Efficacy of electroconvulsive therapy in bipolar versus unipolar major depression: a meta‐analysis

Dierckx, Bram; Heijnen, Willemijn T.C.J.; Broek, Walter W. van den; Birkenhäger, Tom K.

doi:10.1111/j.1399-5618.2012.00997.x

Cited by 186 publications

(104 citation statements)

References 23 publications

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“…This study also showed effectiveness of ECT for a long period of time, since patients were followed up for one year post discharge is comparable with other studies 21,22,23,24,25 . As depression is a debilitating illness with prolonged morbidity and suicidal risk, it is better to prescribe ECT to reduce future refractoriness and chronicity.…”

Section: Resultsupporting

confidence: 74%

Electroconvulsive therapy in mood diorders

Adhikari

2015

J Chitwan Med Coll

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Electroconvulsive therapy (ECT) is one of the less used somatic treatments in mood disorders, especially depressive phase. ECT use has importance during acute bipolar episode when patient extremely violent, suicidal and extreme psychomotor retardation. The aim of this study was to know about socio-demographic profile and therapeutic efficacy of the use of ECT in mood disorders. Methods: This is a prospective comparative study between patients who received ECT and who did not. Psychopathology was evaluated using Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale (HDRS) between the groups at admission, at discharge, at 1st month, at 6th month and at 12th month. Modified ECT was performed using general anesthetic agent. Results: Twenty five patients received ECT as compared to 32 patients who were non-receivers. There was significant decrease in HDRS in ECT receiver as compared to non-receivers in patients with depression (both unipolar and bipolar) at discharge, 1st month, and 12th month; in YMRS in patient with mania at discharge, 1st month and at 12th month. Discussion: There was significant improvement in overall psychopathology and psycho-social status of patients who received ECT as compared to non-receivers. The improvement was shown by decrement in scores in HDRS and YMRS at the time of discharge, 1st month, 6th month and 1st year which were statistically significant.

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Section: Resultsupporting

confidence: 74%

Electroconvulsive therapy in mood diorders

Adhikari

2015

J Chitwan Med Coll

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“…8 The latest audit data from the Scottish ECT Accreditation Network (SEAN) reported that about 75% of depressed patients, most of whom have been resistant to previous treatment, had a good clinical response to ECT in 2014. 9 ECT has equal efficacy in both unipolar and bipolar depressed patients 9,10 and in depression with and without psychosis. 9,11 Despite the robust evidence base demonstrating the efficacy of ECT, its use has fallen dramatically in recent decades.…”

Section: Clinical Use Of Electroconvulsive Therapymentioning

confidence: 99%

Randomised controlled trial of ketamine augmentation of electroconvulsive therapy to improve neuropsychological and clinical outcomes in depression (Ketamine-ECT study)

