A review of ECT for children and adolescents

Two cases of electroconvulsive therapy (ECT) in adolescence are presented and the literature on the use of ECT in childhood and adolescence is reviewed. ECT was effective in children and adolescents with bipolar disorder and depression. Inadequate information exists to make a judgment regarding schizophrenia, delirium, and anorexia nervosa. ECT is not effective in autism and chronic organic brain syndromes. Complications cited include organicity and seizures in the period immediately after ECT, anxiety reactions, and disinhibition. Long-term memory deficit or cognitive impairment has not been found, although further research to rule out residual impairment is needed.     

ECT and Anticoagulation

Electroconvulsive therapy (ECT) is an effective and safe treatment for depression. Anticoagulation therapy is used to reduce morbidity or mortality from stroke or recurrent pulmonary embolus in various cardiac and vascular conditions. We report in detail the successful ECT treatment of a patient suffering from major depression with psychotic features who continued warfarin (Coumadin) anticoagulant therapy.     

The use of electroconvulsive therapy in patients with dissociative disorders.

The psychiatric literature generally discourages the use of electroconvulsive therapy (ECT) to treat depression in dissociative disorder patients, but contains little data on outcome. This prospective study of ECT in three dissociative disorder patients demonstrates that ECT is indicated for severe treatment-resistant depression in such patients. Their Hamilton Depression Scale scores fell by 50%, they were remarkably clinically improved, and they maintained their gains for at least 4 months. The ECT proved helpful when depression was felt by most of the active alters rather than just by one depressed personality. Mini-Mental State Examination scores and clinical observation revealed no unusual confusion or side effects from ECT. These patients' dissociated condition was not altered by ECT, which indicates that ECT neither treats nor impairs treatment of dissociation. Electroconvulsive therapy can be helpful in the overall treatment of dissociative disorders by alleviating severe depressions which block utilization of psychotherapy.     

Effects of electroconvulsive therapy on the thyrotropin-releasing hormone test in patients with depression

We investigated the acute and lasting effects of electroconvulsive therapy (ECT) on the thyroid-stimulating hormone (TSH) response to thyrotropin-releasing hormone (TRH) in patients with depression. The TRH stimulation test was conducted (1) under basal conditions, after a first ECT, and at the end of a therapeutic course of 7 ECTs in 20 inpatients with depression; (2) before the initiation of antidepressant therapy and after the therapeutic response in 16 other inpatients with depression who responded to antidepressant drug treatment; and (3) in 20 healthy control subjects. Baseline TSH levels were lower in patients with depression, especially in those with more severe depression who were considered appropriate for ECT. Before the treatment, TSH response to TRH did not differ between the patients with depression and controls; however, more blunted TSH responses to TRH were observed in these patients compared with the controls. TSH response to TRH changed neither with one ECT nor throughout consecutive ECT sessions in patients with depression. Drug treatment also was found to have no impact on this response. These findings suggest that the therapeutic action of ECT in depression is not directly related to its effects on the hypothalamic-pituitary-thyroid axis. However, possible delayed effects of ECT on the HPT axis function should not be overlooked.     

Efficacy of ECT in depression: a meta-analytic review

This study analyzed the efficacy of electroconvulsive therapy (ECT) in depression by means a meta-analytic review of randomized controlled trials that compared ECT with simulated ECT or placebo or antidepressant drugs and by a complementary meta-analytic review of nonrandomized controlled trials that compared ECT with antidepressants drugs. The review revealed a significant superiority of ECT in all comparisons: ECT versus simulated ECT, ECT versus placebo, ECT versus antidepressants in general, ECT versus TCAs and ECT versus MAOIs. The nonrandomized controlled trials also revealed a significant statistical difference in favor of ECT when confronted with antidepressants drugs. Data analyzed suggest that ECT is a valid therapeutic tool for treatment of depression, including severe and resistant forms.     

Electroconvulsive therapy in complex regional pain syndromes

Three cases are presented in which electroconvulsive therapy (ECT) for depression led to the relief of comorbid complex regional pain syndrome as well as depression. In one of the cases, concomitant fibromyalgia was not relieved during 2 separate series of ECT. The literature regarding the role of ECT in the management of chronic pain is reviewed and discussed in light of recent findings about ECT and changes in neurotransmission associated with seizures.     

