Expanded Safety and Efficacy Data for a New Method of Performing Electroconvulsive Therapy

Sahlem, Gregory L.; Short, E. Baron; Kerns, Suzanne E. U.; Snipes, Jon; DeVries, William H.; Fox, James; Burns, Carol; Schmidt, Matthew; Nahas, Ziad; George, Mark S.; Sackeïm, Harold A.

doi:10.1097/yct.0000000000000328

Cited by 28 publications

(20 citation statements)

References 55 publications

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“…FEAST is a method of inducing a focal seizure using high-intensity direct current (Sackeim, 2004). The current passes from a small circular anterior electrode placed above the midpoint of the right eyebrow (right anterior orbitofrontal cortex) to a large oblong posterior electrode placed anteriorly to the right motor cortex (Sahlem et al, 2016). The effect is to induce a focal, frontal seizure as demonstrated by a regional cerebral blood flow study (Chahine et al, 2014).…”

Section: Treatmentsmentioning

confidence: 99%

“…A feasibility study (Nahas et al, 2013) demonstrated the antidepressant efficacy of FEAST, with 8 and 5 of 16 patients reaching response or remission, respectively. A more recent study of 20 patients (Sahlem et al, 2016) demonstrated that FEAST was effective for depression, with response and remission rates of 65% and 55%, respectively. Furthermore, cognitive testing revealed no anterograde or retrograde memory side effects.…”

Section: Treatmentsmentioning

confidence: 99%

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The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders

Malhi

Bell

Bassett³

et al. 2020

Aust N Z J Psychiatry

312

365

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Objectives: To provide advice and guidance regarding the management of mood disorders, derived from scientific evidence and supplemented by expert clinical consensus to formulate s that maximise clinical utility. Methods: Articles and information sourced from search engines including PubMed, EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (e.g. books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Relevant information was appraised and discussed in detail by members of the mood disorders committee, with a view to formulating and developing consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous consultation and external review involving: expert and clinical advisors, key stakeholders, professional bodies and specialist groups with interest in mood disorders. Results: The Royal Australian and New Zealand College of Psychiatrists mood disorders clinical practice guidelines 2020 (MDcpg2020) provide up-to-date guidance regarding the management of mood disorders that is informed by evidence and clinical experience. The guideline is intended for clinical use by psychiatrists, psychologists, primary care physicians and others with an interest in mental health care. Conclusion: The MDcpg2020 builds on the previous 2015 guidelines and maintains its joint focus on both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. Mood disorders committee: Gin S Malhi (Chair), Erica Bell, Darryl Bassett, Philip Boyce, Richard Bryant, Philip Hazell, Malcolm Hopwood, Bill Lyndon, Roger Mulder, Richard Porter, Ajeet B Singh and Greg Murray.

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Section: Treatmentsmentioning

confidence: 99%

Section: Treatmentsmentioning

confidence: 99%

The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders

Malhi

Bell

Bassett³

et al. 2020

Aust N Z J Psychiatry

312

365

View full text Add to dashboard Cite

show abstract

“…In severe cases in which an urgent and definite response is required, however, BT ECT can be chosen from the start. Some alternative placements, such as ‘left anterior right temporal’ (LART) and ‘focal electrically administered seizure therapy’ (FEAST) , should be considered experimental.…”

Section: Techniquementioning

confidence: 99%

When to consider electroconvulsive therapy (ECT)

