On psychiatrictimes.com Prof Max Fink discusses the 2 most important articles on continuation therapy after ECT for depression. ECT is very effective in the treatment of depression even if several antidepressants have failed. He discusses a large, government-supported, collaborative study led by the Columbia University Consortium (CUC), patients with unipolar major depression that had failed to respond to multiple trials of medications were treated with ECT to clinical remission and then randomly assigned to one of three continuation treatments: placebo, nortriptyline alone, or the combination of nortriptyline and lithium.
The other important trials is the multi site Consortium for Research in ECT (CORE) collaborative study that used the same populations with the same inclusion and exclusion criteria, evaluations, and time periods as the CUC study. After remission, the patients were randomly assigned to continuation treatment with the same combination of lithium and nortriptyline or with ECT.
Relapse
The six-month relapse rates for the two treatments were not statistically different from that of the lithium and nortriptyline combination in the CUC study
His conclusions:
1. Efficacy: ECT was effective in both studies. ECT compared favorably with the STAR*D study of patients with nonpsychotic major depression.
2. Psychotic Depression: 95% of the patients who had psychosis and depression remitted compared with 83% of patients who had nonpsychotic depression.
3. Suicide: In the CORE study, 29.5% of the patients expressed suicidal thoughts or reported suicidal acts at baseline. The HAM-D scores for suicidal intent were reduced to zero in 38% of the patients after one week of treatment, in 61% after two weeks, and in 81% at the end of the course. These findings are supported by comparable CUC data.
4. Prior treatment: In the CORE study, the adequacy of prior treatment bore no relation to treatment efficacy, a finding that is confirmed in other studies.
5. Elderly: older patients with depression exhibit better clinical outcomes than younger patients when treated using ECT
6. Relapse rates after successful ECT are reduced by either the combination of lithium and nortriptyline or by continuation ECT.
7. Continuation therapy: the combination of lithium and nortriptyline, both monitored with serum blood levels, is the preferred medication when continuation ECT is not available or is refused.
8. Electrode placement: bilateral electrode placement and half-age dosing estimates, monitored by EEG adequacy, ensures greater efficacy for the first treatment and overall with fewer treatments
Articles used:
1. Sackeim HA, Haskett RF, Mulsant BH, et al. Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial. JAMA. 2001;285:1299-1307.
2. Kellner CH, Knapp RG, Petrides G, et al. Continuation ECT versus pharmacotherapy for relapse prevention in major depression: a multi-site study from CORE. Arch Gen Psychiatry. 2006;63:1337-1344.
Friday, October 5, 2007
8 opinions from an ECT expert about 2 major studies on ECT for Depression
Tuesday, October 2, 2007
Information from the Royal College of Psychiatrists about electroconvulsive therapy
A whole page with information in a Q&A format about electroconvulsive therapy on the website of the Royal College for Psychiatrists.
Tuesday, August 21, 2007
Myths and stigma's about ECT
Leon Rosenberg, a former dean of medicine at Yale University, had just attempted suicide by overdose. He was admitted to hospital and prescribed electroconvulsive therapy, or ECT.
This is the start of an excellent article by Michael Evans an associate professor at the University of Toronto and staff physician at Toronto Western Hospital.
This article also discusses some other myths, for instance about depression:
Those on the outside still see it as not really a disease but a weakness. Those on the inside see it as a chronic disease like any other, but with a twist.
Or this one about suicide, one of the complications of depression:
"Heart attack victims are consoled ('Isn't it a pity?'); suicide victims are cursed ('How could he?')."
About ECT:
We discount a therapy that has proven effectiveness because of its image, yet every day embrace unproven therapies that have benefited from a public-relations makeover.
To my opinion the most nuanced view on side-effects of ECT:
Memory loss seems the side effect of most concern to patients. With current ECT, it is usually transient, but any unauthorized withdrawal from the memory bank is a travesty. The medical community has occasionally shown insensitivity to this, but researchers are now attempting to better delineate the cause and effect.
Tuesday, August 7, 2007
NICE information for the public about electroshock
On this site a clear and concise description of indications for electroshock (ECT) are given by NICE. NICE produces guidance in clinical practice. The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health in the United Kingdom. This information on electroconvulsive therapy is provided for use by the public and provides an explanation of the guidance.
NICE was asked to look at the available evidence on electroconvulsive therapy and to provide guidance that will help the NHS in England and Wales decide when it should be used. This resulted in a nice pdf file with that information.
Saturday, July 21, 2007
Electroshock (ECT) Round Up
This blog about depression and it's treatment especially with ECT is in the air for a while. I hope a lot of readers benefit from these scribbles. The truth be told, I learn a lot from writing these articles. Mostly I gather a lot of information for my work as a psychiatrist which end somewhere in a drawer or the "round archive" without being read at all. Since writing this blog I actually read them and when appropriate post the information on my blog. Surfing on the net nowadays is always accompanied by the question: Is this information relevant, blogable?
Now I take the privilege today to look back on my posts and make a round up of the most important sites with information about ECT relevant for interested readers in this subject, hope you like it.
1. About ECT for bipolar disorder from healthyplace.com, also more general information about ECT, the procedure, side effects.
2. Take it easy on ECT. Opinion of a patient treated with ECT about the side effects and the discussions about this topic in the media.
3. Another patient's opinion about ECT and it's side effects adding to the discussion in the media.
4. Electroconvulsive therapy (ECT): Treating severe depression and mental illness. Information by the Mayo Clinic. Very informative for patients facing the choice.
5. ECT get's a makeover. On ABC News, the opinion of patients and doctors.
Friday, July 20, 2007
ECT gets a makeover
New article with proponents and antagonists of ECT, objectively written by Sibile Morency at ABC news.
