ECT of Major Depressed Patients in Relation to Biological and Clinical Variables: A Brief Overview

Abstract

The knowledge that spontaneous or induced convulsions can improve mental disorders has been present for several centuries. electroconvulsive therapy (ECT) has undergone fundamental changes since its introduction, and in the last 15-20 years there has been a legitimate renewal of interest for this therapy. Today the indications for use of ECT seem well codified, and its technique and practices have evolved considerably. It is now firmly established as an important and effective method of treating certain severe forms of depression. However, still very little is known about the mechanism of ECT. In this paper, first, we will give a short overview as to how far we have got concerning ECT in relation to various clinical and biological variables. Second, we will describe ECT in relation to electroencephalographic (EEG) technique and clinical outcome as well as give some proposals as to how to go on with the data analysis of EEG. In conclusion, the superior effect of ECT compared to other antidepressives in severe depression may depend on neurochemical and neurobiological cascade effects initiated by repeated treatments. Above all, ECT offers a unique experimental opportunity to study how neuromodulation of the major transmitter systems may be involved in brain dynamics and alteration of connectivity. Neuropsychopharmacology (2003) 28, S21-S26.

Effects of Risperidone Augmentation in Patients with Treatment-Resistant Depression: Results of Open-Label Treatment Followed by Double-Blind Continuation

“…There is a general consensus, however, that potential options include (1) augmentation with psychotherapy (De Jonghe et al, 2004), (2) switching classes of medication (McGrath et al, 1993), (3) supplementation with a second antidepressant of a different class (Bodkin et al, 1997;Gomez Gomez and Teixido Perramon, 2000), (4) somatic therapy such as rapid transcranial magnetic stimulation, electroconvulsive therapy, or vagal-nerve stimulation (Figiel et al, 1998;Rush et al, 2000;Wahlund and von Rosen, 2003), and (5) augmentation strategies with agents usually not considered as classical antidepressants, such as lithium (Fava, 2001) or thyroid hormone (Joffe et al, 1993). One augmentation strategy that has recently been explored is supplementation of antidepressants with atypical antipsychotic medications (Ostroff and Nelson, 1999;Shelton et al, 2001;Adson et al, 2004;Papakostas et al, 2004).…”

Age-related cognitive effects of ECT and ECT-induced mood improvement in depressive patients

“…The improvement in cognitive functions might be explained by g-aminobutyric acid (GABA) involvement in ECT's mechanism [Sanacora et al, 2003], and/or by neurochemical and neuromodulation cascade effects initiated by repeated treatments [Wahlund and Von Rosen, 2003]. Indeed, increased cortical GABA concentrations have been found in depressed patients receiving ECT [Sanacora et al, 2003].…”

COMT val158met influence on electroconvulsive therapy response in major depression

“…In turn, given the dopaminergic effects of ECT [e.g., Yoshida et al, 1998;Ishihara and Sasa, 1999;Andrade et al, 2002], particularly carriers of the more active COMT 158val allele conferring a decreased potentially prefrontal availability of dopamine might benefit from partly dopaminergic electroconvulsive therapy as possibly captured by the present finding. However, since ECT has also been shown to alter adrenergic and serotonergic transmission as well as several subtypes of 5-HT-receptors and neurotrophic factors in the central nervous system [as reviewed by Wahlund and von Rosen, 2003], genetic influence on ECT response has to be interpreted within a very complex framework of neurotransmission and neural networks-particularly, since patients were treated with a combination of ECT and antidepressant pharmacotherapy. Thus, further research is warranted to conclusively evaluate the impact of COMT gene variation-preferably COMT tagging SNPs applying haplotype analysis-on antidepressant treatment response with respect to pharmacotherapy, electroconvulsive therapy or a combination of both, respectively.…”