Search Results for: electroconvulsive therapy
Excellent information in this video about Electroconvulsive therapy (ECT) from Medicana life. Haven’t written about ECT for a while, hope you find all the information on this site useful. The information about ECT is carefully selected by me, a psychiatrist with special interest in ECT and depression. Related posts on ECT can be found down this blog post.
Another short introduction especially on indications for ECT by Dr Daniel Carlat can be found online here
The major recent enhancements to ECT technique are:
- Right Unilateral electrode placement. The cognitive side-effects of ECT such as retrograde and anterograde amnesia are significantly less compared to Bilateral electrode placement.
- Brief pulse stimulus currents. The characteristics of the electrical stimulus affect the effectiveness and cognitive outcomes of the seizure. Sine wave stimuli have been replaced with rectangular pulses on modern ECT devices, leading to a substantial decrease in cognitive effects
- Improved anesthesia techniques makes it possible to regulate the cardiac output during ECT when necessary
- The “dose titration” technique to individualize treatment stimulus dosing
- The discovery of the dose-response relationship between electrical stimulus dosing and antidepressant outcome with RUL electrode placement
- Pulse width. Several studies conclude that right unilateral (RUL) electroconvulsive therapy (ECT) given with ultrabrief pulse-width stimulus packages causes less cognitive impairment than other techniques
Contemporary ECT devices can be set to deliver pulse-widths between 0.25 and 2.0 milliseconds. Stimuli between 0.5 and 2.0 milliseconds are called “brief,” and those less than 0.5 millisecond are called “ultrabrief.”
A recent study from Sackeim and colleagues was published about ultrabrief puls width and efficcay and cognitiev side-effects. Those participating in this trial were assessed for depressive symptoms and cognition at baseline, during and after the acute course of ECT, and at 2 and 6 month time points. Responders were monitored for 1 year. Reported remission rates were 73% for ultrabrief RUL, 65% for brief pulse BL, 59% for brief pulse RUL, and 35% for ultrabrief BL. Ultrabrief pulse RUL produced less severe cognitive effects than the other 3 treatment groups, both acutely and long-term, on multiple measures in several cognitive domains, including subjective assessment of memory function. Relapse in the year following acute ECT was unrelated to treatment group. These authors concluded, “the use of an ultrabrief stimulus coupled with high-dosage RUL stimulation is a strategy that appears to retain the therapeutic properties of ECT, although substantially reducing its potential for adverse cognitive side effects.”
The big problem is that ultrabrief bilateral treatment is less efficacious in this trial than Right unilateral electrode placement. Normally bilateral ECT is the most efficacious form of ECT. Is this a real difference or is this another strange finding from the Columbia University Group comparable to their results with medication resistant depressed patients. According to their research patients with “medication resistance” as defined by arbitrary (ATHF) criteria were less responsive to ECT. Other researchers couldn’t find any influence of medication resistance on efficacy of subsequent ECT. It seems that medication resistance is irrelevant in the decision for a trial of ECT in patients with severe depressive illness, whether psychotic or non-psychotic.
Does pulse width influence efficacy of bilateral ECT? Opinion from another expert, Charles H Kellner:
Fortunately, the nature of ECT is such that if, after several RUL treatments with ultrabrief pulse stimuli, the patient is not responding adequately, the treatment technique can be switched, either to a different waveform or electrode placement, or both.
We did a retrospective study comparing bilateral ultrabrief pulse width compared to brief pulse width for depressive disorder. We couldn’t find a significant difference. Is to be continued.
SACKEIM, H., PRUDIC, J., NOBLER, M., FITZSIMONS, L., LISANBY, S., PAYNE, N., BERMAN, R., BRAKEMEIER, E., PERERA, T., & DEVANAND, D. (2008). Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy Brain Stimulation, 1 (2), 71-83 DOI: 10.1016/j.brs.2008.03.001
The most recent hands on experience with ECT and it’s side-effects. There is an excellent lecture by a doctor who has had electroconvulsive therapy: Sherwin Nuland, the surgeon and author, talks about the development of electroshock therapy as a cure for severe, life-threatening depression. Midway through, his story turns personal. It’s a moving and deeply felt talk about relief, redemption, second chances
You can view another 9 video’s on ECT in a recent post. All video’s were selected by the author of this blog because he finds them to be genuine and true.
This blog also has a post about 11 websites and blogs with trustworthy information about ECT.
