Does psychosis predict response to ECT in depressed elderly patients?

1999 ◽  
Vol 16 (1) ◽  
pp. 13-15
Author(s):  
Niall Gormley ◽  
Con Cullen ◽  
Liam Watters ◽  
Michael Philpot ◽  
Brian A Lawlor
Keyword(s):  
Retrospective Study ◽  
Elderly Patients ◽  
Treatment Option ◽  
Electroconvulsive Therapy ◽  
Therapy Response ◽  
Psychiatric Hospitals ◽  
Depressive Illness ◽  
Response To Treatment ◽  
Depressed Patients

AbstractObjectives: To compare the electroconvulsive therapy response of a sample of depressed elderly patients as a function of the presence or absence of psychosis.Method: Retrospective study of patients over age 65 treated with ECT at three psychiatric hospitals over a three year period.Results: One hundred and eighty-nine ECT courses were administered to 135 patients. Almost 8 5% of patients made a marked or moderately good response to treatment. There was no difference in ECT response between psychotic and non-psychotic depressed patients.Conclusions: ECT should be considered as a treatment option for severe depressive illness, regardless of depressive subtype.

Which Depressed Patients will Respond to Electroconvulsive Therapy?

1989 ◽  
Vol 154 (1) ◽  
pp. 8-17 ◽  
Author(s):  
Allan I. F. Scott
Keyword(s):  
Effective Treatment ◽  
Clinical Features ◽  
Electroconvulsive Therapy ◽  
Physiological Responses ◽  
Depressive Illness ◽  
Seizure Threshold ◽  
Posterior Pituitary ◽  
Clinical Predictors ◽  
Depressed Patients ◽  
Wide Range

A small yet significant minority of contemporary patients with endogenous depressive illness who are treated with electroconvulsive therapy (ECT) gain little or no benefit. It is argued that the use of clinical features alone may not improve the ability to predict outcome after ECT. Many biological measures have been used to attempt to identify depressed patients for whom ECT would be an effective treatment, but none has yet been shown to be superior to clinical predictors. Depressed patients show a wide range of physiological responses to the first treatment of a course of ECT. Of these physiological responses, estimations of seizure threshold and of the release of posterior pituitary peptides merit further investigation as putative predictors of recovery.

Influence of electroconvulsive therapy on white matter structure in a diffusion tensor imaging study

2019 ◽  
Vol 50 (5) ◽  
pp. 849-856 ◽  
Author(s):  
Jonathan Repple ◽  
Susanne Meinert ◽  
Irene Bollettini ◽  
Dominik Grotegerd ◽  
Ronny Redlich ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
White Matter ◽  
Prospective Study ◽  
Electroconvulsive Therapy ◽  
Inpatient Treatment ◽  
Right Hemisphere ◽  
Diffusion Tensor ◽  
Therapy Response ◽  
Seizure Duration ◽  
Depressed Patients

AbstractBackgroundElectroconvulsive therapy (ECT) is a fast-acting intervention for major depressive disorder. Previous studies indicated neurotrophic effects following ECT that might contribute to changes in white matter brain structure. We investigated the influence of ECT in a non-randomized prospective study focusing on white matter changes over time.MethodsTwenty-nine severely depressed patients receiving ECT in addition to inpatient treatment, 69 severely depressed patients with inpatient treatment (NON-ECT) and 52 healthy controls (HC) took part in a non-randomized prospective study. Participants were scanned twice, approximately 6 weeks apart, using diffusion tensor imaging, applying tract-based spatial statistics. Additional correlational analyses were conducted in the ECT subsample to investigate the effects of seizure duration and therapeutic response.ResultsMean diffusivity (MD) increased after ECT in the right hemisphere, which was an ECT-group-specific effect. Seizure duration was associated with decreased fractional anisotropy (FA) following ECT. Longitudinal changes in ECT were not associated with therapy response. However, within the ECT group only, baseline FA was positively and MD negatively associated with post-ECT symptomatology.ConclusionOur data suggest that ECT changes white matter integrity, possibly reflecting increased permeability of the blood–brain barrier, resulting in disturbed communication of fibers. Further, baseline diffusion metrics were associated with therapy response. Coherent fiber structure could be a prerequisite for a generalized seizure and inhibitory brain signaling necessary to successfully inhibit increased seizure activity.

