Journal articles: 'Mechanism of action of electroconvulsive therapy'

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Smulewicz, Klaudia, Alicja Wójcik, Wojciech Pakaszewski, Bartosz Rusin, and Bartłomiej Ziomko. "Potential mechanisms of action and effectiveness of electroconvulsive therapy in the treatment of depressive disorders." Journal of Education, Health and Sport 12, no. 11 (November 3, 2022): 216–21. http://dx.doi.org/10.12775/jehs.2022.12.11.028.

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The aim of this study is to prove the positive effect of electroconvulsive therapy on depressive disorders. Depression as a mental illness has not been fully studied in terms of its relationship in combination with electroconvulsive therapy. Nevertheless, despite many uncertainties, its positive effect on this type of treatment is indicated. Analysing a number of studies, electroconvulsive therapy is considered to be the most effective treatment for depression. As the research work shows, thanks to the use of electroconvulsive therapy in older people over 60 years of age, a positive effect on the patient's health can be observed in the entire study group. The mechanism of action of electroconvulsive therapy is multifaceted. There are several theories of how it works, affecting different areas of the individual's body. These include an anticonvulsant theory (GABAergic), effects on serotonergic and dopaminergic functions in the brain, effects on neurogenesis in the hippocampus and amygdala and neuropathicity, effects on gene transcription, an increase in the Narp protein with a presumed antidepressant effect, support for the neuroendocrine mechanism, as well as effects on inflammation (cytokines).

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Merkl, Angela, Isabella Heuser, and Malek Bajbouj. "Antidepressant electroconvulsive therapy: Mechanism of action, recent advances and limitations." Experimental Neurology 219, no. 1 (September 2009): 20–26. http://dx.doi.org/10.1016/j.expneurol.2009.04.027.

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Rojas, Milagros, Daniela Ariza, Ángel Ortega, Manuel E. Riaño-Garzón, Mervin Chávez-Castillo, José Luis Pérez, Lorena Cudris-Torres, et al. "Electroconvulsive Therapy in Psychiatric Disorders: A Narrative Review Exploring Neuroendocrine–Immune Therapeutic Mechanisms and Clinical Implications." International Journal of Molecular Sciences 23, no. 13 (June 22, 2022): 6918. http://dx.doi.org/10.3390/ijms23136918.

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Electroconvulsive therapy (ECT) is based on conducting an electrical current through the brain to stimulate it and trigger generalized convulsion activity with therapeutic ends. Due to the efficient use of ECT during the last years, interest in the molecular bases involved in its mechanism of action has increased. Therefore, different hypotheses have emerged. In this context, the goal of this review is to describe the neurobiological, endocrine, and immune mechanisms involved in ECT and to detail its clinical efficacy in different psychiatric pathologies. This is a narrative review in which an extensive literature search was performed on the Scopus, Embase, PubMed, ISI Web of Science, and Google Scholar databases from inception to February 2022. The terms “electroconvulsive therapy”, “neurobiological effects of electroconvulsive therapy”, “molecular mechanisms in electroconvulsive therapy”, and “psychiatric disorders” were among the keywords used in the search. The mechanisms of action of ECT include neurobiological function modifications and endocrine and immune changes that take place after ECT. Among these, the decrease in neural network hyperconnectivity, neuroinflammation reduction, neurogenesis promotion, modulation of different monoaminergic systems, and hypothalamus–hypophysis–adrenal and hypothalamus–hypophysis–thyroid axes normalization have been described. The majority of these elements are physiopathological components and therapeutic targets in different mental illnesses. Likewise, the use of ECT has recently expanded, with evidence of its use for other pathologies, such as Parkinson’s disease psychosis, malignant neuroleptic syndrome, post-traumatic stress disorder, and obsessive–compulsive disorder. In conclusion, there is sufficient evidence to support the efficacy of ECT in the treatment of different psychiatric disorders, potentially through immune, endocrine, and neurobiological systems.

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O'Connor, M. Kevin. "Hypotheses Regarding the Mechanism of Action of Electroconvulsive Therapy, Past and Present." Psychiatric Annals 23, no. 1 (January 1, 1993): 15–18. http://dx.doi.org/10.3928/0048-5713-19930101-06.

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Scott, Allan I. F. "Mode of action of electroconvulsive therapy: an update." Advances in Psychiatric Treatment 17, no. 1 (January 2011): 15–22. http://dx.doi.org/10.1192/apt.bp.109.007039.

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SummaryIt has become acceptable for psychiatrists to say that they simply do not know how electroconvulsive therapy (ECT) works. This frame of mind runs the risk that there will be no expectation that psychiatrists remain familiar with seminal studies on the mode of action of ECT. This article is intended as a reminder of these studies and illustrates how the original theories have evolved. This evolution has been brought about largely by modern brain imaging techniques in human studies and in patients treated with ECT. These new findings will be set in the context of contemporary ideas about the neuroanatomy of mood disorders and the cellular mechanisms of the long-term effects of antidepressant treatments.

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Malcolm, Katy. "Patients' perceptions and knowledge of electroconvulsive therapy." Psychiatric Bulletin 13, no. 4 (April 1989): 161–65. http://dx.doi.org/10.1192/pb.13.4.161.

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Most research on electroconvulsive therapy (ECT) has focused on technical aspects, such as indications for treatment, efficacy, side effects of treatment, and theories of mechanism of action. Little investigation has been made of the attitudes and experience of patients receiving ECT and less regarding patients' understanding and knowledge of this treatment. Earlier studies have looked at specific aspects of patients' perceptions of ECT, such as subjective side effects, (Gomez, 1975), or the effect of the media on attitudes towards ECT (Bird, 1979). Other studies have investigated these and related issues more comprehensively (Freeman & Kendell, 1980; Hughes et al, 1980). These studies were carried out some time after the ECT course had been completed; in some cases, over a year. It may be that patients' perception and knowledge of ECT are different before and after treatment. Attitudes and knowledge may also change or fade over time.

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Tullio, Valeria, Stefania Zerbo, Antonietta Lanzarone, Salvatore Procaccianti, and Antonina Argo. "Psychological and Medico-Legal Perspectives on Electroconvulsive Therapy and Patient-Centered Care: A Short Review of Cross-Cutting Issues." Open Psychology Journal 13, no. 1 (September 8, 2020): 253–63. http://dx.doi.org/10.2174/1874350102013010253.

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Electroconvulsive therapy is a treatment that, since its first administration, has been a major topic for debate within the scientific world. In recent years, the debate has become increasingly focused on the short- and/or long-term efficacy of electroconvulsive therapy, its appropriateness in clinical settings, its mechanism of action, the impact evaluation of transient and/or persistent adverse effects, and the drafting of international guidelines, etc. From the authors’ point of view, these themes are inevitably crossed by three other fundamental issues of significant psychological, relational, ethical, and medico-legal impact. Still, they are less studied than purely biomedical issues in recent times. Therefore, the aim of this article is to focus on the following cross-cutting issues: the therapist-patient relationship, the patient’s perspective, the attitude on electroconvulsive therapy, and informed consent. This short review refers to the international literature on ECT published since 2000. Analyses of the three previously listed topics are, in part, made within the context of Italian medical settings.

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Nobler, Mitchell S., and Harold A. Sackeim. "Mechanisms of Action of Electroconvulsive Therapy: Functional Brain Imaging Studies." Psychiatric Annals 28, no. 1 (January 1, 1998): 23–29. http://dx.doi.org/10.3928/0048-5713-19980101-07.