Kellner

Obbels

Sienaert

2019

Acta Psychiatr Scand

133

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When to consider electroconvulsive therapy (ECT) Kellner CH, Obbels J, Sienaert P. When to consider electroconvulsive therapy (ECT).Objective: To familiarize the reader with the role of electroconvulsive therapy (ECT) in current psychiatric medicine. Method: We review clinical indications for ECT, patient selection, contemporary ECT practice, maintenance treatment and ECT in major treatment guidelines. Results: ECT is underutilized largely due to persisting stigma and lack of knowledge about modern ECT technique. Conclusion: ECT remains a vital treatment for patients with severe mood disorders, psychotic illness and catatonia. Clinical recommendations for ECT• ECT should be prescribed earlier in the course of a severe depressive episode, not necessarily withheld until after numerous medication trials • ECT may be considered a first-line (primary) treatment for certain urgently ill patients, including those who are very suicidal, psychotic, or physically debilitated from depression Diagnostic indications for ECT • In many Western countries, severe and treatment-resistant depression is the main indication for ECT • Schizophrenia is the number one indication for ECT worldwide, but is little used for this indication in Western countries • ECT is an effective treatment for treatment-resistant mania • Delirious mania is an urgent indication for ECT • ECT is effective for treatment-resistant schizophrenia, including clozapine-resistant illness • Catatonia is very responsive to ECT • Both the motor and behavioural symptoms of Parkinson's disease respond to ECT Predictors of ECT response • Older age, psychotic symptoms, and shorter episode duration are predictors of better ECT response • Melancholic features and greater baseline depressive symptom severity are likely associated with better ECT response 304 ECT technique • Bilateral, bifrontal, and right unilateral electrode placement are all effective ECT techniques • Less urgently ill patients are often treated initially with right unilateral electrode placement • Brief and ultrabrief pulse width stimuli, now commonly used, are associated with a more benign cognitive effect profile • There is no a priori fixed number of ECT in an acute course: patients should continue treatment with ECT until they remit or a plateau has been reached, or tolerability issues require interruption of the course • Tapering of acute courses of ECT should be considered for most patients (e.g., approximately weekly treatments for several weeks past remission) • Continuation/Maintenance (C/M) ECT should be considered for patients with a history of severe, recurrent episodes who have failed to remain well on medications Additional comments • ECT is underutilized because of stigma, lack of knowledge about it, and bureaucratic restrictions • ECT is among the safest procedures performed under general anesthesia • Cognitive adverse effects are markedly decreased with modern ECT techniques, largely transient, and should not deter seriously ill patients from considering ECT.

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“…Of interest, Focal Electrically Administered Seizure Therapy (FEAST) has recently been proposed which moves one electrode anteriorly close to the frontal electrode in fronto‐parietal placement. FEAST uses different sized electrodes and administration of a unidirectional rather than a bidirectional current . Recent pilot studies of FEAST also suggest that moving the temporal electrode to the frontal position may deliver an effective form of ECT with less cognitive effects .…”

Section: Discussionmentioning

confidence: 99%

A systematic review and computational modelling analysis of unilateral montages in electroconvulsive therapy

Martin

Lin

Bai

et al. 2019

Acta Psychiatr Scand

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S, Loo CK. A systematic review and computational modelling analysis of unilateral montages in electroconvulsive therapy Objective: To examine the clinical outcomes of ECT unilateral placements compared in prior studies and apply insights from computational modelling to understand differences between placements. Methods: PubMed, Embase, Scopus and PsycINFO and reference lists were systematically searched for studies of depressed patients where two unilateral placements were compared and clinical outcomes were reported. Computational modelling was done to generate electric field maps for each unilateral placement identified in the systematic review. Results: A total of 29 studies met criteria for inclusion. Eight studies reported efficacy outcomes and 23 studies reported cognitive outcomes. Most studies found no significant difference in efficacy between right unilateral (RUL) and left unilateral (LUL) ECT, and no difference was found between temporo-parietal and fronto-temporal ECT. For the majority of studies, RUL placements had better verbal anterograde memory outcomes compared with the LUL placements. There was some evidence suggestive of cognitive advantages for fronto-frontal and fronto-parietal placements relative to temporo-parietal ECT. Conclusions: For efficacy, studies mainly focused on the comparison of right vs. left hemispheric stimulation, with the available evidence suggesting no substantive difference. RUL placements tended to have better verbal anterograde memory outcomes relative to LUL placements, though limited differences were found between the RUL placements.• RUL and LUL ECT were found to be comparable in efficacy in most studies.• RUL tended to have better verbal memory outcomes relative to LUL ECT placements. • Fronto-frontal and fronto-parietal placements may be superior to temporo-parietal placement in cognitive outcomes. Limitations• The included studies were small, and heterogeneous in methodology and the reporting of treatment methods and clinical outcomes.• Insufficient report of unilateral montage details in the included studies may have hindered the accuracy of interpreting the clinical outcomes and computational modelling. 408

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Expanded Safety and Efficacy Data for a New Method of Performing Electroconvulsive Therapy

Cited by 28 publications

References 55 publications

The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders

The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders

When to consider electroconvulsive therapy (ECT)

A systematic review and computational modelling analysis of unilateral montages in electroconvulsive therapy

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