One-year follow-up after successful ECT: A naturalistic study in depressed inpatients

Background: The aim of this study is to examine both long-term efficacy of electroconvulsive therapy (ECT) and the predictive value of adequate pre-ECT pharmacotherapy and the presence of delusions in relation to post-ECT relapse in patients who suffered from DSM-III-R major depression. Method: Forty responders (a decrease in Hamilton Rating Scale for Depression score ≥ 50%) to ECT were followed for 1 year, the majority (N = 28) prospectively and the remainder (N = 12) retrospectively. Relapse was defined as readmission, an obvious decline in social functioning, or a change of antidepressant medication caused by a clear worsening of depressive symptoms. Results: Both 6- and 12-month post-ECT relapse was significantly lower in patients with delusional depression compared with nondelusional patients: 3/24 (12%) versus 8/15 (53%) and 5/24 (21%) versus 11/15 (73%), respectively. Relapse rates for the whole sample were 11/39 (28%) at 6 months and 16/39 (41%) at 12 months. Regarding the impact of adequate pre-ECT antidepressant trials on relapse, our data are inconclusive, because only a few patients did not receive adequate pharmacotherapy prior to ECT. Conclusion: The remarkable finding of the present study is the favorable 1-year outcome for patients with delusional depression. The relapse rate for patients adequately pretreated with antidepressants (45% over 1 year) is somewhat

Influence of an adjuvant antidepressant on the efficacy of electroconvulsive therapy: A systematic review and meta-analysis

Objective: The primary indication for electroconvulsive therapy is medication-resistant major depression. There is some evidence that combining electroconvulsive therapy with an antidepressant, instead of electroconvulsive therapy monotherapy, might improve remission rates. However, data on this topic have not been systematically studied. We undertook a systematic review and meta-analysis to determine the effectiveness of an adjuvant antidepressant during electroconvulsive therapy for major depression. Methods: Embase, Medline Ovid, Web of Science, Cochrane Central, PsychINFO Ovid and Google Scholar were searched up to January 2019. Randomized controlled trials and cohort studies reporting on the influence of an adjuvant antidepressant on the efficacy of electroconvulsive therapy for major depression were included. Authors independently screened records, extracted data and assessed study quality. We reported this systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Nine studies were included in the meta-analysis. The meta-analysis revealed a significant advantage of adjuvant antidepressants versus placebo. The overall effect size per category of antidepressant was as follows: tricyclic antidepressants: Hedges’ g 0.32 (95% confidence interval: [0.14, 0.51]) (k = 6) with low heterogeneity (I2: 4%, p = 0.39); selective serotonin reuptake inhibitors/serotonin noradrenaline reuptake inhibitors: Hedges’ g 0.27 (95% confidence interval: [0.03, 0.52]) (k = 2) with a lack of heterogeneity (I2: 0%, p = 0.89); and monoamine oxidase inhibitors: Hedges’ g 0.35 (95% confidence interval: [−0.07, 0.77]) with moderate heterogeneity (I2: 43%, p = 0.17) (k = 3). Conclusion: An adjuvant antidepressant enhances the efficacy of electroconvulsive therapy for major depression. Tricyclic antidepressants, selective serotonin reuptake inhibitors/serotonin noradrenaline reuptake inhibitors and monoamine oxidase inhibitors showed the same effect size. However, the effect sizes of tricyclic antidepressants and monoamine oxidase inhibitors are most likely underestimated, due to insufficient doses in most of the included studies. We recommend the routine use of an adequately dosed antidepressant during electroconvulsive therapy for major depression

Influence of adjuvant nortriptyline on the efficacy of electroconvulsive therapy : a randomized controlled trial and 1-year follow-up

