Electroconvulsive Therapy

ECT symposium in Lisbon

2009-01-31T17:02:00.002+01:00

We had a wonderful symposium on ECT, at the European Congress of Psychiatry, in Lisbon, Portugal (January 24-28, 2009). Nuno Borja-Santos was co-chairing the symposium with me. It was scheduled on Sunday, at 16.30, so we thought everybody would be gone by then, but the room was too small to fit all the attendants. I first had a lecture on new technical developments, presenting some data on electrodeposition and of course on the recent hype on ultrabrief pulse ECT. Berta Ferreira, a young colleague working in one of the very few ECT-units in Portugal, in Amodora to be precise, gave an overview on continuation ECT and concluded that a number of questions, such as how frequent treatments should be, and how long treatment should last, remain unanswered. Same story with the lecture on post-ECT pharmacotherapy, by Lindy Jarosch-von Schweder, a Norwegian clinician and researcher. She presented unpublished data on the Sackeim-study on the combination of nortryptiline and venlafaxine during a course of ECT, concluding that both increase remission rates, but not, however, decrease relapse. Tom Bolwig concluded the symposium sharing his thoughts on hippocampal neurogenesis and ECT. He kept on teaching, so we kept on learning from his broad experience, even at the table in the restaurant of the amazingly beautiful Pestana Palace hotel, where we had a delicious meal to conclude a fruitful day.
Thanks for the picture, Tom!

Great EFFECT in Barcelona!

2008-09-04T21:28:00.004+02:00

A superb location (the Grand Marina), in a beautiful town (Barcelona) full of sunshine (31°). A perfect setting for the 3rd Annual Meeting of EFFECT. Highly interested and highly interesting clinicians from all over the world attended the meeting to share experience and gain knowledge. Edward ‘Ned’ Shorter (Canada) (pic 1) gave an exciting and lively historic overview of the ‘fall and rise’ (yes, you’ve got it right, not ‘the rise and fall’) of ECT in a very much appreciated key-note lecture.
Anders Tingström (pic 2 with Tom Bolwig and his wife Birthe)’s talk on neurogenesis, gliagenesis and vascular neogenesis was accompanied by a wealth of beautifull and didactic slides. ‘Does ECT alter brain structure?’ ‘Absolutely!’, he stated. Max Stek (The Netherlands) taught that medial temporal lobe atrophy, but not white matter hyperintensities or general cortical atrophy, predicted a poor response to ECT in depressed elderly patients. Antonia Benabarre then shared us his large experience with ECT in different phases of bipolar disorder. The afternoon started with a review on bifrontal ECT by Pascal Sienaert (Belgium), concluding that there is no such thing as the best electrodeposition and that antidepressant efficacy and cognitive side-effects depend on an interaction of electrodeposition and stimulus parameters such as pulse width. Worrawat Chanpatta (Thailand) flew from Bangkok to Barcelona and back, to present his data on ECT in schizophrenic patients, and showed that longer duration of current episode and greater severity of baseline negative symptoms were predictive of poor outcome. The case of Zoltan L., one of the first cases that were treated by von Meduna wit convulsive therapy, was then presented by Gabor Gazdag (Hungary). Hakan Odeberg (Sweden) had no problem keeping the audience concentrated with the concluding lecture, ‘individualized continuation ECT and medication in severe mood disorders’, which gave rise to a lively clinical discussion.

I realised it is a privilege to be part of a meeting, gathering a group of experts from all over the world, to learn and eat, drink and discuss, in a friendly and pleasurable way. Up to Instanbul’s Bakirkoy Hospital, the next and unique location for the 4th Annual Meeting in September 2009!

Edward Shorter at EFFECT!

2008-06-18T22:03:00.002+02:00

Professor Edward Shorter has confirmed his attendance at the 3rd Annual Meeting of EFFECT! Edward Shorter is a Professor at the University of Toronto where he holds the Hannah Chair in the History of Medicine. He is the author of 'A History of Psychiatry from the Era of the Asylum to the Age of Prozac', as well as many other books in the fields of history and medicine. On ECT, he recently wrote the book 'Shock Therapy', with David Healy as a co-author. At the EFFECT-meeting in Barcelona, he will be the keynote speaker on the history of ECT. Do not miss this opportunity!

