Electroconvulsive Therapy (ECT)

Kellner, Daniel B.; Bryson, Ethan O.; Liebman, Lauren S.; Majeske, Matthew; Aloysi, Amy; Ahle, Gabriella M.; Kellner, Charles H.

doi:10.1097/yct.0000000000000113

Cited by 8 publications

(8 citation statements)

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“…These advances, while associated with better cognitive outcomes, have not necessarily improved ECT's acceptability (Chen et al, 2017;Rose et al, 2003). In fact, subjective cognitive complaints have been evoked as one of the main reasons for suboptimal prescription of ECT (Kellner, 2012).…”

Section: Introductionmentioning

confidence: 99%

Subjective cognitive complaints and subjective cognition following electroconvulsive therapy for depression: A systematic review and meta-analysis

Semkovska

Knittle

Leahy

et al. 2022

Aust N Z J Psychiatry

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Background: Subjective cognitive complaints represent a leading reason for suboptimal prescription of electroconvulsive therapy, the most acutely effective treatment for depression. However, research findings regarding their presentation are conflicting. Objective: To describe, quantify and explain the variability in subjective cognitive complaints and subjective cognition following electroconvulsive therapy for depression. Methods: We searched systematically PubMed, Embase, PsycARTICLES, CINAHL and relevant reviews for research published from 1 January 1972 to 31 August 2020. We included all independent studies of patients whose subjective cognition was assessed following brief-pulse electroconvulsive therapy for depression. Three meta-analyses were conducted to quantify: (1) the prevalence of patients presenting with cognitive complaints following electroconvulsive therapy; (2) the pre–post electroconvulsive therapy change in subjective cognition and (3) the association between change in depressive symptoms and change in cognitive complaints. Effect sizes were calculated using random-effects models. Eight prespecified demographic and clinical moderators of between-study variability were assessed using sub-group analyses and meta-regressions. Results: Data from 72 studies including 5699 participants were meta-analysed. Weighted mean prevalence of patients with cognitive complaints was 48.1% (95% confidence interval = [42.3%, 53.9%]). The type of subjective measure used significantly impacted the pre–post electroconvulsive therapy change in subjective cognition, showing, respectively, large improvement ( g = 0.81; 95% confidence interval = [0.59, 1.03]) after electroconvulsive therapy with the Squire Self-Rating Scale of Memory and small worsening (g = –0.48; 95% confidence interval = [–0.70, –0.26]) with 1-item memory scales. The strongest predictors of improved post-electroconvulsive therapy subjective cognition were increased age and larger post-electroconvulsive therapy decrease in depressive symptoms. The weighted mean correlation between pre–post electroconvulsive therapy decrease in depressive symptoms and pre–post electroconvulsive therapy decrease in cognitive complaints was 0.46 (95% confidence interval = [0.39, 0.53]). Conclusion: Variability in subjective cognition following electroconvulsive therapy is mostly explained by the degree of post-treatment persisting depression and by the subjective assessment used. Scales measuring exclusively subjective worsening present limited clinical utility and instruments allowing the detection of both improvement and worsening in subjective cognition should be preferred.

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Section: Introductionmentioning

confidence: 99%

Subjective cognitive complaints and subjective cognition following electroconvulsive therapy for depression: A systematic review and meta-analysis

Semkovska

Knittle

Leahy

et al. 2022

Aust N Z J Psychiatry

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“…Although remission rates exceed those seen with other somatic treatments, high rates of relapse, especially early relapse, are observed and acknowledged as a major clinical problem (Kellner et al, 2006;Sackeim et al, 2001). Consolidating and prolonging remission is a key clinical challenge surrounding ECT use (Kellner 2013).…”

Section: Introductionmentioning

confidence: 99%

Relapse Following Successful Electroconvulsive Therapy for Major Depression: A Meta-Analysis