Found a new recent blog called Electroconvulsive Therapy, all about…. you guessed it.
It has a recent post on cognitive side-effects with ultrabrief stimulus. The results were presented as a poster at the European congress of psychiatry of the AEP in Nice, France, 4-9 April.
We concluded that bifrontal and unilateral ultra-brief pulse ECT are effective treatment techniques that do not cause measurable cognitive side-effects or cognitive complaints.
The author also has a blog called: A day in the life of a shrink. It is in Dutch or should I say Belgian.
Patients with bipolar depression treated with ECT in the past (on average 45 months ago with a standard deviation of 21 months) only performed significantly worse on the Californian Verbal Learning Test compared to patients with bipolar disorder not previously treated with ECT.
These bipolar patients previously treated with ECT also had significantly more subjective memory complaints.
These two conclusions were drawn from a recent study in which 3 groups of subjects were compared. A group with bipolar disorder previously treated with ECT at least 6 months before memory assessment, a group of patients with bipolar disorder with an equal past illness burden but that had never received ECT and a group of healthy controls. All groups were matched for sex and age.
Now why was this research done?
Cognitive effects of ECT is largely studied in unipolar depressed patients, seldom solely in bipolar patients.
Unipolar and bipolar disorder differ from each other not only in demographic and clinical features but also in treatment and medications.
Some studies suggest that people with bipolar disorder are generally more likely to have cognitive deficits when euthymic than people with unipolar depression. This might be due to the disease it self or due to medication or both.
Extrapolating results from research with unipolar depression and cognitive side effects of ECT to bipolar patients might for these reasons not be very reliable.
Up until this reasoning I can follow the importance of further research into this matter of side effects of ECT and bipolar disorder. But the method used in this trial doesn’t remotely answer this question alas.
The researchers didn’t focus on the most important side effects of ECT such as retrograde amnesia and anterograde amnesia. They used memory tests not very specific for the cognitive side-effects of ECT.
Confounding factors such as medication used prior to testing and during testing as well as other important clinical variables influencing outcome could not be excluded due to small sample size. The differences found could be explained by these variables instead of ECT treatment.
Patients were not randomized to ECT or no ECT.
So what is the bottom line then?
It is still possible that patients with bipolar disorder will have a different long term outcome after ECT than unipolar patients. This research shows that although not very focused on the usual side effects of ECT the cognitive changes are small and are unlikely to influence the risk-benefit ratio of ECT.
In a recent post I mentioned the opinion that some subjective memory complaints can be considered as a somatoform disorder
A post about a memory test for retrograde amnesia
Everyday memory not affected by ECT
Bipolar disorder and ECT
MacQueen, G. (2007). The long-term impact of treatment with electroconvulsive therapy on discrete memory systems in patients with bipolar disorder. Journal of Psychiatry and Neuroscience, 32(4), 241-249.
Both increase the exercise regulated gene for producing VGF a neuropeptide precursor. The administration of synthetic VGF-derived peptide produces a robust antidepressant effect in mice. Blocking the gene for VGF inhibited the effect of exercise and induced depressive-like behavior in the mice.
This information further supports the benefit of exercise and provides a novel target for the development of new antidepressants with a different mode of action than the ones now being used.
From Science Daily
A written account on Vicarious Therapy about her experiences during an ECT course.
I did not create a video when I went through my ECT treatments, but I did the next best thing; I wrote about my experiences with ECT on a Bipolar/Depression Discussion Board as I was going through the 8 treatments I received.
A compelling story about the ECT and how she experienced the treatment.
My 1st treatment was Friday. As my brain is super important to me I had all sort of concerns about the procedure and its effect on my intellectual abilities. I read tons. The document on this website: http://www.mheccu.ubc.ca/ has lots of info. The Drs told me that I may have some short term memory loss for around the time of the treatments, but that most of those would come back within a few weeks of the treatments ending. The literature and studies I have read say the same thing.
1. A very nice introduction is the video by Sherwin Nuland, a surgeon and author, he talks about the development of electroshock therapy as a cure for severe, life-threatening depression. Midway through, his story turns personal. You can see his lecture on ECT here.
2. A patient who has ECT shares his views on this treatment on video (vlog). You can follow him during the course because he is giving regular updates of his experiences.
Before his first ECT
3. This video shows the preparations before ECT
4. This video shows a patient both before and after ECT. There is also some footage of the treatment itself