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  • 1.
    Ahmad, Irma
    et al.
    Orebro Univ, Sweden.
    Sandberg, Matilda
    Orebro Univ, Sweden.
    Brus, Ole
    Orebro Univ, Sweden.
    Ekman, Carl Johan
    Karolinska Inst, Sweden.
    Hammar, Åsa
    Univ Bergen, Norway.
    Landén, Mikael
    Karolinska Institutet, Stockholm, Sweden; The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Lundberg, Johan
    Karolinska Inst, Sweden; Stockholm Health Care Services, Stockholm, Sweden.
    Nordanskog, Pia
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Psykiatricentrum, Psykiatriska kliniken i Linköping. Linköping University, Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience.
    von Knorring, Lars
    Uppsala University, Uppsala, Sweden.
    Nordenskjöld, Axel
    Örebro University, Örebro, Sweden.
    Validity of diagnoses, treatment dates, and rating scales in the Swedish national quality register for electroconvulsive therapy2022In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 76, no 2, p. 96-103Article in journal (Refereed)
    Abstract [en]

    Background The Swedish national quality register for electroconvulsive therapy (Q-ECT) contains data on patients receiving treatment with electroconvulsive therapy (ECT) in Sweden. Aim This study determined the validity of diagnoses, treatment dates, and rating scales in the Q-ECT by investigating the degree of accordance between data from the Q-ECT and patient records. Materials and methods From January 2016 to December 2017, 200 treatment series were randomly selected from the Q-ECT. The corresponding patient records were requested from the treating hospitals. Data on the indicative diagnosis, dates for the first and the last ECT session, and rating scales were compared between the Q-ECT and patient records using (i) a strict and (ii) a liberal method of assessment. Using the liberal method, each variable was assessed as accordant if it belonged to the same diagnosis group, or if the dates differed by less than 1 week, or ratings differed by only 1 point on the Clinical Global Impression Scale (CGI- S), or no more than 3 points on the Montgomery angstrom sberg Depression Rating Scale between the Q-ECT and the patient record. Results A total of 179 patient records were received. The strict method of assessment showed an accordance of 89% or higher for all studied variables. The liberal method showed an accordance of 95% or higher. Conclusions We conclude that data on the studied variables in the Q-ECT have high validity. However, limited use of some rating scales makes the results uncertain. Measures can be taken to further improve the data quality.

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  • 2.
    Brus, O.
    et al.
    Örebro University, Sweden.
    Cao, Y.
    Örebro University, Sweden; Karolinska Institute, Sweden.
    Gustafsson, E.
    Umeå University Hospital, Sweden.
    Hulten, M.
    Lund University, Sweden.
    Landen, M.
    Karolinska Institute, Sweden; Gothenburg University, Sweden.
    Lundberg, J.
    Karolinska Institute, Sweden; Stockholm County Council, Sweden.
    Nordanskog, Pia
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Nordenskjold, A.
    Örebro University, Sweden.
    Self-assessed remission rates after electroconvulsive therapy of depressive disorders2017In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 45, p. 154-160Article in journal (Refereed)
    Abstract [en]

    Background: Electroconvulsive therapy (ECT) effectively treats severe depression, but not all patients remit. The aim of the study was to identify clinical factors that associate with ECT-induced remission in a community setting. Methods: Depressed patients who underwent ECT in 2011-2014 were identified from the Swedish National Quality Register for ECT. Remission was defined as self-rated Montgomery-Asberg Depression Rating Scale scores of 0-10 after ECT. Other registers provided data on previous antidepressant use, comorbidities, and demographics. Results: Of 1671 patients fulfilling the inclusion criteria, 42.8% achieved remission. Older age, education length over 9 years, psychotic symptoms, shorter duration of preceding antidepressant use, pulse width stimulus amp;gt;= 0.50 ms, absence of substance use disorders, anxiety diagnosis, lamotrigine, and benzodiazepines, were associated with remission. Conclusions: This study shows that psychotic subtype of depression and older age are clinically relevant predictors of a beneficial ECT effect. Additionally, ECT outcomes can be further improved by optimizing the treatment technique and concomitant medication. (C) 2017 The Author(s). Published by Elsevier Masson SAS.