Modulation of interhemispheric functional coordination in electroconvulsive therapy for depression

Considerable evidence suggests that depression is related to interhemispheric functional coordination deficits. For depression, electroconvulsive therapy (ECT) is the most rapid and effective therapy, but its underlying mechanism remains unknown. The aim of this study was to explore the impact of ECT on the interhemispheric functional coordination in depression patients. We used resting-state functional magnetic resonance imaging to observe the change of interhemispheric functional coordination with the method of voxel-mirrored homotopic connectivity (VMHC) in 11 depressed patients before and after ECT, compared with 15 healthy controls. The results showed that, compared with depression patients before ECT, VMHC was significantly increased in superior frontal gyri (BA 8), middle frontal gyri (two clusters: BA 8/9 and BA 10) and angular gyri (BA 39) in depression patients after ECT. Compared with healthy controls, VMHC in those areas was significantly lower in the middle frontal gyri (BA 8/9) and angular gyri (BA 39) in depression patients before ECT, but no significant difference was observed in the superior frontal gyri (BA 8) and middle frontal gyri (BA 10). There was no significant correlation between the changes of Hamilton Depression Rating Scale scores and changed VMHC values in those four areas in depression patients. The results suggest that ECT selectively modulated interhemispheric functional coordination in depression patients. Such may play an important mechanistic role in the treatment of depression, and may afford a useful avenue for optimizing treatment.     

ECT Treatment of Demented Elderly Patients with Major Depression: A Retrospective Study of Efficacy and Safety

Retrospective analysis of a 4-year sample of demented patients who had major depression and who were treated with electroconvulsive therapy (ECT) showed that they responded as well to ECT as did a previously studied group of elderly depressed subjects from our institution. Cardiac side effects were no greater in this group, but some patients did have transitory increased confusion. ECT is a safe and effective therapy for the demented patient who has concomitant major depression and who has proven to be resistant to tricyclic antidepressant drug therapy, is intolerant of such medicines, or requires emergency treatment.     

Electroconvulsive Therapy and Chronic Subdural Hematoma

An elderly female patient with major depression was found to have an asymptomatic chronic subdural hematoma. Electroconvulsive therapy (ECT) resulted in full remission of her depression without neurological deterioration. The use of ECT in patients with cerebral lesions is discussed.     

Recent Updates on Electro-Convulsive Therapy in Patients with Depression

Objective Electro-convulsive therapy (ECT) has been established as a treatment modality for patients with treatment-resistant depression and with some specific subtypes of depression. This narrative review intends to provide psychiatrists with the latest findings on the use of ECT in depression, devided into total eight sub-topics. Methods We searched PubMed for English-language articles using combined keywords and tried to analyze journals published from 1995–2020. Results Pharmacotherapy such as antidepressants or maintenance ECT is more effective than a placebo as prevention of recurrence after ECT. The use of ECT in treatment-resistant depression, depressed patients with suicidal risks, elderly depression, bipolar depression, psychotic depression, and depression during pregnancy or postpartum have therapeutic benefits. As possible mechanisms of ECT, the role of neurotransmitters such as serotonin, dopamine, gamma-aminobutyric acid (GABA), and other findings in the field of neurophysiology, neuro-immunology, and neurogenesis are also supported. Conclusion ECT is evolving toward reducing cognitive side effects and maximizing therapeutic effects. If robust evidence for ECT through randomized controlled studies are more established and the mechanism of ECT gets further clarified, the scope of its use in the treatment of depression will be more expanded in the future.     

Några reflexioner over kotfrakturerna vid elektrochock

Depression and other neuropsychiatric symptoms are frequently reported in patients with dementia. These symptoms may seriously compromise the function and quality of life of demented patients. Both biologic and behavioral strategies are necessary in dealing with these problems. This article documents the efficacy of electroconvulsive therapy (ECT) in a 67-year-old woman with early-onset Alzheimer's disease. She developed severe depression that did not respond to drug therapy. Unilateral ECT was immediately effective, and she was given maintenance therapy with paroxetine. Two post-ECT relapses were effectively treated with further ECT series, and maintenance ECT was the most efficient prophylactic treatment. It is recommended that ECT is prescribed for demented patients with treatment refractory, severe depression.

