Journal of Ect最新文献

Objectives: Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for depression. However, knowledge of changes in treatment numbers and the proportion of acute versus maintenance rTMS is lacking. This study aimed to examine the number of rTMS treatments, rates of return for additional treatment, and factors associated with these patterns in Northern Finland from 2016 to 2022.

Methods: Data were collected from the electronic patient registry of the Oulu University Hospital neuromodulation unit. We analyzed the number of treatment sessions given annually, the number of patients treated and retreated, and whether the main diagnosis, age, or gender were associated with retreatment.

Results: The annual number of rTMS treatment sessions increased from 549 to 2884, with a 3-fold increase in acute and a 35-fold increase in maintenance treatments. There was a 3-fold increase in patients receiving acute and a 16-fold increase in patients receiving maintenance treatments. A total of 64% were females. The most common diagnosis was recurrent depressive episode (49%). The rTMS rate was 9.5 per 100,000 in 2017 and 24 per 100,000 in 2022. In all, 23% of patients returned to acute or maintenance treatment. Female gender and recurrent depressive disorder were associated with retreatment.

Conclusions: rTMS use increased substantially, especially in maintenance sessions, with rising retreatment rates. While access improved, demand for maintenance care is straining capacity and prolonging waiting for acute treatment. Additional resources and research on optimal treatment schedules, relapse prevention, and cost‑effectiveness are needed.

Background: Electroconvulsive therapy (ECT) is an effective and safe treatment for severe or treatment-resistant psychiatric disorders, but transient asystole and arrhythmias can occur during the treatment. Reports have shown that bifrontal electrode placement may reduce these adverse events. Our clinic changed the preferred electrode placement from bitemporal (BT) to bifrontal (BF) in May 2022. We wanted to evaluate whether this transition reduced the duration of asystole and the incidence of arrhythmias, and whether this resulted in similar remission rates.

Methods: We retrospectively reviewed the records of 69 patients who had BF ECT between May 2022 and October 2025, and the same number of consecutively treated patients who had received BT ECT before May 2022. We had data on arrhythmias for all patients, on ECG recordings for 69 BF and 42 patients with BT, and ratings for remission on all but 4 patients. Regression analysis controlling for age, sex, and concomitant medications was used to assess differences in the duration of the longest heart interbeat intervals, the rates of arrhythmia, and of clinical remission.

Results: Patients treated with BF ECT had a much shorter duration of interbeat intervals [0.74 s (SD=0.18) vs. 1.32 s (SD=0.57), P=1.5×10-14]. The rates of arrhythmias were reduced, but the difference was not significant (15.9% vs. 27.5%, P=0.082). Remission rates were not significantly different (BF=59.7%, BT=63.6%, P=0.49).

Conclusions: BF ECT had a marked effect on reducing the rate of asystole and possibly the rate of arrhythmias during ECT, without reducing clinical effectiveness. This electrode placement could be preferable for older people and those at increased risk of heart complications.

Electroconvulsive therapy (ECT) is an effective treatment for severe and treatment-resistant bipolar depression, yet intracranial vascular malformations such as cerebral cavernous malformations raise safety concerns due to transient ECT-induced increases in blood pressure and intracranial pressure, potentially elevating the risk of hemorrhage. We report a case of a woman in her mid-60s with treatment-resistant bipolar depression and severe symptom burden (MADRS 45; HAMD-17 35; HAMD-21 39) in whom brain MRI incidentally revealed a 6×4 mm cavernous hemangioma in the left precentral gyrus without signs of prior hemorrhage. Following interdisciplinary consultation with neurosurgery and anesthesiology, an index course of ECT was initiated with careful hemodynamic monitoring and pharmacological blood pressure control. The patient received 16 sessions; initial bifrontal stimulation yielded insufficient seizure quality despite maximal stimulus intensity, prompting a switch to right unilateral electrode placement, which produced adequate seizures. Hypertensive peaks up to 210/150 mmHg were successfully managed with metoprolol and intravenous urapidil. Apart from transient anisocoria after the first session with unremarkable cranial CT findings, no neurological complications occurred. Depressive symptoms markedly improved by the end of treatment (MADRS 12; HAMD-17 15; HAMD-21 17). This case suggests that ECT can be performed safely and effectively in patients with cerebral cavernous hemangioma when multidisciplinary assessment and targeted hemodynamic management are implemented, and that the combination of metoprolol and urapidil may represent a useful strategy to mitigate blood pressure surges during ECT.

Objectives: The electroconvulsive therapy for the acute management of severe agitation in dementia (ECT-AD) trial is a multisite study evaluating the effectiveness of ECT for severe agitation in individuals with advanced dementia. Given that participants lack decisional capacity because of advanced cognitive impairment, the trial required a structured and ethically sound approach to obtaining informed consent and assent across jurisdictions with differing legal requirements, including Massachusetts, New York, Georgia, Minnesota, and Michigan. This paper describes the approach used in the study.

Methods: We describe the consent framework developed for the ECT-AD trial, including procedures for identifying legally authorized representatives, complying with state-specific laws for ECT consent, obtaining surrogate consent for research participation, and assessing patient assent and dissent using a standardized tool.

Conclusions: The approach used in this study may serve as a practical model for future research involving individuals without decision-making capacity and legally complex interventions such as ECT.