  • 3.
    Chau, David T.
    et al.
    Laureate Institute for Brain Research, Tulsa, Oklahoma, USA.
    Fogelman, Phoebe
    University of Tennessee, Knoxville, Tennessee, USA.
    Nordanskog, Pia
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Drevets, Wayne C.
    Laureate Institute for Brain Research, Tulsa, Oklahoma, USA; Janssen Research and Development, Janssen Pharmaceuticals of Johnson and Johnson, Titusville, New Jersey, USA.
    Hamilton, Paul J.
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Laureate Institute for Brain Research, Tulsa, Oklahoma, USA.
    Distinct Neural-Functional Effects of Treatments With Selective Serotonin Reuptake Inhibitors, Electroconvulsive Therapy, and Transcranial Magnetic Stimulation and Their Relations to Regional Brain Function in Major Depression: A Meta-analysis2017In: Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, ISSN 2451-9030, Vol. 2, no 4, p. 318-326Article in journal (Refereed)
    Abstract [en]

    Functional neuroimaging studies have examined the neural substrates of treatments for major depressive disorder (MDD). Low sample size and methodological heterogeneity, however, undermine the generalizability of findings from individual studies. We conducted a meta-analysis to identify reliable neural changes resulting from different modes of treatment for MDD and compared them with each other and with reliable neural functional abnormalities observed in depressed versus control samples.

  • 4.
    Ekstrand, Joakim
    et al.
    Lund Univ, Sweden.
    Fattah, Christian
    Lund Univ, Sweden.
    Persson, Marcus
    Lund Univ, Sweden.
    Cheng, Tony
    Lund Univ, Sweden.
    Nordanskog, Pia
    Linköping University, Center for Social and Affective Neuroscience (CSAN). Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Psykiatricentrum, Psykiatriska kliniken i Linköping. Linköping University, Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience.
    Åkeson, Jonas
    Lund Univ, Sweden.
    Tingström, Anders
    Lund Univ, Sweden.
    Lindström, Mats B.
    Lund Univ, Sweden.
    Nordenskjöld, Axel
    Örebro Univ, Sweden.
    Rad, Pouya Movahed
    Lund Univ, Sweden.
    Racemic Ketamine as an Alternative to Electroconvulsive Therapy for Unipolar Depression: A Randomized, Open-Label, Non-Inferiority Trial (KetECT)2022In: International Journal of Neuropsychopharmacology, ISSN 1461-1457, E-ISSN 1469-5111, Vol. 25, no 5, p. 339-349Article in journal (Refereed)
    Abstract [en]

    Background Ketamine has emerged as a fast-acting and powerful antidepressant, but no head to head trial has been performed, Here, ketamine is compared with electroconvulsive therapy (ECT), the most effective therapy for depression. Methods Hospitalized patients with unipolar depression were randomized (1:1) to thrice-weekly racemic ketamine (0.5 mg/kg) infusions or ECT in a parallel, open-label, non-inferiority study. The primary outcome was remission (Montgomery angstrom sberg Depression Rating Scale score <= 10). Secondary outcomes included adverse events (AEs), time to remission, and relapse. Treatment sessions (maximum of 12) were administered until remission or maximal effect was achieved. Remitters were followed for 12 months after the final treatment session. Results In total 186 inpatients were included and received treatment. Among patients receiving ECT, 63% remitted compared with 46% receiving ketamine infusions (P = .026; difference 95% CI 2%, 30%). Both ketamine and ECT required a median of 6 treatment sessions to induce remission. Distinct AEs were associated with each treatment. Serious and long-lasting AEs, including cases of persisting amnesia, were more common with ECT, while treatment-emergent AEs led to more dropouts in the ketamine group. Among remitters, 70% and 63%, with 57 and 61 median days in remission, relapsed within 12 months in the ketamine and ECT groups, respectively (P = .52). Conclusion Remission and cumulative symptom reduction following multiple racemic ketamine infusions in severely ill patients (age 18-85 years) in an authentic clinical setting suggest that ketamine, despite being inferior to ECT, can be a safe and valuable tool in treating unipolar depression.

