07/09/2009

1.      Evidence for efficacy and treatment modality

Randomised comparison of ultra-brief bifrontal and unilateral electroconvulsive therapy for major depression: Clinical efficacy. (2008). Sienaert P et al. J. Affect. Disord.2008.11.001.
This small study showed no difference in cognitive side-effects or eventual outcome although unilateral ECT appeared to work faster than bifrontal. Cognitive side-effects were measured using the MMSE. The authors concede that more research needs to be carried out using different machine parameters before new treatment methods are adopted into clinical practice. The article contains a useful summary of studies that have reported on bifrontal and ultra brief pulse ECT.

Response to ECT in bipolar I, bipolar II and unipolar depression. (2009). Medda et al. J Affect.Disord.2009.01.014.
This prospective study compared outcome at ECT in three groups of patients. All responded well but the unipolar group showed the best response and bipolar patients tended to exhibit residual psychotic symptoms.

The origins of electroconvulsive therapy: Prof Bini’s first report on ECT. (2009). Faedda et al. J. Affect.Disord.2009.01.023.
The authors translate Professor Bini’s original report on ECT to celebrate the 70^th anniversary of electrically induced seizure therapy.

Convulsive therapy turns 75. (2009). Gazdag et al. BJPsych. 194, 387-388.

This editorial describes the work of Laszlo Meduna who is accredited with being the first psychiatrist to induce seizures for the treatment of mental illness. He did this, initially by use of camphor then by cardiazol  injections in the belief that people with schizophrenia did not suffer from epilepsy. He concluded that cardiazol accelerated remission rate in acute cases and this accorded with other observation at the time that the main indication for ECT was affective disorder. 

The difficult-to-treat electroconvulsive therapy patient – strategies for augmenting outcomes. (2009) Loo C et al. JAffect.Disorders 2009.07.011.
The authors suggest ways to improve efficacy at ECT by concomitant use of antidepressant medication or the use of techniques aimed at reducing seizure threshold. They are careful to point out that the level of evidence for any of the techniques is at present preliminary.

Effect of concomitant pharmacotherapy on electroconvulsive therapy outcomes. (2009). Sackeim H et al. Arch.Gen.Psych.Vol 66(no7) 729-737.
Usual practice in the USA has been to stop antidepressants prior to ECT; this differs from practice in the UK where antidepressant medication is often continued. Sackeim’s group looked at the efficacy of ECT in combination with either venlafaxine or nortriptyline compared to placebo and found that both antidepressants enhanced the antidepressant effect and had different effects on cognitive function. The group also reports that high dose unilateral ECT was superior to bilateral and resulted in less severe amnesia.

Is baseline medication resistance associated with potential relapse after successful remission of a depressive episode with ECT? Data from the Consortium for Research on Electroconvulsive Therapy (CORE). (2009) Rasmussen K et al. J Clin Psychiatry. Vol 70 (2); 232-237. 
The authors used the data from this large multi-centre trial to examine whether medication resistance, a common indication for ECT, was associated with relapse within the first week following successful treatment. They found that 31% of medication resistant patients relapsed compared to 10% of those not having at least one antidepressant trial pre ECT.

Sham electroconvulsive therapy studies in depressive illness. (March 2009) Keith Rasmussen. J of ECT; 25:54-59.
A review of the double blind placebo controlled trials (real vs sham ECT) carried out in the 1970s and 1980s that have formed the basis for the Department of Health review and subsequent NICE guidelines on ECT. In addition the question has been posed about the people who responded to sham ECT, could these people be classified as a depressive subtype by virtue of their placebo response? The author cautions further researchers into other physical therapies to be aware of the strength of the placebo response.

2.      Safety and cost-benefit analysis

A critical examination of bifrontal electroconvulsive therapy: clinical efficacy, cognitive side-effects and directions for future research. (December 2008) Crowley K et al. J of ECT; 24:268-271.
The authors remind us of the need to develop tests to pick up cognitive side-effects involving frontal lobe function (for example executive function) before concluding that bifrontal ECT offers benefits over the more traditional bitemporal and unilateral electrode placements.

3.    Side effects of ECT 

4.    Mortality and suicide rates

Continued