Jelovac

Kolshus

McLoughlin

2013

Neuropsychopharmacol

203

155

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High rates of early relapse following electroconvulsive therapy (ECT) are typically reported in the literature. Current treatment guidelines offer little information to clinicians on the optimal nature of maintenance therapy following ECT. The aim of this study was to provide a systematic overview of the existing evidence regarding post-ECT relapse. A keyword search of electronic databases was performed for studies appearing in the peer-reviewed literature before January 2013 reporting on relapse rates in responders to an acute course of ECT administered for a major depressive episode. Meta-analyses were performed where appropriate. Thirty-two studies with up to 2 years' duration of follow-up were included. In modern era studies of continuation pharmacotherapy, 51.1% (95% CI ¼ 44.7-57.4%) of patients relapsed by 12 months following successful initial treatment with ECT, with the majority (37.7%, 95% CI ¼ 30.7-45.2%) relapsing within the first 6 months. The 6-month relapse rate was similar in patients treated with continuation ECT (37.2%, 95% CI ¼ 23.4-53.5%). In randomized controlled trials, antidepressant medication halved the risk of relapse compared with placebo in the first 6 months (risk ratio ¼ 0.49, 95% CI ¼ 0.39-0.62, po0.0001, number needed to treat ¼ 3.3). Despite continuation therapy, the risk of relapse within the first year following ECT is substantial, with the period of greatest risk being the first 6 months. The largest evidence base for efficacy in post-ECT relapse prevention exists for tricyclic antidepressants. Published evidence is limited or non-existent for commonly used newer antidepressants or popular augmentation strategies. Maintenance of well-being following successful ECT needs to be improved.

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“…The convulsion is induced by an electrode that is placed on one or both sides of the head and emits an electrical pulse for several seconds (Kellner, 2019;Weiss et al, 2019).…”

Section: Backg Rou N Dmentioning

confidence: 99%

“…In life-threatening situations, such as when depressed patients refuse fluid or nutrition, or in cases of severe catatonia, the effectiveness of ECT is around 90% (Hengeveld et al, 2016). ECT reduces symptoms such as disturbed sleeping patterns, anxiety and feelings of despair (Kellner, 2019;Rasmussen, 2019;The UK ECT Review Group, 2003).…”

Section: Backg Rou N Dmentioning

confidence: 99%

Factors influencing motivation of patients diagnosed with depression to have electroconvulsive therapy

Schuurmans

Bruin

Asperen

et al. 2023

Psychiatric Ment Health Nurs

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Accessible SummaryWhat is known on the subject? The clinical effect of electroconvulsive therapy (ECT) has been confirmed for a majority of patients with several psychiatric disorders. ECT is mostly used in patients with severe depression. Choosing, persevering with and completing ECT depends on the patients' motivation for undergoing this therapy. However, the factors influencing patients' motivation for ECT have not yet been studied. What the paper adds to existing knowledge: Four important factors that influence the motivation of patients diagnosed with major depression to have ECT were identified: (1) psychological pain and distress; (2) perceived need for treatment; (3) perception of ECT as an effective treatment; (4) influence of the environment. The first factor, psychological pain and distress, was perceived as the primary motivator for starting and continuing ECT. What are the implications for practice? Professionals should be aware of the factors that influence patients to have electroconvulsive therapy and their own role in the decision‐making process and during treatment. As patients are susceptible to emotional support and as the motivation of patients for starting and continuing ECT is positively influenced by the advice and support of mental health professionals, these professionals have a key role in motivating patients for ECT. When the patient has decided to start ECT, mental health professionals should explore the factors that influence their motivation and regularly assess these factors so that they can guide the patient in their process. The professional should have an overview of these factors and investigate how they can be positively influenced to help patients keep their motivation during the treatment process. This will contribute to person‐centred care and could lead to better treatment outcomes. AbstractIntroductionThe factors influencing patients' motivation for undergoing electroconvulsive therapy (ECT) have not yet been subjected to a thorough study. Knowledge of these factors could improve the quality of care for patients with depression recommended to have ECT.AimTo identify the factors that influence the motivation of patients diagnosed with depression to have ECT.MethodThis qualitative study followed a grounded theory approach in which semi‐structured interviews were conducted with 18 patients from four different psychiatric hospitals to study their perspectives on factors influencing their motivation to have ECT.ResultsThe explanatory framework of factors influencing motivation for ECT comprises four main categories, starting with the most important category, psychological pain and distress, and continuing with the following categories: perceived need for treatment; perception of ECT as an effective treatment; environmental influences.DiscussionIn this study, we found that the psychological pain and distress of depression, and their consequences in daily life, had been the primary experiences that motivated patients to start and continue ECT.Implications for PracticeThis is the first study that has examined motivational factors for patients with severe depression to participate in ECT. Professionals appear to have a key role in motivating patients for ECT. They should explore factors that influence motivation for ECT, regularly assess their motivation and intervene on influential factors.

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Electroconvulsive Therapy (ECT)

Cited by 8 publications

References 0 publications

Subjective cognitive complaints and subjective cognition following electroconvulsive therapy for depression: A systematic review and meta-analysis

Subjective cognitive complaints and subjective cognition following electroconvulsive therapy for depression: A systematic review and meta-analysis

Relapse Following Successful Electroconvulsive Therapy for Major Depression: A Meta-Analysis

Factors influencing motivation of patients diagnosed with depression to have electroconvulsive therapy

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