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  • 5.
    Goeterfelt, Linda
    et al.
    Orebro Univ, Sweden.
    Ekman, Carl Johan
    Karolinska Inst, Sweden; Stockholm Cty Council, Sweden.
    Hammar, Asa
    Univ Bergen, Norway; Haukeland Hosp, Norway.
    Landen, Mikael
    Karolinska Inst, Sweden; Gothenburg Univ, Sweden.
    Lundberg, Johan
    Karolinska Inst, Sweden; Stockholm Cty Council, Sweden.
    Nordanskog, Pia
    Linköping University, Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Psykiatricentrum, Psykiatriska kliniken i Linköping.
    Nordenskjoeld, Axel
    Orebro Univ, Sweden.
    The Incidence of Dental Fracturing in Electroconvulsive Therapy in Sweden2020In: Journal of ECT, ISSN 1095-0680, E-ISSN 1533-4112, Vol. 36, no 3, p. 168-171Article in journal (Refereed)
    Abstract [en]

    Objectives 

    One adverse effect of electroconvulsive therapy (ECT) is dental fracture; thus, a bite guard and muscle relaxants are used to prevent it. Earlier research reported varying rates of dental fracture, but there is no large-scale study on the incidence of dental fracture during ECT. This study aimed to examine the incidence of dental fracture during ECT and to investigate whether the incidence differs between different sexes, age groups, diagnosis groups, electrode placements, or number of treatment sessions.

    Methods 

    This register-based study used data from the Swedish national quality register for ECT. All hospitals offering ECT report to this register, and the coverage ratio is about 90%. All registered patients who started an ECT series between January 2012 and January 2019 were included in this study, with the data representing 16,681 individuals, 38,862 series, and 254,906 sessions.

    Results 

    Forty-six dental fractures were identified, giving an incidence of dental fracture of 0.2% per series, 0.02% per session, and 0.3% per individual. We did not find any significant associations between dental fracture rates and male or female populations, age, or different diagnosis groups, nor was there any significant difference between dental fracture rates and electrode placement. The mean number of treatments was significantly higher in the dental fracture group than in patients without dental fracture.

    Conclusions 

    There is a minimal risk of dental fracture during ECT. Our findings, together with those of other studies, provide further motivation for the use of a bite guard and muscle relaxant.

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  • 6.
    Holm, Jonas
    et al.
    Örebro University, Sweden.
    Brus, Ole
    Örebro University, Sweden.
    Bave, Ullvi
    Karolinska Institute, Sweden.
    Landen, Mikael
    Karolinska Institute, Sweden; Gothenburg University, Sweden.
    Lundberg, Johan
    Karolinska Institute, Sweden.
    Nordanskog, Pia
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    von Knorring, Lars
    Uppsala University, Sweden.
    Nordenskjold, Axel
    Örebro University, Sweden.
    Improvement of cycloid psychosis following electroconvulsive therapy2017In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 71, no 6, p. 405-410Article in journal (Refereed)
    Abstract [en]

    Background: The treatment of choice for cycloid psychosis has traditionally been electroconvulsive therapy (ECT), but there is a lack of studies on its effectiveness.Aims: The primary aim of this register study was to determine the rates of remission and response after ECT for cycloid psychosis. The secondary aim was to examine possible predictors of outcome.Methods: Data were obtained from the National Quality Register for ECT in Sweden. The study population was patients (n=42) who received ECT for acute polymorphic psychotic disorder without symptoms of schizophrenia or for cycloid psychosis between 2011-2015 in 13 hospitals. Remission and response rates were calculated using Clinical Global Impression-Severity (CGI-S) and -Improvement scores, respectively. Variables with possible predictive value were tested using Chi-square and Fishers exact test.Results: The response rate was 90.5%. The remission rate was 45.2%. Of 42 patients, 40 improved their CGI-S score after ECT (pamp;lt;0.001). The mean number of ECT treatments was 2.5 for non-responders and 7.0 for responders (p=0.010). The mean number of ECT treatments did not differ significantly between remitters and non-remitters (7.2 vs 6.1, p=0.31). None of the other investigated potential predictors was statistically significantly associated with outcome.Conclusions: ECT is an effective treatment for cycloid psychosis. Future studies need to compare the outcome of ECT to that of other treatment strategies. Clinical implications: The high response rate with ECT indicates that cycloid psychosis is a clinically useful diagnosis.

