6. Attitudes and opinions 

Predictors of patient satisfaction after ultrabrief bifrontal and unilateral electroconvulsive therapies for major depression.
(2010) Sienaert PA, Vansteelandt K, Demyttenaere K et al
Forty-eight patients completed a questionnaire at least 6 months following ultrabrief pulse bifrontal or unilateral ECT. Three out of the total of 48 questions related to satisfaction ie “glad” to have had treatment, would have ECT “again” and “satisfied” with the results. Seventy-three percent of patients were “glad” to have had treatment, 58% would have ECT “again” and the same number were “satisfied” with the result. The most satisfied were those who were not psychotic at baseline and whose mood and cognitive function improved most.

7. Anaesthesia for ECT

Rapid antidepressant effect of ketamine anaesthesia during electroconvulsive therapy of treatment resistant depression. (2010) Okamoto NA, Nakai T, Sakamoto K et al. J of ECT;26:223-227.
Ketamine is an NMDA receptor blocker and is used as an anaesthetic in view of its ability to suppress the cerebral cortex resulting in slow wave generation. It also stimulates the central limbic system which can result in euphoria and perceptual abnormalities and so potential for abuse. In addition it may lower seizure threshold and may also have some cognitive sparing abilities in view of suppression of excitotoxicity hence the interest in this agent for ECT anaesthesia. This was a small open label study of 31 patients assigned to either ketamine or propofol. The ketamine group showed a more rapid improvement as measured by a reduction in Hamilton Depression Rating Scores but there was no difference between groups by the end of the course of ECT. Adverse events are listed.

Electroconvulsive therapy-induced persistent retrograde amnesia: could it be minimised by ketamine or other pharmacological approaches? (2010) Gregory-Roberts EM, Naismith SL, Cullen KM et al. J of Affective Disorders;126:39-45.
This is a review of human studies between 1950 and 2009 in which cognitive function was assessed. Retrograde amnesia may result from disruption of long term potentiation. An NMDA blocker may prevent this disruption. Ketamine is an NMDA blocker and whilst there are some concerns with respect to its use with ECT in view of its psychomimetic effects the authors conclude that a clinical trial would be worthwhile to assess speed of action and possible reduction in cognitive side-effects compared to other agents.

8. Side-effects of antidepressants

9. Mechanisms of ECT action

Electroconvulsive therapy. A theory for the mechanism of action.
(2010) Frais AT. J of ECT;26:60-61
The author postulates that recovery from depression following ECT treatment relates to improvement in autobiographical memory and hence improved connection with personal identity.

Effect of electroconvulsive therapy on brain 5HT2 receptors in major depression. (2010) Yatham LN, Liddle PF, Lam RW et al. Brit J Psych;196:474-479.
This positron emission tomography (PET) study of 15 patients receiving ECT for treatment resistant depression found that, contrary to rat studies, there was down regulation of 5HT2 in limbic and pre-frontal areas of humans who responded. This finding is therefore in line with that of antidepressant response and the opposite of a previously held view that ECT exerted a different action from that of drug treatments.

Increase in hippocampal volume after electroconvulsive therapy in patients with depression. A volumetric magnetic resonance imaging study.
(2010) Nordanskog P, Dahlstrand U, Larsson MR et al. J of ECT;26:62-67
Hippocampal volumes, both left and right, increased after successful combined antidepressant and ECT in this prospective study of twelve depressed patients lending support to the theory that hippocampal volume loss is associated with depressive disorders. Mechanisms leading to the volume changes noted are postulated but there was no evidence of oedema

The level of serum brain derived neurotrophic factor is associated with the therapeutic efficacy of modified electroconvulsive therapy in Chinese patients with depression. (2010) Hu Y, Yu x, Yang F et al. J of ECT;26:121-125
There was a significant correlation in the rise of serum BDNF with improvement as measured by a fall in Hamilton rating score for depression in this prospective study of 28 patients. Patients with depression had lower serum BDNF with respect to controls at the outset, this rose to near normal levels at two weeks post successful treatment.

Electroconvulsive therapy stimulus parameters. Rethinking dosage. (2010) Peterchev AV, Rosa MA, Prudic J et al. J of ECT;26:159-174
This article, printed in a special edition of the Journal of ECT focussing on effectiveness of treatment, describes the components that make up total charge or energy. It may be that attention to machine variables such as pulse width, pulse shape, pulse amplitude, frequency and length of pulse train prove important in optomising treatment but as yet there is no definitive evidence. A biomedical overview of ECT is included.

9. Other Physical Therapies 

Neurophysiological characterization of high-dose magnetic seizure therapy. (2009) Cycowicz Y, Luber B, Spellman T et al. J of ECT;25:157-164.
This is a small, case control study that looked to identify differences between EEG characteristics and cognitive effects following either electroconvulsive seizures (ECS) or high dose magnetic seizures (MST) induced in rhesus monkeys. The results add to the evidence base for differential patterns of ictal expression and rate of cognitive side-effects.