Effect of Electroconvulsive Therapy on Erythrocyte Adenosine Triphosphatase Activity in Depressive Illness

1980 ◽  
Vol 137 (4) ◽  
pp. 343-345 ◽  
Author(s):  
L. J. Whalley ◽  
M. Scott ◽  
H. W. Reading ◽  
J. E. Christie
Keyword(s):  
Atpase Activity ◽  
Erythrocyte Membrane ◽  
Electroconvulsive Therapy ◽  
Healthy Subjects ◽  
Adenosine Triphosphatase ◽  
Depressive Illness ◽  
Slight Reduction ◽  
Acute Effects ◽  
Adenosine Triphosphatase Activity ◽  
Depressed Patients

SummaryErythrocyte membrane adenosine triphosphatase activities were examined in twelve unipolar depressed patients receiving ECT. Eleven patients undergoing diagnostic cystoscopy served as controls for the acute effects of anaesthesia, and sixteen healthy subjects served as non-depressed controls. The unipolar depressed patients had a slight reduction in their (Na++K+)-ATPase activity but effective ECT treatment was not associated with any increase in this activity. This approach is unlikely to cast further light on the membrane phenomenology of depressive illness.

Clinical Features of Depression and the Response to Imipramine (“Tofranil”)

1962 ◽  
Vol 108 (452) ◽  
pp. 101-104 ◽  
Author(s):  
J. J. Fleminger ◽  
Bernard M. Groden
Keyword(s):  
Clinical Trials ◽  
Clinical Features ◽  
Antidepressant Drugs ◽  
Depressive Illness ◽  
Response To Treatment ◽  
Depressive State ◽  
Important Place ◽  
Depressed Patients ◽  
Better Than

Since it was first reported by Kuhn in 1957, the value of imipramine in the treatment of depressive illness has become generally recognized and confirmed by clinical trials (Blair, 1960; Daneman, 1961; Rees et al., 1961). It continues to hold an important place in therapy despite the introduction of many other antidepressant drugs and the occasional adverse report (Ashby & Collins 1961). Nevertheless the indications for its use are by no means established. It has been claimed that certain types of depression respond better than others: “psychotic” better than “neurotic” (Azima, 1959), “endogenous” better than “reactive” (Ball and Kiloh, 1959). Yet the difficulty of making these categorical distinctions, and of making reliable comparisons between the findings based upon them by different workers remains notorious. It is clear, however, that only a proportion of depressed patients respond well to imipramine. It is also certain that within the group which does respond well are to be found representatives of every type and degree of depressive state. There is evident need, therefore, for information that will help to indicate which characteristics of an individual will render him more or less susceptible to imipramine, and there does not appear to have been any study particularly devoted to this. In this paper we give the results of correlating certain clinical features of depression with the response to treatment by this drug.

Short- and long-term neurocognitive functioning after electroconvulsive therapy in depressed elderly: a prospective naturalistic study

2013 ◽  
Vol 26 (2) ◽  
pp. 315-324 ◽  
Author(s):  
Esmée Verwijk ◽  
Hannie C. Comijs ◽  
Rob M. Kok ◽  
Harm-Pieter Spaans ◽  
Caroline E.M. Tielkes ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Elderly Patients ◽  
Electroconvulsive Therapy ◽  
Verbal Learning ◽  
Effect Sizes ◽  
Medium Effect ◽  
Neurocognitive Functioning ◽  
Naturalistic Study ◽  
Depressed Patients

ABSTRACTBackground:It is generally assumed that the elderly patients are more vulnerable to cognitive side effects after electroconvulsive therapy (ECT) than younger depressed patients. The current study aims to evaluate the nature and extent of changes across multiple domains of neurocognitive functioning in a group of elderly depressed patients after ECT.Methods:In this prospective naturalistic study, we included 42 depressed patients aged ≥55 years. Global cognitive function, memory, and executive function were assessed before ECT treatment and within one week (short-term post-ECT) and six months after ECT (long-term post-ECT). Associations between cognitive functioning and electrode placement, total number of treatment sessions, age, and the severity of depression at the time of cognitive measurement were studied.Results:Our data offered no evidence of decline for any of the neurocognitive tests after ECT, given its power to detect the difference. Post-ECT improvement of neurocognitive functioning was statistically significant for the Mini-Mental State Examination, Visual Association Test, 10 Words Verbal Learning Test, and Expanded Mental Control Test. Effect sizes were medium to large. After six months, compared with post-ECT performance, statistically significant improvement was found only for the Trail Making Test-A and the Letter Fluency Test with small to medium effect sizes.Conclusions:In our severely depressed elderly patients, neurocognitive performance improved or did not change after ECT. Patients with poor cognitive function were not able to participate in neuropsychological assessment before ECT started. Consequently these results may not apply to patients with more severe cognitive impairment prior to the start of ECT.