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Ryan, K. M., and D. M. McLoughlin. "From Molecules to Mind: Mechanisms of Action of Electroconvulsive Therapy." FOCUS 17, no. 1 (January 2019): 73–75. http://dx.doi.org/10.1176/appi.focus.17104.

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Ryan, K. M., and D. M. McLoughlin. "From molecules to mind: mechanisms of action of electroconvulsive therapy." Acta Psychiatrica Scandinavica 138, no. 3 (August 16, 2018): 177–79. http://dx.doi.org/10.1111/acps.12951.

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Sharma, Nitasha, Sandhya Ghai, and Sandeep Grover. "Knowledge and Attitude of Nursing Students toward Electroconvulsive Therapy." Journal of Neurosciences in Rural Practice 08, S 01 (August 2017): S007—S012. http://dx.doi.org/10.4103/jnrp.jnrp_441_16.

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ABSTRACT Background: Electroconvulsive therapy (ECT) is one of the commonly used treatment modalities for patients with severe mental disorders. However, acceptance of ECT by the patient and relatives often depends on how the health-care professionals themselves present the treatment modality to the patients and their relatives. There is a lack of information about the knowledge and attitude toward ECT among health professionals. Aim: This study aimed to evaluate the knowledge about and attitude toward ECT among nursing students. Methodology: Knowledge of and attitudes toward ECT among nursing students were assessed using ECT knowledge and attitude questionnaires. Results: The study included 183 nursing students. Majority (n = 62; 60.8%) of the participants obtained information about ECT from media (movies, television, print media, etc.). None of the students had full knowledge about ECT. Although a significant proportion of students had knowledge about the ECT procedure and consent procedure, majority of them had poor knowledge about the effectiveness, mechanism of action, indications, and side effects of ECT. Negative attitudes were also highly prevalent, with more than two-thirds of the participants having negative attitudes toward ECT on more than half of the attitude items of the scale. Total knowledge score positively correlated with total attitude score, suggesting that higher knowledge was associated with more positive attitude. Conclusions: Although nursing students have knowledge about basic ECT procedure and consent, they lack knowledge about the effectiveness, mechanism of action, indications, and side effects of ECT. Negative attitude toward ECT is also highly prevalent among nursing students. Accordingly, there is a need to improve the knowledge and address the negative attitude of nursing students, which may ultimately lead to better acceptance of the treatment.

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Hoirisch-Clapauch, Silvia, Marco AU Mezzasalma, and Antonio E. Nardi. "Pivotal role of tissue plasminogen activator in the mechanism of action of electroconvulsive therapy." Journal of Psychopharmacology 28, no. 2 (October 9, 2013): 99–105. http://dx.doi.org/10.1177/0269881113507639.

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Dogaru, Ioana-Alexandra, Maria Gabriela Puiu, Mirela Manea, and Vlad Dionisie. "Current Perspectives on Pharmacological and Non-Pharmacological Interventions for the Inflammatory Mechanism of Unipolar Depression." Brain Sciences 12, no. 10 (October 18, 2022): 1403. http://dx.doi.org/10.3390/brainsci12101403.

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Since depression remains a major public health issue there is a constant need for new and more efficient therapeutic strategies based on the mechanisms involved in the aetiology of depression. Thus, the pathogenic link between depression and inflammation is considered to play a potential key role in the development of such therapies. This review summarizes the results of various pharmacological (non-steroidal anti-inflammatory drugs, aspirin, cyclooxygenase inhibitors, cytokine inhibitors, corticosteroids, statins, minocycline, N-acetyl cysteine, omega-3 fatty acids and probiotics) and non-pharmacological interventions (electroconvulsive therapy, physical exercise and psychological therapy) and outlines their efficacy and discusses potential challenges. Both conventional and non-conventional anti-inflammatory drugs showed promising results according to the specific group of patients. The pre-existing pro-inflammatory status was, in most cases, a predictor for clinical efficacy and, in some cases, a correlation between clinical improvement and changes in various biomarkers was found. Some of the non-pharmacological interventions (physical exercise and electroconvulsive therapy) have also showed beneficial effects for depressive patients with elevated inflammatory markers. Treatments with anti-inflammatory action may improve clinical outcomes in depression, at least for some categories of patients, thus opening the way for a future personalised approach to patients with unipolar depression regarding the inflammation-related mechanism.

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Cassidy, Frederick, Richard D. Weiner, Thomas B. Cooper, and Bernard J. Carroll. "Combined catecholamine and indoleamine depletion following response to ECT." British Journal of Psychiatry 196, no. 6 (June 2010): 493–94. http://dx.doi.org/10.1192/bjp.bp.109.070573.

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SummaryThe mechanism of action of electroconvulsive therapy (ECT) in treating major depression is unknown. We studied two candidate mechanisms through inhibiting simultaneously the synthesis of noradrenaline and serotonin in patients immediately after successful treatment with ECT using a randomised, placebo-controlled, double-blind crossover design. There were no significant changes in depression scores under any experimental conditions, or between the amine-depleted and placebo groups despite reductions of 61% in serum homovanillic acid, 47% in 3-methoxy-4-hydroxyenylethyleneglycol, and 89% in serum tryptophan. Catecholamine and serotonin availability may not be necessary for maintaining the initial antidepressant response to ECT.

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Koch, H. J. "Possible Hypothetical Mode of Action of ECT (Electroconvulsive Therapy) Based on DNA Dipole Character and Epigenetics." Acta Medica Bulgarica 48, no. 4 (November 1, 2021): 57–61. http://dx.doi.org/10.2478/amb-2021-0049.

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Abstract The human genome consists of roughly 23000 genes which cannot explain the enormous diversity of proteins or behavior. A second epigenetic code warrants adaptive variation of gene expression. The rationale of this variation are transfer reactions such as methylation, acetylation or phosphorylation of DNA or histones including reverse reactions which are supposed to be altered by electroconvulsive therapy (ECT). The method has been successfully used since the 1930ies but the underlying molecular mechanism of action has not been elucidated yet. The paper discusses the theoretical involvement of epigenetic gene expression as an adaptive process to explain biochemical changes after ECT administration.

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Kara, Waheed ashokatkassam, Khamis Hassan Bakari, Henry Anselmo Mayala, Bing Shao, and Mao Jing. "Neurocognitive Effects of Electroconvulsive Therapy in Psychiatric Disorders, Mechanism of Action And its Prevention: Review Article." IOSR Journal of Dental and Medical Sciences 16, no. 04 (May 2017): 87–92. http://dx.doi.org/10.9790/0853-1604078792.

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Lisanby, Sarah H., Oscar Morales, Nancy Payne, Edward Kwon, Linda Fitzsimons, Bruce Luber, Mitchell S. Nobler, and Harold A. Sackeim. "New Developments in Electroconvulsive Therapy and Magnetic Seizure Therapy." CNS Spectrums 8, no. 7 (July 2003): 529–36. http://dx.doi.org/10.1017/s1092852900019003.