Pascal et al from Brasil...

2008-05-05T14:18:00.019+02:00

Sunday, May 4th, the 18th Annual Meeting of the Association of Convulsive Therapy took place in Sibley's Memorial Hospital, Washington DC. After a highly interactive discussion on creating a self-assessment checklist for monitoring ECT programs, Sarah Lisanby (photo, with Max Fink) gave an excellent talk on various brain stimulation techniques, and what the new and the old have to teach to each other. After a 'boxed lunch', an un-European but tasty combination of tuna sandwich & crisps, Don Malone gave an overview on the practical isues of deep brain stimulation. Since Borckardt missed his plane, Mark George and Sharlene Sampson presented data on TMS in chronic pain. They selected a group of severe and refractory chronic pain patients 'without depression'. Mean Hamilton score was 3-something. I kept wondering where they could find chronic pain patients with a HDRS that is lower than that of an average psychiatrist?

Charles Kellner seemed a bit reluctant to present the preliminary data on the CORE-3 electrodeplacement trial. Remission rates in this large study were 55% for unilateral, 61% for bifrontal, and 64% for bitemporal ECT, but to their and my surprise, bifrontal ECT yielded cognitive scores that were somewhat worse than bitemporal and unilateral (although not significantly). It has to be said that the pulse width used in this study was 1 msec, instead of the shorter pulse widths used nowadays. The search for the chimera seems to be continuing...

Before that, Joan Prudic presented Sackeim's study on the efficacy of brief-pulse bilateral and unilateral ECT (to be published soon in Brain Stimulation), and stated that ultrabrief pulse ECT with bilateral placement is an inefficacious treatment technique, as opposed to unilateral ultrabrief pulse ECT. She concluded with two studies confirming her research: Colleen Loo's study on unilateral ultrabrief ECT and a study that showed that bifrontal and unilateral ECT had the same efficacy. In my humble opinion, this is not a confirmation of the Sackeim's trial. She said the study was from Pascal and coworkers from Brasil. Wish it were true! I would be walking on white beaches instead of rainy streets of Belgium.

Sienaert P et al. Comparison of Bifrontal and Unilateral Ultra-Brief Pulse Electroconvulsive Therapy for Depression. European Neuropsychophramacology, 2006; 16 (suppl 4):S286.

A history of ECT.

2008-04-26T21:33:00.007+02:00

This new book on the history of ECT is a must read! I have 2 copies: I bought one the moment it was published and Max Fink sent me a copy as a new year's present (thanks again, Max!!), but I only read it once :°). Edward Shorter became famous with his book 'A History of Psychiatry: From the Era of the Asylum to the Age of Prozac' (New York, John Wiley & Sons, 1997). The ECT-book, he wrote with another great author, David Healy. The book adressess different aspects of the history of ECT, with an emphasis on the American history of ECT, i.e. Max Fink. The European situation, however, is also described and even our own association, the European Forum for ECT (EFFECT) is mentioned in the book, and has thus become part of history!

Preconceptions in Nice!

2008-04-18T20:32:00.006+02:00

Recently, I presented a poster at the European congress of psychiatry of the AEP in Nice, France, 4-9 April, on the absence of cognitive side-effects after ultrabrief ECT . 64 patients with a depressive episode that was highly medication refractory, and with a high degree of comorbidity completed a course of bifrontal ECT at 1.5 times seizure threshold (ST) or unilateral ECT at 6 times ST, with a pulse width of 0.3 msec by random assignment. An extensive cognitive battery was performed at baseline and at 1 and 6 weeks post-treatment, by a blinded rater. At the end of the treatment course, 78.1% of patients responded (≥ 50% decrease HDRS-scores). There was a significant increase in global cognitive function (MMSE), verbal memory (RAVLT), attention (CPT), executive function (WCST) and autobiographical memory (AMI). Patients reported a significant increase of their subjective memory function both during and after the ECT-course. There were no significant differences between the patients given bifrontal ECT and those given unilateral ECT. Thus, we concluded that bifrontal and unilateral ultra-brief pulse ECT are effective treatment techniques that do not cause measurable cognitive side-effects or cognitive complaints. One of the psychiatrists at the congress stood back and looked puzzled at the graphs on the poster, listened to what I had to explain and said: "I don't believe you".

