Chronotherapy Network Netherlands (CNN)

Information is provided about the Chronotherapy Network Netherlands (CNN)

Is ketamine an appropriate alternative to ECT for patients with treatment resistant depression? A systematic review:A systematic review

OBJECTIVE: Ketamine has repeatedly shown to have rapid and robust antidepressant effects in patients with treatment resistant depression (TRD). An important question is whether ketamine is as effective and safe as the current gold standard electroconvulsive therapy (ECT). METHODS: The literature was searched for trials comparing ketamine treatment with ECT for depression in the Pubmed/MEDLINE database and Cochrane Trials Library. RESULTS: A total of 137 manuscripts were identified, 6 articles were included in this review. Overall quality of the included studies was diverse with relevant risk of bias for some of the studies. Results suggest that ketamine treatment might give faster but perhaps less durable antidepressant effects. Side effects differed from ECT, in particular less cognitive impairment was apparent in ketamine treatment. LIMITATIONS: The included studies have limited sample sizes, use different treatment protocols and in most trials, longer term follow up is lacking. Furthermore, allocation bias appears likely in the non-randomized trials. CONCLUSIONS: Current available literature does not yet provide convincing evidence to consider ketamine as an equally effective treatment alternative to ECT in patients with TRD. There are indications for a more favourable short term cognitive side effect profile after ketamine treatment. Methodologically well-designed studies with larger sample sizes and longer follow up duration are warranted

Chronotherapeutische interventies

De effecten van het natuurlijk dag-en-nachtritme van de mens in zijn leefomgeving mogen zich in toenemende aandacht verheugen. Biologische, psychologische en sociaalmaatschappelijke factoren spelen daarbij een rol. Verstoringen van dat ritme kunnen tot diverse klachten leiden zoals onder andere slaapproblemen en depressies. Het beïnvloeden van de biologische ritmes door middel van chronotherapie (o.a. waaktherapie, lichttherapie en sociaalritmetherapie) blijkt in toenemende mate een effectieve manier van behandelen. In dit artikel worden deze interventies besproken

Chronotherapeutic interventions

De effecten van het natuurlijk dag-en-nachtritme van de mens in zijn leefomgeving mogen zich in toenemende aandacht verheugen. Biologische, psychologische en sociaalmaatschappelijke factoren spelen daarbij een rol. Verstoringen van dat ritme kunnen tot diverse klachten leiden zoals onder andere slaapproblemen en depressies. Het beïnvloeden van de biologische ritmes door middel van chronotherapie (o.a. waaktherapie, lichttherapie en sociaalritmetherapie) blijkt in toenemende mate een effectieve manier van behandelen. In dit artikel worden deze interventies besproken

Chronotherapy Network Netherlands (CNN)

Information is provided about the Chronotherapy Network Netherlands (CNN)

Early Complete Remitters After Electroconvulsive Therapy: Profile and Prognosis

OBJECTIVE: To investigate the prevalence, characteristics, and prognosis of depressive patients who show early complete remission after right unilateral (ultra)brief pulse electroconvulsive therapy (ECT). METHODS: Early complete remitters (ECRs) were those patients who were rated 1 on the Clinical Global Impression Scale (maximum score, 7) within 4 ECT sessions and achieved remission (Montgomery Åsberg Depression Rating Scale score, <10). The ECRs were compared with late complete remitters (LCRs), which fulfilled the same criteria after 9 to 12 ECT sessions and with the nonremitters/nonresponders (NRs). RESULTS: Of the 87 patients who completed the index treatment phase, 50 (57.5%) achieved remission. Of these remitters, 12 (14%) were ECRs and 9 (10%) were LCRs. The ECRs were characterized by a higher mean age (71.0 vs 53.9 years; P = 0.008), a shorter current depressive episode (mean, 5.8 vs 15.4 months; P = 0.042), and more psychotic features (75% vs 22%; P = 0.030) and were treated more often with brief pulse ECT (P = 0.030) compared with the LCRs. Although not significant, cognitive performances of ECRs were lower than that of LCRs at baseline with a large effect size: Autobiographical Memory Interview (P = 0.099; d = 0.83), Amsterdam Media Questionnaire (P = 0.114; d = 0.84), and Letter fluency (P = 0.071; d = 0.95). The ECR group had a lower relapse rate during 6 months' follow-up: 10% (1 of 10) versus 62.5% (5 of 8) (P = 0.043). No significant differences in demographic and clinical characteristics were found between LCRs (n = 9) and NRs (n = 27). CONCLUSIONS: Older patients with a psychotic depression and a profile of cognitive slowing have a high chance of achieving complete remission within 4 ECT sessions, with a favorable 6-month prognosis

Psychotic depressive subtype and white mater hyperintensities do not predict cognitive side effects in ECT: A systematic review of pretreatment predictors

Background: Most studies regarding cognitive side-effects following ECT for treating depression report transient forms of cognitive disturbances. However, a growing number of studies also report considerable differences among individual patients. Objective: The aim of this systematic review was to identify pretreatment patient characteristics for predicting the risk of developing cognitive side-effects following ECT. Methods: Online databases PubMed/Medline, Embase, and PsycINFO were searched for articles published from 2002 through May 2019, using the following relevant search terms: #cognitive deficits AND #Electro Convulsive Therapy. Inclusion and exclusion criteria were applied for full-text inclusion. PRISMA guidelines were used. Results: Our initial search yielded 2155 publications; 16 studies were included. A total of 16 possible predictive factors were identified. Two factors, psychotic features and white matter hyperintensities, were conclusively found to not predict cognitive side-effects following ECT; the remaining 14 factors were inconclusive. Conclusions: There is robust evidence that psychotic features and white matter hyperintensities are not predictive of cognitive side-effects following ECT. None of the other 14 factors examined were predictive, however these levels of evidence were weak and therefore inconclusive. Additional studies focusing primarily on pretreatment patient characteristics for predicting cognitive side-effects following ECT are needed, including demographic, clinical, physiological, neurobiological, and genetic factors. Finally, we provide suggestions for future research