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ABSTRACTNew findings regarding the mechanisms of action of electroconvulsive therapy (ECT) have led to novel developments in treatment technique to further improve this highly effective treatment for major depression. These new approaches include novel electrode placements, optimization of electrical stimulus parameters, and new methods for inducing more targeted seizures (eg, magnetic seizure therapy [MST]). MST is the use of transcranial magnetic stimulation to induce a seizure. Magnetic fields pass through tissue unimpeded, providing more control over the site and extent of stimulation than can be achieved with ECT. This enhanced control represents a means of focusing the treatment on target cortical structures thought to be essential to antidepressant response and reducing spread to medial temporal regions implicated in the cognitive side effects of ECT. MST is at an early stage of development. Preliminary results suggest that MST may have some advantages over ECT in terms of subjective side effects and acute cognitive functioning. Studies designed to address the antidepressant efficacy of MST are underway. As with all attempts to improve convulsive therapy technique, the clinical value of MST will need to be established through controlled clinical trials. This article reviews the experience to date with MST, and places this work in the broader context of other means of optimizing convulsive therapy in the treatment of depression.

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Kobayashi, Katsunori, Yuki Imoto, Fumi Yamamoto, Mayu Kawasaki, Miyuki Ueno, Eri Segi-Nishida, and Hidenori Suzuki. "Rapid and lasting enhancement of dopaminergic modulation at the hippocampal mossy fiber synapse by electroconvulsive treatment." Journal of Neurophysiology 117, no. 1 (January 1, 2017): 284–89. http://dx.doi.org/10.1152/jn.00740.2016.

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Electroconvulsive therapy (ECT) is an established effective treatment for medication-resistant depression with the rapid onset of action. However, its cellular mechanism of action has not been revealed. We have previously shown that chronic antidepressant drug treatments enhance dopamine D1-like receptor-dependent synaptic potentiation at the hippocampal mossy fiber (MF)-CA3 excitatory synapse. In this study we show that ECT-like treatments in mice also have marked effects on the dopaminergic synaptic modulation. Repeated electroconvulsive stimulation (ECS), an animal model of ECT, strongly enhanced the dopamine-induced synaptic potentiation at the MF synapse in hippocampal slices. Significant enhancement was detectable after the second ECS, and further repetition of ECS up to 11 times monotonously increased the magnitude of enhancement. After repeated ECS, the dopamine-induced synaptic potentiation remained enhanced for more than 4 wk. These synaptic effects of ECS were accompanied by increased expression of the dopamine D1 receptor gene. Our results demonstrate that robust neuronal activation by ECS induces rapid and long-lasting enhancement of dopamine-induced synaptic potentiation at the MF synapse, likely via increased expression of the D1 receptor, at least in part. This rapid enhancement of dopamine-induced potentiation at the excitatory synapse may be relevant to the fast-acting antidepressant effect of ECT. NEW & NOTEWORTHY We show that electroconvulsive therapy (ECT)-like stimulation greatly enhances synaptic potentiation induced by dopamine at the excitatory synapse formed by the hippocampal mossy fiber in mice. The effect of ECT-like stimulation on the dopaminergic modulation was rapidly induced, maintained for more than 4 wk after repeated treatments, and most likely mediated by increased expression of the dopamine D1 receptor. These effects may be relevant to fast-acting strong antidepressant action of ECT.

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Llorca, P. M., G. Reine, and M. A. Wolf. "Mécanisme d'action des antidépresseurs." Canadian Journal of Psychiatry 38, no. 10 (December 1993): 649–56. http://dx.doi.org/10.1177/070674379303801005.

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Modifications in noradrenergic and serotonergic systems are involved in the central mechanism of action of antidepressants. Most antidepressants (electroconvulsive therapy included) induce a desensitization of the β-noradrenergic receptor, as shown by a decrease in noradrenalin-stimulated cAMP production. Down-regulation of the β receptor is often associated with desensitization, as well as modifications in the activity of the serotonergic system, among which alterations in 5-HT2 receptors are frequent. Finally, complex interactions between noradrenergic and serotonergic receptors may also contribute to the pharmacological effect of long term antidepressive treatment.

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COWEN, P. J. "Neuroendocrine Responses as a Probe into the Mechanisms of Action of Electroconvulsive Therapy." Annals of the New York Academy of Sciences 462, no. 1 Electroconvul (March 1986): 163–71. http://dx.doi.org/10.1111/j.1749-6632.1986.tb51250.x.

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Andrade, Chittaranjan. "A Primer for the Conceptualization of the Mechanism of Action of Electroconvulsive Therapy, 1: Defining the Question." Journal of Clinical Psychiatry 75, no. 05 (May 15, 2014): e410-e412. http://dx.doi.org/10.4088/jcp.14f09185.

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Andrade, Chittaranjan. "A Primer for the Conceptualization of the Mechanism of Action of Electroconvulsive Therapy, 2: Organizing the Information." Journal of Clinical Psychiatry 75, no. 06 (June 15, 2014): e548-e551. http://dx.doi.org/10.4088/jcp.14f09234.

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Herzog, David, Gregers Wegener, Klaus Lieb, Marianne Müller, and Giulia Treccani. "Decoding the Mechanism of Action of Rapid-Acting Antidepressant Treatment Strategies: Does Gender Matter?" International Journal of Molecular Sciences 20, no. 4 (February 22, 2019): 949. http://dx.doi.org/10.3390/ijms20040949.

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Gender differences play a pivotal role in the pathophysiology and treatment of major depressive disorder. This is strongly supported by a mean 2:1 female-male ratio of depression consistently observed throughout studies in developed nations. Considering the urgent need to tailor individualized treatment strategies to fight depression more efficiently, a more precise understanding of gender-specific aspects in the pathophysiology and treatment of depressive disorders is fundamental. However, current treatment guidelines almost entirely neglect gender as a potentially relevant factor. Similarly, the vast majority of animal experiments analysing antidepressant treatment in rodent models exclusively uses male animals and does not consider gender-specific effects. Based on the growing interest in innovative and rapid-acting treatment approaches in depression, such as the administration of ketamine, its metabolites or electroconvulsive therapy, this review article summarizes the evidence supporting the importance of gender in modulating response to rapid acting antidepressant treatment. We provide an overview on the current state of knowledge and propose a framework for rodent experiments to ultimately decode gender-dependent differences in molecular and behavioural mechanisms involved in shaping treatment response.

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Burgese, Daniel Fortunato, and Débora Pastore Bassitt. "Variation of plasma cortisol levels in patients with depression after treatment with bilateral electroconvulsive therapy." Trends in Psychiatry and Psychotherapy 37, no. 1 (January 30, 2015): 27–36. http://dx.doi.org/10.1590/2237-6089-2014-0031.

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Introduction: More than 60 years after the introduction of modern psychopharmacology, electroconvulsive therapy (ECT) continues to be an essential therapeutic modality in the treatment of mental disorders, but its mechanism of action remains unclear. Hormones play an essential role in the development and expression of a series of behavioral changes. One aspect of the influence of hormones on behavior is their potential contribution to the pathophysiology of psychiatric disorders and the mechanism of action of psychotropic drugs and ECT.Objective: We measured blood levels of the hormone cortisol in patients with unipolar depression according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) and compared results with levels found in healthy adults.Method: Blood cortisol levels were measured before the beginning of treatment with ECT, at the seventh session, and at the last session, at treatment completion. Depression symptoms were assessed using the Beck Depression Inventory (BDI).Results: Cortisol levels remained stable in both men and women between the seventh and the last sessions of ECT; values ranged from 0.686±9.6330 g/dL for women, and there was a mean decrease of 5.825±6.0780 g/dL (p = 0.024). Mean number of ECT sessions was 12. After the seventh and the last ECT sessions, patients with depression and individuals in the control group had similar cortisol levels, whereas BDI scores remained different.Conclusion: Cortisol levels decreased during ECT treatment. ECT seems to act as a regulator of the hypothalamic-pituitaryadrenal axis.