Alzheimer's disease, Dementia, Depression, Electroconvulsive therapy.     

A comparison of inpatients with primary unipolar depression and depression secondary to anxiety

Retrospective comparisons between primary unipolar depression and depression secondary to anxiety in 65 inpatients revealed a number of differences. Secondary depression was associated with a significantly higher incidence of neurotic traits in childhood, chronic unhappiness, and unsupportive family. Tricyclic antidepressants and ECT were both more effective in primary depression, and some secondary depressives became worse on ECT. When primary depression was sub-divided into familial, nonfamilial and spectrum types, the greatest differences were noted between familial and secondary depressions. In the former group a more stable life style was noted. Secondary and spectrum types differed on only two variables and several similarities were noted. Platelet monoamine oxidase activity was significantly higher in secondary depression.     

Application of electroconvulsive therapy in treatment of retinitis pigmentosa comorbid with major depressive disorder and panic disorder

A substantial proportion of retinitis pigmentosa (RP) patients have depression/anxiety and a phobic pathology that may be related to changes in melatonin secretion. We discuss electroconvulsive therapy (ECT) in a patient with RP comorbid with depression and panic disorder. A 51-year-old man was admitted because of major depression, panic disorder, and RP. Ultrabrief pulse (0.3 millisecond) right unilateral ECT was performed 9 times in total. The symptoms relieved, and patient tolerated the treatments well. Electroconvulsive therapy increases serum melatonin, providing therapeutic effects in depression. The application of ECT in this population therefore appears to be an alternative treatment.     

Combined use of lamotrigine and electroconvulsive therapy in bipolar depression: a case series

OBJECTIVE: Lamotrigine and electroconvulsive therapy (ECT) are both safe and effective treatments for bipolar depression. Concerns exist that anticonvulsants may interfere with seizure expression during ECT or may exacerbate cognitive side effects, potentially affecting clinical response. This report examines the clinical use of concurrent ECT and lamotrigine for acute bipolar depression and the transition to maintenance therapy. METHODS: Nine patients with acute bipolar depression were simultaneously treated with a course of ECT while titrating lamotrigine for maintenance therapy. We compared mean stimulus intensity, mean seizure duration, and mean time to orientation after treatment for each patient during treatment with their highest and lowest lamotrigine dose. RESULTS: All 9 patients were treated to remission. From the lowest daily dose to the highest daily dose, mean increase in lamotrigine was 102.8 mg. Clinically adequate seizures were obtained in each patient. Lamotrigine had minimal effect on each measured ECT parameter. The interval between ECT treatments was spaced to a mean of 15.2 days. The treatment combination was well tolerated, with no serious adverse events, no rashes, and no worsening of cognitive side effects. CONCLUSIONS: Concurrent use of lamotrigine with ECT in bipolar depression seems safe, did not interfere with routine ECT practice, and allowed for transition to maintenance pharmacotherapy.     

Current use of ECT in the treatment of depressive disorders

If used with correct indication, electroconvulsive therapy (ECT) is a very effective and safe treatment for some forms of major depression, provided due consideration is given to possibly concomitant somatic conditions and that the cardiovascular reactions during and after the ECT treatments are managed carefully. Despite this, ECT remains controversial, especially in Germany. This article provides an overview of the current state of the art in ECT: appropriate indications, best practice in conducting ECT, side effects and recent developments in the use of ECT as maintenance therapy. This, it is hoped, will contribute to a more factually grounded discussion of the use of ECT.     

