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.

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.

scholarly journals Clinical predictors of seizure threshold in electroconvulsive therapy: a prospective study

2012 ◽  
Vol 263 (2) ◽  
pp. 167-175 ◽  
Author(s):  
Jeroen A. van Waarde ◽  
Lucas J. B. van Oudheusden ◽  
Bastiaan Verwey ◽  
Erik J. Giltay ◽  
Rose C. van der Mast
Keyword(s):  
Prospective Study ◽  
Electroconvulsive Therapy ◽  
Seizure Threshold ◽  
Clinical Predictors ◽  
A Prospective Study

scholarly journals Initial seizure threshold in bilateral electroconvulsive therapy

1998 ◽  
Vol 22 (5) ◽  
pp. 298-299 ◽  
Author(s):  
Sheena R. Dykes ◽  
Allan I. F. Scott
Keyword(s):  
Electroconvulsive Therapy ◽  
Important Determinant ◽  
Seizure Threshold ◽  
Men And Women ◽  
Depressed Patients ◽  
The Uk ◽  
Made In

The extent to which electrical dose exceeds the seizure threshold is an important determinant of the efficacy of electroconvulsive therapy (ECT) but seizure thresholds have not before been evaluated using an ECT machine made in the UK. In this study seizure threshold was empirically titrated at the outset of bilateral ECT given to 100 consecutive depressed patients treated with an Ectron Series 5A ECT machine. No patient received anti-epileptic drugs. Men and women under 30 years of age (n=14) had low thresholds and men of 60 years or more (n=3) had high thresholds. Seizure thresholds varied at least threefold among other groups, suggesting that empirical titration may be desirable for most patients treated by bilateral ECT.

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.

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.

Barbiturate tolerance and psychological functioning in elderly depressed patients

1973 ◽  
Vol 3 (1) ◽  
pp. 39-52 ◽  
Author(s):  
Robert H. Cawley ◽  
Felix Post ◽  
Antonia Whitehead
Keyword(s):  
Clinical Features ◽  
Psychological Functioning ◽  
Severity Of Illness ◽  
Depressive Illness ◽  
Cognitive Tests ◽  
Depressed Patients

SynopsisIncreases in barbiturate tolerance and in scores on certain cognitive tests were found to have occurred after the treatment of elderly depressives. These changes were related to original severity of illness and to the extent of improvement, as well as to a number of other clinical features including age at first attack. The reported findings lent support to theories linking depressive illness with reduction in cortical arousability.

Use of ultrabrief pulse width electroconvulsive therapy to induce therapeutic seizures in an elderly patient with a high seizure threshold: a case report

2019 ◽  
Vol 28 (3) ◽  
pp. 291-296
Author(s):  
David Plevin ◽  
Susan Waite
Keyword(s):  
Case Report ◽  
Electroconvulsive Therapy ◽  
Pulse Width ◽  
Depressive Illness ◽  
Electrode Placement ◽  
Seizure Threshold ◽  
Augmentation Strategies ◽  
Seizure Quality ◽  
Unipolar Major Depression

Objective: This case report describes a 73-year-old man suffering from unipolar major depression with melancholic features, in whom treatment with electroconvulsive therapy (ECT) proved difficult due to inadequate seizure generation. Methods: A number of augmentation strategies were trialled in an attempt to improve seizure quality. Pre-ECT and Post-ECT measurement of symptoms, quality of life and cognition were undertaken with a variety of validated scales. Results: The single most efficacious strategy to elicit therapeutic seizures was the use of right unilateral (RUL) electrode placement with an ultrabrief pulse width. The patient subsequently had a resolution of his depressive illness, with a concomitant improvement in cognitive functioning. Conclusion: This case demonstrates that a number of ECT augmentation strategies can be used in routine clinical practice for patients with high seizure thresholds. It highlights that UB pulse width may be considered earlier in the treatment course for patients in whom conventional brief pulse ECT fails to generate effective seizures.

scholarly journals Unilateral electroconvulsive therapy

1971 ◽  
Vol 9 (11) ◽  
pp. 41-42
Keyword(s):  
Effective Treatment ◽  
Therapeutic Effect ◽  
Electroconvulsive Therapy ◽  
Cerebral Hemisphere ◽  
Muscle Relaxants ◽  
Short Acting ◽  
Depressed Patients ◽  
Antidepressive Drugs ◽  
Memory Disturbance

Although the introduction of antidepressive drugs has lessened the use of electroconvulsive therapy (ECT) in psychiatry, it remains the most effective treatment for severely depressed patients.1 Since the introduction of muscle relaxants and short-acting anaesthetics the main unwanted effects of ECT have been the brief period of disorientation after the treatment, and occasionally embarrassing but usually short-lived memory disturbances. In the late fifties and early sixties it was suggested that the application of electrodes to the head over the non-dominant cerebral hemisphere instead of the more usual bitemporal placement might produce the desired therapeutic effect while minimising the unwanted disorientation and memory disturbance.

scholarly journals Administration of electroconvulsive therapy: training, practice and attitudes

1993 ◽  
Vol 17 (3) ◽  
pp. 154-155 ◽  
Author(s):  
Tom Henderson ◽  
Marilyn J. Anderson ◽  
Cameron R. Stark
Keyword(s):  
Effective Treatment ◽  
Electroconvulsive Therapy ◽  
Research Evidence ◽  
Depressive Illness ◽  
Junior Doctors ◽  
Therapy Training ◽  
Training Practice

Electroconvulsive therapy (ECT) is an effective treatment in severe depressive illness (Kendell, 1981). It is unusual in being administered predominantly by junior doctors, although prescribed by consultants. Pippard (1988) has drawn attention to a tendency for practice to depend on established custom rather than research evidence, and to a lack of consultant involvement in ECT teaching.

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