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Ray, Anindya. "Treatment of refractory status epilepticus with electroconvulsive therapy: Need for future clinical studies." International Journal of Epilepsy 04, no. 01 (June 2017): 098–103. http://dx.doi.org/10.1016/j.ijep.2017.01.002.

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AbstractStatus epilepticus (SE) is a serious medical emergency. Refractory-SE non-responsive to anesthetic medication is a life threatening condition with very high mortality rate. Proper management of those cases is a big medical challenge. Over the last two decades there are anecdotal reports of successful management of such cases with electroconvulsive therapy (ECT) in 12 patients of different age group with variable pattern of seizures and different etiology. However, there is no systematic research about it. ECT is a well-known safe, easy- to-administer, low-cost therapeutic modality in the field of neuro-psychiatry. Thus its potential to treat refractory-SE which essentially lacks effective management should be evaluated in future research. The objectives of this article are to do a thorough literature review on use of ECT in refractory-SE; mechanism of action of ECT in refractory-SE; and finally formulate a working protocol for future study of using ECT in patients of refractory-SE.

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Warneke, Lorne. "Intravenous Chlorimipramine Therapy in Obsessive-Compulsive Disorder*." Canadian Journal of Psychiatry 34, no. 9 (December 1989): 853–59. http://dx.doi.org/10.1177/070674378903400902.

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A brief summary of the etiological factors and pharmacological approaches to therapy of obsessive-compulsive disorder is given. Evidence for the serotonergic hypothesis is reviewed. Three case reports of patients with severe OCD who had not responded to traditional chemotherapeutic approaches and electroconvulsive therapy are presented. All three responded to a series of 14 intravenous chlorimipramine infusions with a maximum dose of 350 mgms per infusion. The technique of infusion therapy and possible mechanisms of action are discussed. It is concluded that OCD is no longer accepted as a rare disorder and that effective treatment exists. For patients who do not respond to oral chlorimipramine, the treatment of choice, intravenous chlorimipramine is suggested as a viable alternative.

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Conway, Charles R., Mehret D. Gebretsadik, and Richard D. Bucholz. "Marked Response to VNS in a Post-Cingulotomy Patient: Implications for the Mechanism of Action of VNS in TRD." CNS Spectrums 16, no. 6 (June 2011): 135–41. http://dx.doi.org/10.1017/s1092852912000302.

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AbstractTreatment-resistant major depression (TRMD, major depressive disorder that fails to respond to numerous therapies) is a relatively common and clinically challenging disorder. In many cases, the most severely affected TRMD patients have received surgical intervention (subcaudate tractotomy, limbic leucotomy, anterior capsulotomy, and anterior cingulotomy). New treatments, including vagus nerve stimulation (VNS) and deep brain stimulation, have emerged to treat individuals with TRMD. We describe the case of a woman, 53 years of age, with a long and sustained history of TRMD (33 years), which was unresponsive to numerous treatments (multiple pharmacotherapies, psychotherapy, electroconvulsive therapy [ECT]). Additionally, her TRMD failed to respond to a bilateral anterior cingulotomy. She underwent placement of a cervical vagus nerve stimulator and a brief course of ECT (3 unilateral treatments). Her depression improved markedly, and it has remained in sustained remission for 3.5 years. This case suggests a potential synergistic effect of VNS and ECT, as well as provides possible clues to the neural circuitry of VNS in TRMD.

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Schwartzman, Robert J. "Treatment of CRPS with ECT." July 2007 4;10, no. 7;4 (July 14, 2007): 573–78. http://dx.doi.org/10.36076/ppj.2007/10/573.

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Background: Electroconvulsive therapy (ECT) is a well-established treatment method for medically refractory depression. ECT has also been used in the treatment of pain for over 50 years. The mechanism of action of ECT is still unknown, although several observations have been made regarding the effect of ECT on pain processes. It has been reported that several patients with medically refractory depression and Complex Regional Pain Syndrome who were treated with ECT for their depression were also cured of their CRPS symptoms. Objective: We report a case of CRPS in a patient who also suffered from medically refractory depression. She was treated with ECT for her depression and subsequently was relieved of all her CRPS symptoms. Case Report: A 42 year-old female patient underwent a series of 12 standard bitemporal electroconvulsive therapy treatments for medically refractory depression. Physical examination and Quantitative Sensory Testing was done before and after the patient’s treatment with ECT. This standard treatment procedure for refractory depression completely resolved the patient’s depressive symptoms. In addition, the patient’s CRPS symptoms were also reversed. Physical examination as well as Quantitative Sensory Testing done before and after the ECT treatment correlated with her CRPS symptom improvement. Conclusion: ECT was effective in the treatment of severe refractory CRPS in this patient. Key words: Iimpedance, posture change, spinal cord stimulation

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Takano, Harumasa, Nobutaka Motohashi, Takeshi Uema, Kenichi Ogawa, Takashi Ohnishi, Masami Nishikawa, Haruo Kashima, and Hiroshi Matsuda. "Changes in regional cerebral blood flow during acute electroconvulsive therapy in patients with depression." British Journal of Psychiatry 190, no. 1 (January 2007): 63–68. http://dx.doi.org/10.1192/bjp.bp.106.023036.

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BackgroundAlthough electroconvulsive therapy (ECT) is widely used to treat psychiatric disorders such as depression, its precise neural mechanisms remain unknown.AimsTo investigate the time course of changes in cerebral blood flow during acute ECT.MethodCerebral blood flow was quantified serially prior to, during and after acute ECT in six patients with depression under anaesthesia using [15O]H2O positron emission tomography (PET).ResultsCerebral blood flow during ECT increased particularly in the basal ganglia, brain-stem, diencephalon, amygdala, vermis and the frontal, temporal and parietal cortices compared with that before ECT. The flow increased in the thalamus and decreased in the anterior cingulate and medial frontal cortex soon after ECT compared with that before ECT.ConclusionsThese results suggest a relationship between the centrencephalic system and seizure generalisation. Further, they suggest that some neural mechanisms of action of ECT are mediated via brain regions including the anterior cingulate and medial frontal cortex and thalamus.

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Tracy, Derek K., and Anthony S. David. "Clinical neuromodulation in psychiatry: the state of the art or an art in a state?" BJPsych Advances 21, no. 6 (November 2015): 396–404. http://dx.doi.org/10.1192/apt.bp.115.014563.

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SummaryClinical neuromodulation began in psychiatry with electroconvulsive therapy (ECT), but in recent years several new techniques have been developed: repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), vagal nerve stimulation (VNS), trigeminal nerve stimulation (TNS) and deep brain stimulation (DBS). Each works in a different way, although the principle remains to effect therapeutic change through physically modifying brain activity. Their use in different clinical groups varies between techniques, as does their underlying evidence base. Most support currently exists for rTMS, with a more modest, but growing database for tDCS. Understandably, but problematically, most research in the other techniques has, to date, been in unmasked open trials. This article describes the mechanism of action and current evidence base for each technique, and notes the challenges facing future work in this potentially important field and new clinical avenue.