et al. 2017

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BackgroundElectroconvulsive therapy (ECT) is the most effective acute treatment for severe depression, but there are concerns about its adverse cognitive effects. ECT may impair cognition through stimulation of glutamate receptors, and preliminary evidence has suggested that ketamine, a glutamate antagonist, may alleviate these effects. Ketamine has been shown to have a rapid, but temporary, antidepressant effect after a single infusion.ObjectiveTo determine the efficacy and safety of adjunctive low-dose ketamine to reduce cognitive impairments caused by ECT and, secondarily, to improve symptomatic outcome.DesignMulticentre, two-arm, parallel-group, patient-randomised, placebo-controlled superiority trial.SettingEleven ECT suites based in seven NHS trusts in the north of England.ParticipantsSeverely depressed hospitalised patients or outpatients who received ECT as part of their usual clinical care.InterventionsPatients were randomised to ketamine (0.5 mg/kg) or saline as an adjunct to their anaesthetic for their ECT course in a 1 : 1 ratio.Main outcome measuresThe primary outcome was delayed verbal recall on the Hopkins Verbal Learning Task – Revised (HVLT-R) after four ECT treatments (mid-ECT), analysed using a Gaussian repeated measures model. Secondary outcomes included autobiographical, working and visual memory and verbal fluency, symptoms and quality of life; assessments occurred at mid-ECT, end of treatment and 1 and 4 months after the last ECT. Neuropsychological function was compared with that of healthy control subjects and a functional near-infrared spectroscopy (fNIRS) substudy investigated prefrontal cortex function. A patient survey of study participation was carried out.ResultsSeventy-nine severely depressed patients were randomised to ketamine (0.5 mg/kg) or saline as an adjunct to their anaesthetic for their ECT course; the modified intention-to-treat sample included 70 patients. Compared with saline, adjunctive ketamine had no significant effect on HVLT-R delayed recall [treatment effect difference –0.43, 95% confidence interval (CI) –1.73 to 0.87], other neuropsychological outcomes, improvement in depression [difference in Montgomery–Åsberg Depression Rating Scale (MADRS) score of 0.44, 95% CI –1.03 to 1.91], the number of ECT treatments to remission (MADRS score of ≤ 10: 0.83, 95% CI –3.2 to 4.9), anxiety symptoms or quality of life. By the end of ECT treatment, 37% (saline 35%, ketamine 39%) of patients had remitted. Tolerability was similar in the two treatment arms; two patients had isolated transient psychological effects attributable to ketamine. Preliminary fNIRS analysis found that patients had blunted prefrontal cortical haemodynamic responses compared with control subjects during a verbal fluency task at baseline; this was further diminished at mid-ECT without modulation by ketamine. Greater haemodynamic responsivity to ECT appeared to be associated with a better clinical response. The majority of patients surveyed reported a positive experience of study participation.ConclusionsThe results of the study do not support the use of adjunctive ketamine in routine ECT treatment in the NHS. Although no evidence of benefit was found for ketamine, moderate benefits or harms cannot be excluded, as recruitment was < 50% of that planned, limiting the power of the clinical trial. Low numbers also meant that in the fNIRS substudy the effect of ketamine could not be assessed and the other findings must be viewed as preliminary. Included patients were younger than those not included and had only limited cognitive impairment with ECT, limiting generalisation to more cognitively compromised patients. fNIRS appeared to be a potentially feasible portable brain imaging technology in severely ill patients and further research is warranted to investigate its clinical utility.Trial registrationCurrent Controlled Trials ISRCTN14689382.FundingThis project was funded by the Efficacy and Mechanism Evaluation programme, a Medical Research Council and National Institute for Health Research partnership.

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“…Recovery and reorientation after MST sessions were faster and other cognitive functions, such as retrograde and anterograde memory, seem to be unaffected, too. MST is an effective treatment, with response rates ranging from 40 to 70 % and remission rates ranging from 15 to 46 % and promising to become as effective as ECT with reported remission rates of 50-75 % (Husain et al 2004;Dierckx et al 2012;Sackeim et al 2000).…”

Section: Discussionmentioning

confidence: 97%

An overview on clinical aspects in magnetic seizure therapy

Engel

Kayser

2016

J Neural Transm

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The aim of the presented work is to provide an overview on the clinical data of the promising convulsive brain stimulation technique, the magnetic seizure therapy (MST). We review the advantages and disadvantages of MST, focusing on rationale, development and current treatment procedure. We also provide a summary of the current literature including clinical trials and case reports found in the PubMed database. Furthermore, we consider effectiveness and side effects, emphasizing on crucial issues to be addressed for a better understanding of this potential new treatment option in treatment-resistant depression (TRD).

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Efficacy of electroconvulsive therapy in bipolar versus unipolar major depression: a meta‐analysis

Abstract: ECT appears to be equally effective for both bipolar and unipolar depression and the remission rates are encouraging, especially for bipolar depression.

Cited by 186 publications

References 23 publications

Electroconvulsive therapy in mood diorders

Electroconvulsive therapy in mood diorders

Randomised controlled trial of ketamine augmentation of electroconvulsive therapy to improve neuropsychological and clinical outcomes in depression (Ketamine-ECT study)

An overview on clinical aspects in magnetic seizure therapy

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