Sienaert P, Vansteelandt K, Demyttenaere K, Peuskens J. Absence of cognitive side-effects after ultrabrief electroconvulsive therapy. European Psychiatry, 2008,23,S287.

By the way, the above picture, is from the nice exhibition on the work of Jaume Plensa (Barcelona, 1955) at the MAMAC.

3rd Annual Meeting EFFECT

2008-03-27T18:36:00.007+01:00

The 3rd Annual Meeting of the European Forum for ECT (EFFECT) will take place on wednesday 3 september 2008 in the Grand Marina Hotel (photo) in Barcelona. More details on registration and call for abstracts are on the EFFECT-website!

Thank you and goodbye...

2008-03-26T20:19:00.010+01:00

Willy Milo (1951-2008) recently passed away after two years of struggle with a tumor. Willy was a great man, loyal and dedicated to his work in a way that is rarely seen. As head nurse ECT, he started and built the ECT-team of the University Psychiatric Center, Catholic University of Leuven, campus Kortenberg (Belgium), from 2001, together with my colleague dr Filip Bouckaert and myself. A high standard of care for the patient was all he wanted to achieve. He tried to raise the standards of nursing so as to achieve the highest possible compliance with e.g. outpatient maintenance ECT, because he wanted patients that got wel with ECT to remain well. He succeeded 'con brio'. Our thoughts are with him and his wife Magda, who herself is an ECT-nurse at our unit. The picture is a still from the patientvideo on ECT that we have produced in 2003.

Homer Simpson gets ECT!

2008-03-26T11:15:00.007+01:00

Great scene from The Simspons "Don't Fear the Roofer" (Season 16, Episode 16), where Homer gets ECT because of a psychotic episode. Homer befriends a beer loving roofer, Ray. Ray and Homer attempt to repair Homer's roof. Ray never shows and everyone believes that Ray is a figment of Homer's imagination. After a round of ECT, however, Homer and family meet Ray in the hospital lobby who explains the errors in the previous testimonials.

Homer seems to like the taste of the rubber biteblock very much! Even though a great cartoon, again ECT is depicted as a kind of torture.

Pictures of Vienna...

2008-03-26T09:42:00.008+01:00

Above is a pic of the speakers dinner, the night before the Second Annual Meeting of EFFECT, in Vienna. I had a fever and felt terrible (although it doesn't show on the picture). More pics are at the membersection of the EFFECT-website!

First National Conference on ECT, Lisbon, Portugal, 22-23.02.2008

2008-03-24T22:44:00.006+01:00

On februari 22, I was invited by Berta Fereira (a Portugese psychiatrist I met at the APA in Tornonto), to the first national conference on ECT in Portugal. The conference took place at the Museum of Electricity in Belèm, Lisbon, very close to the Monasterio Jerónimo (photo). About 240 participants had registered and about 200 turned up. I gave a lecture on ECT in Europe and the European Forum for ECT (EFFECT), and Chris Freeman from Edingburg talked about the 'quality-control' of ECT units in the UK (ECTAS). The other speakers were all Portugese practioners, talking about the practice of ECT in their new units, where the standards of practice appear to be high. It was shown that in Portugal, in the past few years, a total of 6 ECT-units became active, 3 of which are situated in the Lisbon area (Lisbon, Amadora). All these units performed an estimate of 500-1200 treatment sessions in 2007. This corresponds to an ECT-rate of 0.5-1.2/10.000 inhabitants. At least one new unit (Azores) will start activities in 2008. As in other European countries, the main indication for ECT is medication resistant depression, the bilateral electrodeposition is used most frequently, as is the hypnotic propofol (Sienaert & van den Broek, 2008). During the meeting, a Portugese association for ECT (the Sociedade Portuguesa de Electroconvulsivoterapia) was established, with António Gamito as president.

Sienaert & Van den Broek (2008). Electroconvulsive therapy in continental Western Europe: a literature review. In: Swartz C. (Ed.) Electroconvulsive Therapy and Neuromodulation. Cambridge University Press