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Adão, C., A. A. Quintão, A. Velosa, P. Trindade, and C. Almeida. "Electroconvulsive therapy in treatment resistant schizophrenia: Old beacon of hope when nothing else works." European Psychiatry 65, S1 (June 2022): S782—S783. http://dx.doi.org/10.1192/j.eurpsy.2022.2021.

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Introduction Electroconvulsive therapy (ECT) is one of the oldest psychiatric treatments used to this day. It is particularly useful in cases of schizophrenia resistant to treatment with antipsychotics. 49% of patients with schizophrenia experience little or no response with one trial of antipsychotics, 71% do not achieve remission and up to 20% of patients are also resistant to clozapine. Objectives Description of a clinical case where ECT is used in the treatment of resistant schizophrenia and review of the literature. Methods Description of a clinical case. Non systematic review of the literature, searching the terms “treatment resistant”; “schizophrenia”; “ect” in the databases Pubmed, Medline, Cochrane and Uptodate. Results Male, 38-year-old patient, diagnosed with schizophrenia for 20 years, with history of multiple hospitalizations, institutionalized for 9 years. Treated with risperidone 50 mg intramuscular fortnightly, clozapine 750 mg daily, aripiprazol 30 mg daily and diazepam 10 mg daily. He presented with increased delusional intensity for a year. Hospitalized for treatment with ECT, submitted to 12 sessions with bitemporal stimuli, with effective convulsions. MoCA, PANSS and BPRS were applied before and after treatment, with an increase of 25% in MoCA and a decrease of 47.3% and 57.9% respectively, in the psychotic symptoms scales. Conclusions We present a case of schizophrenia resistant to treatment with multiple antipsychotics, including clozapine. ECT was used, with clinically demonstrated efficacy. In the future, it might be interesting to study in detail the mechanism of action of this treatment with the goal of deepening the knowledge of the neurobiology of schizophrenia. Disclosure No significant relationships.

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Werstiuk, Eva S., Margaret Coote, Lauren Griffith, Harry Shannon, and Meir Steiner. "Effects of Electroconvulsive Therapy on Peripheral Adrenoceptors, Plasma, Noradrenaline, MHPG and Cortisol in Depressed Patients." British Journal of Psychiatry 169, no. 6 (December 1996): 758–65. http://dx.doi.org/10.1192/bjp.169.6.758.

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BackgroundThe mechanism of the antidepressant action of electroconvulsive therapy (ECT) remains unknown. Based on previous work with antidepressant drugs and their effects on the noradrenergic system, we undertook this study to further determine the effects of ECT on selected indices of peripheral adrenoceptor function in depressed patients.MethodsBinding parameters (Bmaxand Kd) of plateletα2- and leukocyteβ2-adrenoceptors, plasma noradrenaline (NA), 3-methoxy-4-hydroxy-phenylglycol (MHPG) and cortisol levels were determined in 18 patients, prior to treatment and 14 days after the last of a series of ECTs, and compared with samples obtained from 18 matched control subjects.ResultsPlateletα2-adrenoceptor sites were significantly elevated in untreated patients compared with controls (P< 0.03), but leukocyteβ2-adrenoceptor numbers did not differ. Treatment with ECT led to a significant reduction in plateletα2-adrenoceptor numbers, whereas leukocyteβ2-adrenoceptor densities increased. Pre-ECT plasma NA, MHPG, and cortisol levels were elevated in patients, compared with controls, and decreased following ECT, but these differences were not statistically significant. Post-ECT plasma NA andβ2-adrenoceptor numbers were significantly, negatively correlated (P< 0.05).ConclusionsThese results suggest that plateletα2-adrenoceptors are supersensitive in depressed patients and treatment with ECT results in down-regulation of these receptors, which may be interpreted as a primary therapeutic, ‘normalising’ effect. The post-ECT changes in leukocyteβ2-adrenoceptors are probably only secondary to the lower circulating plasma NA levels.

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Martinotti, G., V. Ricci, M. Di Nicola, C. Caltagirone, P. Bria, A. Martinotti, and F. Angelucci. "Brain-derived neurotrophic factor and electroconvulsive therapy in a schizoaffective patient with treatment-resistant paranoid-hallucinatory symptoms." European Psychiatry 26, S2 (March 2011): 1148. http://dx.doi.org/10.1016/s0924-9338(11)72853-x.

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It has been proposed that deficits in the production and the utilization of brain-derived neurotrophic factor (BDNF) may contribute to the pathogenesis of schizophrenia. At the same time, electroconvulsive therapy (ECT) has been shown to induce a robust increase of BDNF protein in animal models. These findings suggest that one putative mechanism of action of ECT is the regulation of BDNF and/or related neurotrophins. In this case report a 54-year-old man with severe treatment-resistant schizophrenic symptoms was treated with ECT. In order to evaluate the effect of ECT on BDNF serum levels, we collected a blood sample before each ECT session. During the course of ECT treatment the paranoid and hallucinatory symptoms gradually improved while BDNF levels increased over time. In addition, there was a general improvement of its positive and negative schizophrenic symptoms and depressive state.In conclusion, this case report further validates the therapeutic efficacy of ECT in schizophrenic patients with inadequate or poor response to traditional treatments. Moreover, ECT therapeutic effect is associated with an increase in BDNF serum levels. Further studies are needed to characterize the relationship between BDNF and ECT in patients with schizophrenia symptoms.

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Chen, Fenghua, Jibrin Danladi, Gregers Wegener, Torsten M. Madsen, and Jens R. Nyengaard. "Sustained Ultrastructural Changes in Rat Hippocampal Formation After Repeated Electroconvulsive Seizures." International Journal of Neuropsychopharmacology 23, no. 7 (March 26, 2020): 446–58. http://dx.doi.org/10.1093/ijnp/pyaa021.

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Abstract Background Electroconvulsive therapy (ECT) is a highly effective and fast-acting treatment for depression used in the clinic. Its mechanism of therapeutic action remains uncertain. Previous studies have focused on documenting neuroplasticity in the early phase following electroconvulsive seizures (ECS), an animal model of ECT. Here, we investigate whether changes in synaptic plasticity and nonneuronal plasticity (vascular and mitochondria) are sustained 3 months after repeated ECS trials. Methods ECS or sham treatment was given daily for 1 day or 10 days to a genetic animal model of depression: the Flinders Sensitive and Resistant Line rats. Stereological principles were employed to quantify numbers of synapses and mitochondria as well as length of microvessels in the hippocampus 24 hours after a single ECS. Three months after 10 ECS treatments (1 per day for 10 days) and sham-treatment, brain-derived neurotrophic factor and vascular endothelial growth factor protein levels were quantified with immunohistochemistry. Results A single ECS treatment significantly increased the volume of hippocampal CA1-stratum radiatum, the total length of microvessels, mitochondria number, and synapse number. Observed changes were sustained as shown in the multiple ECS treatment group analyzed 3 months after the last of 10 ECS treatments. Conclusion A single ECS caused rapid effects of synaptic plasticity and nonneuronal plasticity, while repeated ECS induced long-lasting changes in the efficacy of synaptic plasticity and nonneuronal plasticity at least up to 3 months after ECS.

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Staton, R. Dennis, John D. Enderle, and Jeffery W. Gerst. "The Electroencephalographic Pattern during Electroconvulsive Therapy: V. Observations on the Origins of Phase III Delta Energy and the Mechanism of Action of ECT." Clinical Electroencephalography 19, no. 4 (October 1988): 176–98. http://dx.doi.org/10.1177/155005948801900404.