A Double-Blind Trial: Vivalan against Placebo in Depressed Elderly Patients

1980 ◽  
Vol 8 (1) ◽  
pp. 18-21 ◽  
Author(s):  
L Knorring Von
Keyword(s):  
Elderly Patients ◽  
Cardiac Disease ◽  
Depressive Illness ◽  
Primary Diagnosis ◽  
Controlled Study ◽  
Double Blind Trial ◽  
Double Blind ◽  
Blind Trial ◽  
Depressed Patients ◽  
Depression Ratings

A double-blind controlled study of viloxazine against placebo in elderly depressed patients with a primary diagnosis of depressive illness records statistically significant improvements in depression ratings in the viloxazine group after three weeks. Viloxazine was effective and well tolerated at doses of 100 to 200 mg in depressed elderly patients, several of whom had concurrent cardiac disease.

The Effects of Mood Changes and Antidepressants on the Cognitive Capacity of Elderly Depressed Patients

1989 ◽  
Vol 1 (2) ◽  
pp. 135-143 ◽  
Author(s):  
Anastasios Georgotas ◽  
Robert E. McCue ◽  
Barry Reisberg ◽  
Steven H. Ferris ◽  
Narmada Nagachandran ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Cognitive Functioning ◽  
Baseline Level ◽  
Cognitive Capacity ◽  
Response To Treatment ◽  
Optimal Conditions ◽  
Double Blind ◽  
Mood Changes ◽  
Depressed Patients ◽  
Before And After

Seventy-eight nondemented elderly depressed patients underwent an extensive battery of cognitive tess both before and after seven weeks of treatment with nortriptyline, phenelzine, or placebo. Clinical and cognitive evaluations of the patients were under double-blind conditions. Response to treatment did not appear to significantly affect cognitive capacity; neither did treatment with an active substance as compared to placebo. In addition, the baseline level of cognitive functioning did not appear related to whether a patient responded to treatment. The authors conclude that under optimal conditions neither antidepressant produces measurable changes in the cognitive capacity of nondemented elderly patients.

Delusional Depressions: Natural History and Response to Treatment

1977 ◽  
Vol 131 (4) ◽  
pp. 351-360 ◽  
Author(s):  
Shepard J. Kantor ◽  
Alexander H. Glassman
Keyword(s):  
Natural History ◽  
Clinical Significance ◽  
Depressive Disorders ◽  
Depressive Illness ◽  
Response To Treatment ◽  
Major Depressive ◽  
Depressed Patients ◽  
Choice Of Treatment ◽  
Almost All

A review of the abundant literature concerning the distinction between delusional and non-delusional depressions, especially of the work of Aubrey Lewis, reveals that before the introduction of specific therapies most in-patients with major depressive illness eventually recovered; the small percentage who did not almost all came from the delusional group. The dichotomy lost its clinical significance after the introduction of ECT, as both groups were equally responsive. However, accumulating evidence indicates that unipolar delusional depressives are significantly less responsive to tricyclic anti-depressant therapy than non-delusional depressives. The presence or absence of delusional thinking should be considered as a significant criterion in the classification of depressive disorders, and the presence or absence of delusional thinking should influence the choice of treatment for severely depressed patients.

What I would say to a patient who asked me about this article

2006 ◽  
Vol 12 (3) ◽  
pp. 237-238 ◽  
Author(s):  
Allan Scott
Keyword(s):  
Informed Consent ◽  
Side Effects ◽  
Clinical Improvement ◽  
Treatment Option ◽  
Electroconvulsive Therapy ◽  
Depressive Illness

Electroconvulsive therapy (ECT) remains an important treatment option for severe depressive illness, but it can have side-effects, including permanent gaps in memory. Where minimising the intellectual side-effects of treatment has priority, then treatment to only one side of the head (unilateral ECT) is preferable; where the speed of clinical improvement is paramount, then bilateral ECT may be preferred. The choice of how ECT is administered should, where possible, be part of the process of informed consent.

scholarly journals Analysis of efficacy and safety of electroconvulsive therapy in elderly patients: a retrospective study in the Polish population

2021 ◽  
pp. 1-19
Author(s):  
Anna Antosik-Wójcińska ◽  
Monika Dominiak ◽  
Zuzanna Goetz ◽  
Adam Gędek ◽  
Anna Braniecka ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Elderly Patients ◽  
Electroconvulsive Therapy ◽  
Polish Population ◽  
Efficacy And Safety
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