Major depressive disorder (MDD) is a highly prevalent and disabling psychiatric condition associated with substantial morbidity and mortality. Although its pathophysiology remains incompletely understood, converging evidence implicates immune dysregulation and inflammatory mechanisms in its development. Electroconvulsive therapy (ECT) remains the most effective intervention for treatment-resistant depression; however, no validated biomarkers currently predict therapeutic response. This systematic review synthesizes current findings on the potential predictive value of inflammatory and immunologic biomarkers-particularly interleukin-2 (IL-2), interleukin-4 (IL-4), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP)-for ECT outcomes in patients with MDD. A comprehensive literature search was conducted across PubMed, EMBASE, Cochrane, and PsycINFO without language or date restrictions, including adult patients (18 years or older) with MDD who received ECT and reported at least one target biomarker and a validated clinical outcome measure. Fifteen studies met the inclusion criteria, with IL-6, TNF-α, and CRP being the most frequently investigated markers. Several studies suggested that elevated baseline IL-6 and moderately increased CRP levels may predict a more favorable ECT response-particularly among women-yet findings were largely inconsistent, and no robust biomarker emerged as a reliable predictor. Overall, the evidence remains insufficient to establish interleukins or CRP as dependable predictors of antidepressant response to ECT in MDD. Substantial heterogeneity in methodology, small sample sizes, and variability in biomarker assays highlight the need for large-scale, standardized, longitudinal studies.

Disorders of consciousness (DoC) following severe brain injury have limited therapeutic options. Noninvasive brain stimulation (NIBS), particularly transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), has shown promise in improving consciousness. However, the use of NIBS in patients with programmable ventriculoperitoneal (VP) shunt valves poses unique challenges, as these devices are susceptible to electromagnetic interference. While TMS may alter valve settings or induce heating, the safety of tDCS in such patients remains largely unexplored. We report the feasibility and safety of high-definition tDCS (HD-tDCS) in a 9-year-old girl with a minimally conscious state following severe traumatic brain injury and an implanted programmable VP shunt. Stimulation targeting the left dorsolateral prefrontal cortex was delivered using a neuronavigation-guided montage optimized through computational modeling. Sessions were conducted with continuous clinical monitoring and serial imaging to assess valve pressure. The patient completed 15 sessions with gradual titration of current intensity up to 1 mA. No major adverse events were observed. Serial imaging confirmed stable VP shunt position and pressure settings throughout the intervention. Although no significant change was noted in Coma Recovery Scale-Revised scores, subtle clinical improvements were observed, including increased spontaneous movements, improved muscle tone, enhanced eye movements, and intermittent responsiveness to environmental stimuli. This case highlights the potential safety and feasibility of HD-tDCS in patients with programmable VP shunts. tDCS may represent a viable neuromodulatory alternative when TMS is contraindicated, warranting further systematic investigation.

Low-intensity transcranial focused ultrasound (tFUS) is a novel noninvasive neuromodulation technique capable of reaching deep brain structures with high spatial precision. The anterior thalamus, a key relay in pain processing, is a promising target for modulating central pain networks. In this context, this study aims to assess the safety, feasibility, and preliminary effects of anterior thalamic low-intensity tFUS in patients with chronic Central Neuropathic Pain (CNP). In this prospective, open-label, single-arm pilot study, 5 adults with refractory central neuropathic pain underwent neuronavigated low-intensity transcranial focused ultrasound targeting the anterior thalamus contralateral to the pain-affected region. Each session consisted of two 10-minute stimulation blocks separated by 20 minutes. Pain intensity was assessed using the visual analog scale at baseline, immediately poststimulation, and also after 4 hours, 24 hours and 10 days after the intervention. Secondary outcomes included the Brief Pain Inventory, McGill Pain Questionnaire, Douleur Neuropatique 4, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Patient Global Impression of Change and Clinical Global Impression of Change scale. The procedure demonstrated feasible with no serious adverse events. One participant experienced mild transient neck discomfort. No statistically significant improvements were observed in pain intensity or secondary outcomes at any time point compared with baseline. Overall, anterior thalamic low-intensity tFUS presented safe and feasible for patients with CNP but did not yield significant short-term analgesic effects. These findings support further controlled clinical trials with larger samples, optimized stimulation parameters and repeated sessions to better evaluate the therapeutic potential of low-intensity tFUS for chronic CNP.

Objectives: To examine the acute and longitudinal effects of repetitive transcranial magnetic stimulation (rTMS) on-autonomic nervous system measures (ANS)-heart rate variability (HRV) and pupillary light reflex (PLR)-in adults with major depressive disorder (MDD). This pilot study explored the feasibility of measurement and associations with clinical outcomes.

Methods: Thirteen adults undergoing rTMS for MDD participated in a single-blind, randomized, sham-controlled initial session, followed by 30 open-label treatments. HRV indices [root mean square of successive differences (RMSSD), high-frequency power in normalized units (HFnu)] were recorded at baseline, during stimulation, and biweekly; PLR indices were assessed pre- and post-treatment at rTMS session #1 and at endpoint. Depression severity was measured with the Hamilton Rating Scale for Depression (HRSD). Mixed-effects linear models evaluated changes over time; correlations examined associations between ANS measures and symptom improvement.

Results: HRSD scores improved significantly across treatment (P<0.01), with 4 remitters, 4 responders, and 5 nonresponders. No significant changes were observed in HRV or PLR for the entire sample over the treatment course. However, PLR maximum constriction velocity (MCV) decreased in the active condition versus sham at rTMS session #1 (P<0.05). There were no significant correlations between changes in HRSD scores and changes in either HRV or PLR variables.

Conclusions: Compared with sham stimulation, rTMS induced hyperacute parasympathetic effects on the ANS, as measured by PLR MCV, but this effect was short-lived. ANS measures showed no overall group change over the course of rTMS and no relationship to improvement in depression symptoms.