mentioned ECT or electroconvulsive therapy or electroshock and it's other synonyms. Overall 111 articles (31,9%) portrayed ECT negatively, 198 articles were neutral and 39 were positive. A substantial comment on ECT was published in 44 (12,6%) articles. The negative comments (14/16) were published in liberal newspapers whereas most positive comments about ECT (10/12) were published in conservative newspapers. Overall most depictions of ECT were neutral, with smaller numbers of negative (111) and positive (39) representations. Not bad compared to the depiction of ECT in Hollywood movies. Euba .....read more »

The strongest evidence exists for Broadman Area 25 in the subcallosal cingulate gyrus (SCG) as target for deep brain stimulation in treatment resistant depression. This area in the brain is depicted in the figure above and is from the most important publication about DBS and depression in Neuron march 2005 by Helen Mayberg. Functional neuroimaging as well as antidepressant treatment effects suggest that this area plays an important role in modulating negative mood states. A decrease in activity is reported with clinical response to antidepressants and electroconvulsive therapy (ECT). But depression is not a disease of a single brain region nor .....read more »

Excellent animation of deep brain stimulation thanks to the Cleveland ClinicRelated posts: When are you eligible for a trial with deep brain stimulation The Bleeding Edge of Deep Brain Stimulation Deep Brain Stimulation for Depression ..read more »

The best information in health care is from patients who have been there. Those who underwent treatment, suffer from a certain illness. It's the kind of hands on experience physicians can't deliver. On this blog I have collected some examples of these "hands on experiences". Some recent posts were written about ECT by them with hands on experience. Aqua on Vicarious Therapy wrote a post on ECT and media portrayals of depression treatment options. She is irritated by the negative portrayal of ECT in the media. It irritates me, (and does not help me explain potential treatments to concerned family .....read more »

This courageous young woman Rachel Star (on twitter) tells about the negative an positive aspects of ECT, a year later. Very impressive story from someone who has been there and is getting along. A kind of sequel of a video at the beginning of this year just before and during the course of ECT on this blog: Hands on experience on video about electroshock therapy. A young woman and her mother on this video about ECT. Very impressive story about having ECT, side-effects and how she improved on ECT. Related posts: The year I was homeless Old Year/New Year Dutch Grand Round 10.1 .....read more »

In a recent online publication about another form of brain stimulation in treatment resistant depression showed promising results. The electrodes are placed on the brain instead of in the brain as with Deep Brain Stimulation (DBS): A new neurosurgical procedure may prove helpful for patients with treatment-resistant depression. Bilateral epidural prefrontal cortical stimulation (EpCS) was found generally safe and provided significant improvement of depressive symptoms in a small group of patients The location for Brain Stimulation in EpCS targets electrical stimulation to the anterior frontal poles and the lateral prefrontal cortex. Two different places on both hemispheres, resulting in four separate paddle .....read more »

Told you earlier this year about an excellent blog of someone undergoing Maintenance ECT at the moment: Jumpstarting a life with a little sparkle to the head. After the fourth lesson there is now a fifth ECT lesson: After ECT treatment continues: I know that by the time we’re considering ECT, we are barely able to make it through the day, but I think it’s better to ask and know upfront what turns your life could take post-ECT rather than be surprised by something that’s already been documented that it might happen. And even a sixth ECT lesson: Communication is key If you .....read more »

A great step forward, patients don't have to be awake during the procedure. This video shows a clear description of the old and new procedure for deep brain stimulation (DBS). In the old procedure a frame has to applied after which a brain mapping procedure has to follow, up to 6-8 hours while the patient has to be awake. At the end the patient has to undergo a MRI to see whether the electrodes are in the right place. All very tedious and time consuming. The new procedure takes place in the MRI with anesthesia and takes less time (50%). .....read more »

This week we had to treat a patient with electroconvulsive therapy (ECT). He had a pacemaker. The cardiologist offered to be there during the first treatment to see how things were going with the pacemaker during ECT. Everything went just fine except for the astonishment of the cardiologist. He was flabbergasted about the ECT procedure. He never realized that his ideas and fantasies were far beyond reality. He still had "one flew over the cuckoo's nest" in his mind. Moreover, he now better understood the challenges faced during ECT. Heart rate and blood pressure can increase for a short while. This .....read more »