Results of electroconvulsive therapy in restrictive indications. A retrospective study of 15 years]

In Tübingen ECT is restricted to severely ill patients who do not respond to other somatic therapies; especially to patients with endogenous depression and pernicious catatonia. Between 1976 and 1990, 45 patients were treated with ECT, of whom 22 suffered from endogenous depression and 10 from pernicious catatonia. Thirteen patients with other diagnoses (schizophrenic and schizoaffective psychoses, borderline schizophrenia and obsessive-compulsive disorder) were treated with ECT for severe depressive states after failure of psychopharmacological therapy. A positive therapeutic response to ECT was observed in 46% of patients with endogenous depression and in all 10 with pernicious catatonia. In the patients with schizophrenia and schizoaffective psychosis, borderline schizophrenia and obsessive-compulsive disorder, an amelioration of the depressive or anxiety syndrome was observed only in individual cases. Side effects of ECT were transit syndromes (20%), reversible amnestic syndromes (20%) and cardiac arrhythmias (6%). According to our results, ECT is highly effective in therapy-resistant endogenous depression and pernicious catatonia, and therefore remains a necessary part of psychiatric therapy.     

Electroconvulsive therapy for poststroke depression

Of the 193 patients with stroke and depression treated at Massachusetts General Hospital from 1969 to 1981, 14 had electroconvulsive therapy (ECT) for poststroke depression. Among these 14 patients, depression developed less than 1 year after stroke in 9 and more than 1 year after stroke in 5. Except for 2 of the patients in whom depression developed within a year, all had marked improvement in depression after ECT. A transitory cardiac arrhythmia developed in 1 patient, but none of the patients had an exacerbation of stroke or a worsening of neurologic status. These findings indicate that ECT is safe and effective for poststroke depression.     

Treatment refractory depression in the elderly: The role of maintenance electroconvulsive therapy

Treatment refractory depression is a major concern for primary care and mental health specialists alike. This is particularly so in the elderly, who are most vulnerable to the effects of depression on physical and psychosocial functioning, as well as suicide. Electroconvulsive therapy (ECT) is the most effective treatment for depression refractory to medication. Patients who are refractory to medication and subsequently respond to ECT are at high risk of relapse following ECT, and as such maintenance treatment has particular salience in the medication refractory population. The use of ECT as maintenance treatment will be reviewed in this article, with a particular focus on the use of this modality in elderly patients who are refractory to medications.     

Electroconvulsive therapy for comorbid major depressive disorder and posttraumatic stress disorder

OBJECTIVE: Posttraumatic stress disorder (PTSD) and major depressive disorder frequently co-occur. Electroconvulsive therapy (ECT) is the most effective treatment for refractory major depressive disorder. We examined the effect of ECT in patients with co-occurring major depression and PTSD. METHOD: Using a retrospective chart review, we examined the outcome of the cases of 26 patients with major depression and co-occurring PTSD who received a course of ECT. The patients received either suprathreshold right unilateral, bilateral, or a combination of both. Using paired t test analysis, we compared the pretreatment and the posttreatment symptoms using the Montgomery-Asberg Depression Rating Scale and the PTSD Checklist. RESULTS: The patients receiving ECT had a significant reduction in the symptoms of major depression and some amelioration in PTSD symptoms. CONCLUSIONS: Electroconvulsive therapy may be an effective treatment for patients with refractory depression and co-occurring PTSD.     

Fixed high-dose electroconvulsive therapy in the elderly with depression: a double-blind, randomized comparison of efficacy and tolerability between unilateral and bilateral electrode placement

OBJECTIVE: To evaluate efficacy and tolerability of unilateral (RUL) and bilateral (BL) electroconvulsive therapy (ECT) in the elderly with depression. METHODS: Thirty-nine elderly inpatients with major depression referred to ECT were randomized into RUL or BL ECT, using high, fixed electrical doses. Cognition and depression severity were assessed before, during, and 1 month after treatment. Adverse effects were assessed after each session. RESULTS: Remission rates for RUL ECT (88.2%) and BL ECT (68.2%) were similar (P = 0.25). Reduction rates of depressive symptoms were also similar. There were no serious adverse events. There were more adverse effects in the BL ECT group (P = 0.05). BL ECT showed more short-term cognitive impairment, whereas improvements in neuropsychological scores were seen in both groups. CONCLUSION: In elderly depressive subjects, high-dose RUL ECT is as effective as BL ECT yet produces less adverse effects and less cognitive impairment.