OBJECTIVE: There is limited evidence that adding an antidepressant to electroconvulsive therapy (ECT), compared with ECT monotherapy, improves outcomes. We aimed to determine whether the addition of nortriptyline to ECT enhances its efficacy and prevents post‐ECT relapse. METHODS: We conducted a randomized, double‐blind, placebo‐controlled trial (RCT). Patients with major depressive disorder and an indication for ECT received either nortriptyline or placebo during a bilateral ECT course. Outcome measures were mean decrease in Hamilton Rating Scale for Depression (HRSD) score, response, remission, and time to response and remission. Patients who attained remission participated in a 1‐year follow‐up study with open‐label nortriptyline. Outcome measures were relapse and time to relapse. RESULTS: We included 47 patients in the RCT. In the nortriptyline group, 83% showed response, 74% attained remission, and the mean decrease in HRSD score was 21.6 points. In the placebo group these figures were, respectively, 81% (p = 0.945), 73% (p = 0.928) and 20.7 points (p = 0.748). Thirty‐one patients participated in the follow‐up study. In patients who had received nortriptyline during the RCT, 47% relapsed at a mean of 34.2 weeks. Patients who had received placebo showed similar treatment results. In both study phases, no statistically significant differences between the nortriptyline and the placebo group were found. CONCLUSION: In our sample of severely depressed patients who were often medication resistant and suffering from psychotic depression, the addition of nortriptyline to ECT did not enhance its efficacy or prevent post‐ECT relapse. Encouragingly, even in these patients ECT was highly effective and relapse rates were relatively low

Quantifying external focus of attention in sailing by means of action sport cameras

The aim of the current study was twofold: (1) to validate the use of action sport cameras for quantifying focus of visual attention in sailing and (2) to apply this method to examine whether an external focus of attention is associated with better performance in upwind sailing. To test the validity of this novel quantification method, we first calculated the agreement between gaze location measures and head orientation measures in 13 sailors sailing upwind during training regattas using a head mounted eye tracker. The results confirmed that for measuring visual focus of attention in upwind sailing, the agreement for the two measures was high (intraclass correlation coefficient (ICC) = 0.97) and the 95% limits of agreement were acceptable (between -8.0% and 14.6%). In a next step, we quantified the focus of visual attention in sailing upwind as fast as possible by means of an action sport camera. We captured sailing performance, operationalised as boat speed in the direction of the wind, and environmental conditions using a GPS, compass and wind meter. Four trials, each lasting 1 min, were analysed for 15 sailors each, resulting in a total of 30 upwind speed trials on port tack and 30 upwind speed trials on starboard tack. The results revealed that in sailing - within constantly changing environments - the focus of attention is not a significant predictor for better upwind sailing performances. This implicates that neither external nor internal foci of attention was per se correlated with better performances. Rather, relatively large interindividual differences seem to indicate that different visual attention strategies can lead to similar performance outcomes

β-blokkers en elektroconvulsietherapie: Een review

BACKGROUND: When patients with cardiovascular disorders undergo electroconvulsive therapy (ECT) they sometimes have to be treated for tachycardia and high blood pressure. AIM: To describe the effects of β-blockers on seizure duration and cardiovascular variables in patients undergoing ECT. METHOD: Search for studies in Medline, with the keywords 'beta-adrenergic blocking agents' and 'electroconvulsive therapy'. Only articles based on randomised placebo-controlled investigations were included. RESULTS: The search strategy produced 21 articles. These were assessed by all authors. Esmolol was the drug administered in most of the trials. Since seizure duration can influence the therapeutic effect of ECT it is advisable to use bilateral electrode placement in patients with cardiovascular risk factors and to administer esmolol prior to seizure induction. CONCLUSION: The beta-blocker of choice for use during ECT seems to be esmolol; it can shorten seizure duration, although the effect is probably dose-dependent. Esmolol is also the drug of choice in ECT sessions for patients without cardiovascular risk factors but who develop prolonged hypertension or tachycardia. A possible alternative is labetalol, but its longer half-life is a disadvantage, particularly if it is administered in a high dose. So far, experience with landiolol is limited, but its short half-life, greater cardioselectivity and higher potency mean that it could be a promising alternative