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Moon, Sun-Young, Minah Kim, Silvia Kyungjin Lho, Sanghoon Oh, Se Hyun Kim, and Jun Soo Kwon. "Systematic Review of the Neural Effect of Electroconvulsive Therapy in Patients with Schizophrenia: Hippocampus and Insula as the Key Regions of Modulation." Psychiatry Investigation 18, no. 6 (June 25, 2021): 486–99. http://dx.doi.org/10.30773/pi.2020.0438.

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Objective Electroconvulsive therapy (ECT) has been the most potent treatment option for treatment-resistant schizophrenia (TRS). However, the underlying neural mechanisms of ECT in schizophrenia remain largely unclear. This paper examines studies that investigated structural and functional changes after ECT in patients with schizophrenia. Methods We carried out a systematic review with following terms: ‘ECT’, ‘schizophrenia’, and the terms of various neuroimaging modalities. Results Among the 325 records available from the initial search in May 2020, 17 studies were included. Cerebral blood flow in the frontal, temporal, and striatal structures was shown to be modulated (n=3), although the results were divergent. Magnetic resonance spectroscopy (MRS) studies suggested that the ratio of N-acetyl-aspartate/creatinine was increased in the left prefrontal cortex (PFC; n=2) and left thalamus (n=1). The hippocampus and insula (n=6, respectively) were the most common regions of structural/functional modulation, which also showed symptom associations. Functional connectivity of the default mode network (DMN; n=5), PFC (n=4), and thalamostriatal system (n=2) were also commonly modulated. Conclusion Despite proven effectiveness, there has been a dearth of studies investigating the neurobiological mechanisms underlying ECT. There is preliminary evidence of structural and functional modulation of the hippocampus and insula, functional changes in the DMN, PFC, and thalamostriatal system after ECT in patients with schizophrenia. We discuss the rationale and implications of these findings and the potential mechanism of action of ECT. More studies evaluating the mechanisms of ECT are needed, which could provide a unique window into what leads to treatment response in the otherwise refractory TRS population.

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Maruyama, Soichiro, Shuken Boku, Satoshi Okazaki, Hiroki Kikuyama, Yoshito Mizoguchi, Akira Monji, Ikuo Otsuka, et al. "ATP and repetitive electric stimulation increases leukemia inhibitory factor expression in astrocytes: A potential role for astrocytes in the action mechanism of electroconvulsive therapy." Psychiatry and Clinical Neurosciences 74, no. 5 (March 5, 2020): 311–17. http://dx.doi.org/10.1111/pcn.12986.

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Pawłowski, Piotr, Wojciech Brodowski, Joanna Borowik, Aleksandra Swora, Oliwer Sygacz, Przemysław Żelazny, Joanna Filipczak, Sara Dankiewicz, Sebastian Bróż, and Katarzyna Basta-Arciszewska. "Diagnosis and treatment of mental disorders – a review of the scientific literature." Journal of Education, Health and Sport 12, no. 9 (September 8, 2022): 572–82. http://dx.doi.org/10.12775/jehs.2022.12.09.067.

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Introduction: Unambiguous definition of mental disorders is difficult, mainly because of the heterogeneity of this group of diseases and the clarity of the line between pathology and normal. The definition proposed by the World Health Organization (WHO) is widely accepted. In practice, definitions from the legislation of a country are also important. Aim of the work: The purpose of this study is to discuss the basic issues of diagnosis and treatment of mental disorders. Material and method: A method of non-systematic literature review from databases such as scientific Google Scholar, PubMed, CinalHl, Scopus, Arianta, Web of Science was used. Results and conclusions: In the treatment of mental disorders, I use pharmacological and non-pharmacological methods. Psychopharmaceuticals are divided into several groups depending on their mechanism of action. Their selection depends mainly on the diagnosed disease entity and tolerance to treatment. The most widely used group of drugs is the group of non-selective serotonin reuptake inhibitors (SSRIs). Non-pharmacological methods include psychotherapy, electroconvulsive therapy, deep brain stimulation, and psychosurgery.

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Li, J., F. Ye, W. Xiao, X. Tang, W. Sha, X. Zhang, and J. Wang. "Increased serum brain-derived neurotrophic factor levels following electroconvulsive therapy or antipsychotic treatment in patients with schizophrenia." European Psychiatry 36 (August 2016): 23–28. http://dx.doi.org/10.1016/j.eurpsy.2016.03.005.

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AbstractBackgroundMany schizophrenia patients experience residual symptoms even after treatment. Electroconvulsive therapy (ECT) is often used in medication-resistant schizophrenia patients when pharmacologic interventions have failed; however, the mechanism of action is unclear. Brain-derived neurotrophic factor (BDNF) levels are reduced in drug-naive, first-episode schizophrenia and are increased by antipsychotic treatment. We tested the hypothesis that ECT increases serum BDNF levels by measuring BDNF concentrations in schizophrenia patients before and after they received ECT.MethodsA total of 160 patients with schizophrenia were examined. The ECT group (n = 80) was treated with antipsychotics and ECT (eight to 10 sessions administered every other day). The drug therapy group (n = 80) received only antipsychotic treatment. A control group (n = 77) was recruited that served as the baseline for comparison.ResultsBaseline serum BDNF level in ECT group was lower than in controls (9.7 ± 2.1 vs. 12.4 ± 3.2 ng/ml; P < 0.001), but increased after ECT, such that there was no difference between the two groups (11.9 ± 3.3 vs. 12.4 ± 3.2 ng/ml; P = 0.362). There was no correlation between patients’ Positive and Negative Syndrome Scale (PANSS) score and serum BDNF level before ECT; however, a negative correlation was observed after ECT (total: r = −0.692; P < 0.01). From baseline to remission after ECT, serum BDNF level increased (P < 0.001) and their PANSS score decreased (P < 0.001). Changes in BDNF level (2.21 ± 4.10 ng/ml) and PANSS score (28.69 ± 14.96) were positively correlated in the ECT group (r = 0.630; P < 0.01).ConclusionsBDNF level was lower in schizophrenia patients relative to healthy controls before ECT and medication. BDNF level increased after ECT and medication, and its longitudinal change was associated with changes in patients’ psychotic symptoms. These results indicate that BDNF mediates the antipsychotic effects of ECT.

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Kasper, S. "Treatment Resistance in Depression." European Psychiatry 26, S2 (March 2011): 2022. http://dx.doi.org/10.1016/s0924-9338(11)73725-7.

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Due to the advancement of antidepressant medication, more patients receive treatment in everyday practice, and response/remission is not achieved in the majority of the patients. Several attempts to validate the definition of treatment resistance have been undertaken and the criteria usually encompased to treatment sequences are that two different classes of antidepressants given in a sufficient dosage for a sufficient time have to be administered. Clinically, it is evident that this defintion does not include the treatment refractory patients which could be defined as not responding to numerus trials including electroconvulsive therapy. The goal to improve treatment through the use of predicitve biomarkers has not as yet been obtained and will be the challenge for the future. The clinical variables predicting treatment resistance include comorbid anxiety disorders as well as melancholic features. Although there is a plethora of hints in textbooks that switching the mechanism of action should be obtained when a patient does not respond to one medication, the few controlled trials which have been undertaken to challenge this notion revealed that staying on the same antidepressant mechanism of action for a longer time is more beneficial. In previous times, the conjunctive use of agents such as lithium or thyroid augmentation have been proposed, however the new data achieved with atypical antipsychotics demonstrate a more rapid improvement. Techniques such as brain stimulation or vagus nerve stimulation have also shown promising early results. Treatment resistance continues to be a major barrier achieving remission in patients with major depressive disorder and a thorough re-evaluation of the condition and its treatment is needed.

