A commentary in the JAMA by Prof Max Fink. In this commentayr he sumarizes the most important recent topics in ECT. 1. Remission for depressive illness with ECT: 55%-86%, these results compare favorably to the response rates in the STAR*D trial. 2. Relapse prevention after ECT, nortriptyline with lithium is first choice, continuation ECT for patients who relapse despite this treatment and for those who may not tolerate medication. 3. ECT is a primary treatment for psychotic depression. 4. ECT reduces the acute risk for suicide. 5. Medication resistance does not bare relation to treatment efficacy with ECT. 6. He still favours bilateral electrode placement. 7. Important side effects are anterograde-, retrograde amnesia. 8. Vagus Nerve Stimulation and Deep Brain Stimulation are not comparable in efficacy to ECT.
This is in short his few about the recent achievements in ECT treatment and it’s research. His preference for bilateral ECT is a topic for debate. Unilateral electrode placement is technically more complex but comparable in efficacy when done the right way. That is with supratreshold stimulus dosage after stimulus titration during the first session. Research with side effects should be done for the long term and focussed on individual differences
This is a video on which a patients tells about her complaints during her depressive episode. It also shows some details on an ECT session. One of the psychiatrists on this video is Prof. Dr. Max Fink, an authority on ECT. He wrote many books. He visits European countries to help them establish good ECT services.
A recently published article by our group in the Journal of ECT. This article describes the long term follow-up of patients who participated in a 6 month continuation trial after ECT. The group with and without relapse during this 6 month period were compared with regard to recurrence of depression up to 8 years later. You can read the abstract following this link
I recently made the decision to try and battle a lifelong struggle with depression with ECT, or electroconvulsive therapy. Because it’s such a hot-button issue in the field of psychiatry and there are many conflicting reports out there on the internet, I thought I would write, from the patient’s point of view, what getting an ECT treatment is all about.
In the interest of full disclosure, I would like to mention that I’ve only received one treatment so far. I’m hoping to use this blog to talk about my experiences as I go through them in the next few weeks while I’m getting the remainder of the treatments.
Ordered this book long ago, it is now underway. Hope to receive it next week. Until than here is a review of the book on globalandmail.com: Simply shocking
Shock Therapy: A History of Electroconvulsive Treatment in Mental Illness, by Edward Shorter and David Healy, tracks the rise, fall and current return to grace of ECT. Though the authors claim it is a “careful … fair and comprehensive investigation of ECT,” it is hardly evenhanded. Rather, it is a polemic reproaching forces that the authors claim stood in the path of ECT during its dark days of reduced use, and a vindication of its stalwart supporters.
Here is another short mentioning of the book and some additional content on the relationship between depression and neurogenesis on The Frontal Cortex
By the way even Mind Hacks has a recent post about ECT, ECT is hot these dark days. This description is accurate.
Hope to write my own review in the next few weeks. Mean while enjoy.
Shock Therapy: The History of Electroconvulsive Treatment in Mental Illness by Edward Shorter, David Healy. Publisher: Rutgers University Press; 1 edition (September 30, 2007) Language: English ISBN-10: 0813541697 ISBN-13: 978-0813541693
Light therapy might be a promising augmentation strategy for treatment-resistant depression and three other nonseasonal depressive disorders. The evolving applications of light therapy are discussed in a recent article.
Beside seasonal affective disorder light therapy can be of use or subject of study for: 1. This articles suggests that light therapy might also be useful for nonseasonal depression. Evidence is based on an inconclusive meta analysis and a recent study which showed good result for light therapy compared to placebo treatment (low-output negative air ionizer placebo).This was done with patients suffering from chronic depression (at least 2 years) and without seasonal modulation.
2. Also the use of light therapy with treatment-resistant depression is substantiated with 4 cases. All cases were unresponsive to conventional drug treatment, electroconvulsive therapy or both. Patients were first treated with tranylcypromine (monoamine oxidase inhibitor) to which 40% responded. The four remaining patients received light therapy as an add-on to the tranylcyromine. Three of four showed positive response to light augmentation of tranylcypromine.
3. Light therapy for Bipolar depression is more complicated. Usually in those cases the antidepressants failed. Most cases described used a mood stabilizer and light was added to this treatment. The time of administration of the light therapy is crucial and variable per patient as well as dosing of the light.
4. Research with light therapy for antepartum depression has had it’s drawbacks. Fear for the effect of light on the fetus stopped a few trials before their start. Recently large trials are underway after promising results in an open trial.
Especially the strategy with treatment-resistant depression looks very promising to me.
Other interesting fields of research with light therapy are: 1. ADHD 2. Dementia 3. Parkinson’s disease These indications were mostly studied in open studies and case series.
The trouble with research for efficacy of light therapy is the placebo condition. Other drawbacks are the conceptual affront to mainline antidepressant pharmacotherapy and the lack of industry support.
A recent meta analysis by American Psychiatric Association from 8 out of 45 potential studies concluded that there was a “significant reduction in depression symptoms severity following bright light therapy” for seasonal affective disorder.
Articles discussed: The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence. PMID: 15800134Related Articles Authors: Golden RN, Gaynes BN, Ekstrom RD, Hamer RM, Jacobsen FM, Suppes T, Wisner KL, Nemeroff CB Journal: Am J Psychiatry, 162 (4): 656-62, 2005
Evolving applications of light therapy. Terman M. Sleep Med Rev. 2007 Oct 24; [Epub ahead of print]
I read the first edition of this book while on holiday in France. We were cross-country skiing. Not that the weather was bad or the company boring but this book is very informative and easy to read. Read all the other editions as well. For me it is the most narrative book about ECT with a critical appraisal of all the scientific literature. Obviously written by an experienced and good clinician. This book is reviewed on Medical Heaven, I couldn’t have done a better job.
Clear and short explanation on depression and it’s treatment, including ECT by Richard Jaffe MD.
Richard Jaffe discussed the “winter blues” and some of the treatment options that are available to those suffering with depression. He also highlighted some of the new refinements that have been made in Electroconvulsive Therapy (ECT)
Last Friday had the pleasure of doing a presentation on the current practice of ECT for lay public. It was during the Publieksdag for the 140th birthday of the Dutch Association of Psychiatry during the annual conference in Amsterdam.
Also found some excellent information on ECT on the Internet: