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 »

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 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 »

Found another excellent blog of someone undergoing ECT. Besides writing about his or her experiences with ECT there are also posts on other topics as well such as depression, mental health rsources etc. ECT lessons I've learned #4, write them down: When I went through ECT the first time around, I wrote down my passwords to the various online accounts that I have on a sheet of paper. This advice came from the book Shock by Kitty Dukakis and Larry Tye. It’s a great safeguard measure, and it was probably good to have my memory refreshed about those passwords anyway. Keep .....read more »

// 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 .....read more »

The Dutch grand round had a short live. Nevertheless some medbloggers in The Netherlands produce interesting posts. Had lost track of most of them. Decided to produce a monthly selection as a kind of grand round. Choices are very biased and made by myself. If you feel left out, unappreciated or anything else please contact me. Posts in English Laika's MedLibLog discusses the use of web 2.0 for personalized medicine. Personalized medicine can be a tool which lets you subscribe to journals, news, media and blogs and (straightforward) PubMed searches. She discusses several tools for personalized medicine or a efficient way to .....read more »

New data are being published about deep brain stimulation and treatment resistant depression. Especially longer follow up is of importance. In recent published research about deep brain stimulation for treatment resistant depression, six months after surgery, 60% of patients were responders and 35% met criteria for remission, benefits that were largely maintained at 12 months. Moreover, there was no significant loss of effect requiring dose adjustments over time. So once a good stimulus dose, high change that it will remain that way over a long period of time. With DBS for TRD symptoms typically return rapidly if the device is turned .....read more »

Compared to 1999 and 2002 data from a recent survey in 2006 show an overall decline in the number of ECT applications and the number of patients treated in the United Kingdom over the 7-year period between 1999 and 2006. An increasing proportion of patients were treated under the Mental Health Act (1983). Clinical implications The number of ECT clinics is likely to continue to decrease and psychiatrists may have decreasing experience of treating patients with ECT. In The Netherlands there is an opposing trend. In the past decades the number of clinics preforming ECT has increased and the number of patients being .....read more »

The last systematic review of this topic was in 1994. According to this recent review ECT does seem to be effective for treating mental illness during pregnancy and the risks of adverse events are low. It should be considered in pregnant women with severe mental illness such as psychotic symptoms, catatonia or strong suicidal urges. Why is this important? The most common mental illness during pregnancy is major depressive disorder. It is estimated that 9% of pregnant patients suffer from major depressive disorder Untreated depression is linked to poor maternal and neonatal outcomes including poor weight gain during pregnancy, higher risk of .....read more »