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ten Doesschate, Freek, Guido A. van Wingen, Boudewijn J. H. B. de Pont, Martijn Arns, and Jeroen A. van Waarde. "The Longitudinal Effects of Electroconvulsive Therapy on Ictal Interhemispheric Coherence and Its Associations With Treatment Outcome: A Naturalistic Cohort Study." Clinical EEG and Neuroscience 50, no. 1 (June 21, 2018): 44–50. http://dx.doi.org/10.1177/1550059418781698.

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Objectives. Electroconvulsive therapy (ECT) is an effective treatment for severe depression. Electroencephalogram (EEG) measures between ECT sessions seem to be related to the antidepressant efficacy of ECT. In this naturalistic cohort study, we examine longitudinal effects of ECT on interhemispheric EEG coherence measures during seizure activity and its relation to the antidepressant efficacy. Methods. This study included 65 patients diagnosed with severe depressive disorder. Depressive symptoms were rated according to the Montgomery-Åsberg Depression Rating Scale before and after the course of ECT. Frequency-specific ictal interhemispheric (fp1-fp2) EEG coherence measures were established during the first and each consecutive sixth treatment session. Linear mixed-effect models were used to determine longitudinal changes in ictal coherence measures during the course of ECT and its relation to treatment efficacy. Results. Ictal interhemispheric coherence in the theta and alpha frequency bands increased over the course of treatment, whereas no significant change was found for the delta and beta frequency bands. A main effect of treatment efficacy on the interhemispheric coherence in the delta and theta band was revealed. However, the longitudinal effects of ECT were not associated with treatment efficacy. Conclusion. The current study suggests that interhemispheric coherence during ECT-induced seizures increases over the course of treatment. Furthermore, these longitudinal effects seem to be unrelated to the antidepressant efficacy of ECT. These findings contribute to the understanding of the mechanism of action of ECT.

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Wanot, Bartosz, Barbara Szczygieł, Wojciech Wanot, and Mariana Magerčiaková. "DEPRESSION - TYPES AND TREATMENT OF DEPRESSION." Scientific Journal of Polonia University 32, no. 1 (April 3, 2019): 121–30. http://dx.doi.org/10.23856/3216.

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The key symptom of depression is lowering the mood, but this is not the only sign of depression. Depression is a disease in which the symptoms reach various intensities and occur in many configurations. We distinguish the following types of depression: reactive, endogenous, neurotic, anankastic, agitated, large and small, morning (subclinical and subliminal), seasonal, masked, psychotic, postpartum, drug resistant, in children and adolescents, in the elderly, involutional, organic , in bipolar disorder, dysthymia, depression and anxiety, and in somatic diseases. Psychotherapy is now a popular and effective method of treating depression. The effects of treatment after the use of antidepressants appear only after a few weeks from the beginning of therapy. Old-generation medicines: these are tricyclic antidepressants (TLPDs), inhibitors of neuromediator reuptake and monoamine oxidase enzyme (IMAO) inhibitors. The new generation of drugs is distinguished by selective serotonin reuptake inhibitors (SSRIs), selective serotonin and noradrenaline reuptake inhibitors (SNRIs), four-ring drugs, noradrenaline reuptake inhibitors, selective reversible MAO inhibitors, and drugs with other mechanisms of action. Phototherapy (treatment of light) is currently a widely accepted method of winter depression therapy. Other treatments for depression include electroconvulsive therapy and transcranial magnetic stimulation.

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Gallop, L., M. Flynn, I. C. Campbell, and U. Schmidt. "Neuromodulation and Eating Disorders." Current Psychiatry Reports 24, no. 1 (January 2022): 61–69. http://dx.doi.org/10.1007/s11920-022-01321-8.

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Abstract Purpose of Review We review recent evidence on the use of neuromodulation for treating eating disorders (EDs), including anorexia nervosa, bulimia nervosa and binge eating disorder. We evaluate studies on (a) modern non-invasive methods of brain stimulation, such as transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), (b) electroconvulsive therapy (ECT) and (c) more invasive techniques, including deep brain stimulation (DBS). Recent Findings Most reports on the clinical applications of neuromodulation in EDs are limited to case studies, case series and small clinical trials. The majority have focused on severe, enduring and hard-to-treat cases of AN. In this population, data suggest that both rTMS and DBS have therapeutic potential and are safe and acceptable. Summary High-quality clinical trials in different ED populations are needed which investigate different stimulation methods, sites and parameters, the use of neuromodulation as stand-alone and/or adjunctive treatment, as well as the mechanisms of action.

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Belge, J. B., P. Mulders, J. Van Oort, L. Van Diermen, P. De Timary, E. Constant, P. Sienaert, D. Schrijvers, B. Sabbe, and P. Van Eijndhoven. "Movement, mood and cognition: Preliminary insight into the effects of electroconvulsive therapy in depression through a data-driven resting-state connectivity analysis." European Psychiatry 64, S1 (April 2021): S128. http://dx.doi.org/10.1192/j.eurpsy.2021.359.

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IntroductionECT is an effective treatment for depression. Beyond its therapeutic effect on mood it has a unique impact on psychomotor and cognitive symptoms.Its mechanism of action remains still unclear. To investigate this, we set out to study the brain’s response to ECT from a large-scale brain-network perspective.ObjectivesThe aim of this study was to investigate changes in resting-state functional connectivity following ECT at the whole brain, between-network and within-network level, in patients with a depressive episode.MethodsResting-state FMRI data were collected from 17 patients with depression before and after an ECT course. Using a group independent component analysis approach, we focused on four networks that are known to be affected in depression: the salience network (SN), default mode network (DMN), cognitive executive network (CEN) and a subcortical network (SCN). Clinical measures including mood, cognition and psychomotor symptoms were assessed.ResultsECT increased connectivity of the left CEN with the left angular gyrus and left middle frontal gyrus. An increase in left CEN within network connectivity was observed. Both the right CEN and the SCN showed increased connectivity with the precuneus. Furthermore, the anterior DMN showed increased connectivity with the left amygdala. Finally, improvement of psychomotor retardation was positively correlated with an increase of within-posterior DMN connectivity.ConclusionsWe demonstrate that ECT induces a significant increase of connectivity at both the whole brain and within-network level. Furthermore, we provide first evidence on the association between an increase of within posterior DMN connectivity and an improvement of psychomotor retardation, a core symptom of depression.DisclosureNo significant relationships.

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Angelats, M., A. Leila, C. David, P. Laia, M. Laura, E. Itziar, B. Adinson, S. Purificación, P. Víctor, and B. Dani. "Description of anesthetic drugs used in hospital del Mar and their impacts on convulsion duration and blood pressure in electroconvulsive therapy." European Psychiatry 41, S1 (April 2017): S373. http://dx.doi.org/10.1016/j.eurpsy.2017.02.388.

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IntroductionThe electroconvulsive therapy (ECT) is an effective treatment used for several psychiatric disorders. However, there are multiple enigmas about the mechanisms of action and factors that improve its results. Some frequent questions are if the anesthetic drug makes a difference in the time of convulsion and blood pressure.AimsOur principal aim is to describe the utilization of anesthetic drugs among the patients that are being treated with ECT in hospital del Mar. We also want to know the differences in the time of convulsion and systolic arterial pressure for every anesthetic drug (propofol, thiopental and etomidate).Material and methodsWe have used the database of ECT in hospital del Mar. It contains information like age, principal diagnosis, medical background and pharmacological treatment at the moment of starting ECTs; it also contains information of each individual ECT session as basal, 2 and 5 minutes arterial pressure; the anesthetic drug used, and convulsion duration.We made an analysis of general conditions of the population, the differences of convulsion time and arterial pressure between the three anesthetic drugs.ResultsPropofol was used in 1140 sessions, thiopental in 61 sessions and etomidate in 54 sessions. The differences in the means of convulsion times between propofol and etomidate are statistically significant (“P” value < 0.05). Etomidate or thiopental increases the difference of arterial pressure more than propofol.ConclusionsFurther research about the factors that improve convulsion duration and minimize adverse effects on blood pressure is needed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Agüera-Ortiz, Luis, Rocío García-Ramos, Francisco J. Grandas Pérez, Jorge López-Álvarez, José Manuel Montes Rodríguez, F. Javier Olazarán Rodríguez, Javier Olivera Pueyo, Carmelo Pelegrín Valero, and Jesús Porta-Etessam. "Focus on Depression in Parkinson’s Disease: A Delphi Consensus of Experts in Psychiatry, Neurology, and Geriatrics." Parkinson's Disease 2021 (February 8, 2021): 1–11. http://dx.doi.org/10.1155/2021/6621991.

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Major and minor forms of depression are significant contributors to Parkinson’s disease morbidity and caregiver burden, affecting up to 50% of these patients. Nonetheless, symptoms of depression are still underrecognized and undertreated in this context due to scarcity of evidence and, consequently, consistent clinical guideline recommendations. Here, we carried out a prospective, multicentre, 2-round modified Delphi survey with 49 questions about the aetiopathological mechanisms of depression in Parkinson’s disease (10), clinical features and connections with motor and nonmotor symptoms (10), diagnostic criteria (5), and therapeutic options (24). Items were assessed by a panel of 37 experts (neurologists, psychiatrists, and a geriatrist), and consensus was achieved in 81.6% of them. Depressive symptoms, enhanced by multiple patient circumstances, were considered Parkinson’s disease risk factors but not clinical indicators of motor symptom and disease progression. These patients should be systematically screened for depression while ruling out both anhedonia and apathy symptoms as they are not necessarily linked to it. Clinical scales (mainly the Geriatric Depression Scale GDS-15) can help establishing the diagnosis of depression, the symptoms of which will require treatment regardless of severity. Efficacious and well-tolerated pharmacological options for Parkinson’s comorbid depression were selective serotonin reuptake inhibitors (especially sertraline), dual-action serotonin and norepinephrine reuptake inhibitors (venlafaxine, desvenlafaxine, and duloxetine), multimodal (vortioxetine, bupropion, mirtazapine, and tianeptine), and anti-Parkinsonian dopamine agonists (pramipexole, ropinirole, and rotigotine). Tricyclic antidepressants and combining type B monoamine oxidase inhibitors with serotonergic drugs have serious side effects in these patients and therefore should not be prescribed. Electroconvulsive therapy was indicated for severe and drug-refractory cases. Cognitive behavioural therapy was recommended in cases of mild depression. Results presented here are useful diagnostic and patient management guidance for other physicians and important considerations to improve future drug trial design.

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Ekemohn, Maria, Marie Kjær Nielsen, Matilda Grahm, Anders Tingström, Birgitte Kousholt, Gregers Wegener, and Cecilie Bay-Richter. "Systematic evaluation of skeletal fractures caused by induction of electroconvulsive seizures in rat state a need for attention and refinement of the procedure." Acta Neuropsychiatrica 29, no. 6 (April 5, 2017): 363–73. http://dx.doi.org/10.1017/neu.2017.7.

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ObjectiveElectroconvulsive therapy (ECT) is one of the most efficient treatments for major depression. Electroconvulsive seizures (ECS), the animal model of ECT, is widely used to study both mechanisms of action and adverse effects of ECT. As the treatment itself serves as an instant anaesthetic and anaesthetic agents may affect memory functions and behaviour, ECS is traditionally administered without muscle relaxation and anaesthesia. A major problem of unmodified ECS, which has only been addressed peripherally in the literature, is that some animals sustain spinal fractures and subsequent hind leg paralysis (paraplegia). This phenomenon leads to a higher degree of suffering and these animals need to be excluded from the studies. To reach sufficient statistical power, the group sizes are therefore often increased and this may lead to a pre-selected study group in risk of skewing the results. Moreover, the study design of the experiments do not comply with the 3R principles, which advocate for both refinement and reduction of animal experiments. The objective of this study is to systematically evaluate injuries caused by ECS.MethodsWe summarise the incidence of spinal fractures from 24 studies conducted during 2009–2015 in six different rat strains and report preliminary findings on scapular fractures following auricular ECS.ResultsIn total, 12.8% of all tested animals suffered from spinal fractures and we find an increase in spinal fracture incidence over time. Furthermore, X-ray analyses revealed that some animals displayed scapular fractures.ConclusionWe discuss consequences of and possible explanations for ECS-induced fractures. Modifications of the method are highly warranted and we furthermore suggest that all animals are thoroughly examined for discrete fractures.

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Haskett, Roger F. "Electroconvulsive Therapy’s Mechanism of Action." Journal of ECT 30, no. 2 (June 2014): 107–10. http://dx.doi.org/10.1097/yct.0000000000000143.

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Charlton, B. G. "The ‘anti-delirium’ theory of electroconvulsive therapy action." Medical Hypotheses 52, no. 6 (June 1999): 609–11. http://dx.doi.org/10.1054/mehy.1999.0857.

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Saran, O., S. Celik, S. Guloksuz, and D. Cakmak. "Electroconvulsive therapy treated patients’ and their relatives’ attitudes toward electroconvulsive therapy." European Psychiatry 26, S2 (March 2011): 1153. http://dx.doi.org/10.1016/s0924-9338(11)72858-9.

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IntroductionElectroconvulsive therapy (ECT), which is a safe and effective treatment option for many of the psychiatric illnesses, is still negatively perceived by lay public. It could be hypothesized this negative view can affect the patients and their relatives. This study aimed to evaluate the attitudes of patients’ and their relatives’ toward ECT.MethodsSixty-four ECT treated patients were recruited from inpatient units of Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery. Patients were evaluated with Clinical Global Impression Scale, Mini Mental State Examination and Columbia ECT Subjective Side Effects Schedule. Both patients and their relatives were interviewed by using a questionnaire for assessing attitudes toward ECT.ResultsThe mean number of ECT sessions was 8.50 ± 1.85. The most common side effects according to the patients were subjective feeling of slowed down and memory problems. The majority of both patients and their relatives stated that they had not received adequate information about ECT. Moreover, their knowledge about technique and mechanism of ECT was very limited. However, their overall perception of ECT was very positive. The relatives of the patients were more satisfied with the benefits of ECT than the patients.DiscussionAlthough perception of ECT among patients and their relatives was very positive, it should be noted that this was mostly subjective in regard to inadequate knowledge about ECT. Thus, clinicians should pay utmost attention to inform both patients and their relatives about ECT.

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Journal articles on the topic 'Mechanism of action of electroconvulsive therapy'

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