  • 7.
    Kalling, Styrbjorn
    et al.
    Uppsala Univ, Sweden.
    Brus, Ole
    Orebro Univ, Sweden.
    Landen, Mikael
    Gothenburg Univ, Sweden; Karolinska Inst, Sweden.
    Lundberg, Johan
    Karolinska Inst, Sweden; Reg Stockholm, Sweden.
    Nordanskog, Pia
    Linköping University, Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Psykiatricentrum, Psykiatriska kliniken i Linköping.
    Nordenskjold, Axel
    Orebro Univ, Sweden.
    Relapse risk after in-ward electroconvulsive therapy for acute polymorphic psychotic disorder2021In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 75, no 3, p. 201-206Article in journal (Refereed)
    Abstract [en]

    Purpose Acute polymorphic psychotic disorder (APPD) without symptoms of schizophrenia is a serious psychiatric condition. APPD can be effectively treated with electroconvulsive therapy (ECT), but little is known about relapse prevention after ECT for APPD. Materials and methods This was a retrospective register-based study conducted with 97 patients with APPD (ICD-10 diagnosis F23.0). We estimated the rates of readmission and suicide, and the prognostic factors of these outcomes after ECT. We combined data from several national Swedish registers and used Coxs regression analysis to identify demographic factors, disease characteristics, and relapse preventive treatments that predicted time to readmission or suicide (relapse). Data registered between 2011 and 2016 were used in the study. Results Twenty percent of cases relapsed within a year. Thereafter, relapse rate was low. Two cases died during follow-up, whereof one by suicide. Anxiolytic treatment, lamotrigine treatment, and having more than four previous psychiatric hospital admissions were associated with shorter time to relapse. The most robust of these associations was between anxiolytics and relapse risk. Conclusions The first year after discharge from APPD is the period associated with the highest risk of relapse. Having many previous admissions was associated to relapse risk after ECT for APPD. The associations between anxiolytics, lamotrigine, and relapse are uncertain and might be influenced by indication bias.

  • 8. Order onlineBuy this publication >>
    Nordanskog, Pia
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    On electroconvulsive therapy in depression: Clinical, cognitive and neurobiological aspects2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Electroconvulsive therapy (ECT) is used worldwide to treat severe mental disorders. The most common mental disorder, and the third leading cause of disease burden in the world is depression. The clinical efficacy of ECT for severe depression is well-established. However, both the pathophysiology of depression and the mechanism of action of ECT remain elusive.

    The main aims of this thesis are to address the following issues: 1) the use and practice of ECT in Sweden has not been systematically evaluated since 1975, 2) cognitive side-effects (memory disturbances) are a major concern with ECT and 3) the mechanism of action of ECT remain elusive. The neurobiological aspects of ECT focus on two hypotheses. First, the recent years´ preclinical studies that have provided evidence that ECT induces hippocampal cell proliferation, including neurogenesis. Second, that enhanced functional inhibition of neuronal activity is a key feature.

    Current use and practice of ECT in Sweden (paper I) is based on data from the national quality register for ECT, the mandatory patient register of the National Board of Health and Welfare and a survey. Treated person rate (TPR) in Sweden 2013 was found to be 41 individuals / 100 000, and thus unchanged since the latest systematic investigation in Sweden 1975. In more than 70% of treatment series the indication was a depressive episode. The selection of patients for ECT and treatment technique in Sweden was similar to that in other western countries, but the consent procedure and the involvement of nurses and nursing assistants in the delivery of ECT differ. Data also shows that there is room for improvement in both the specificity of use and availability of ECT.

    The second study in this thesis is a longitudinal observational trial where 12 (paper II and III) and 14 (paper IV) patients with depression referred for ECT were investigated. Patients underwent a 3 T MRI structural scanning and DSC-MRI perfusion, a neuropsychological test battery and clinical ratings before ECT, within one to two weeks after ECT and after 6 and 12 months.  In line with preclinical findings and the plasticity hypothesis of mechanism of action of ECT, the hippocampal volume increased after ECT in patients with depression. However, this increase was transient and returned to baseline levels within 6 months. No correlation was found between volumetric changes and clinical effect or cognitive outcome. Instead our results suggested an association to the number of treatments, without relation to the side of stimulation. A right-sided decrease in frontal blood flow distinguished remission from non-remission after ECT. There were significant impairments in verbal episodic memory and verbal fluency within one week after ending the ECT course, but these impairments were transient and no persistent cognitive impairments were seen during the follow-up.

    In summary, this thesis present the first update on the use and practice of ECT in Sweden in the last 40 years as well as a pioneering MRI-study on the hippocampal volume increase in the treatment of depression with ECT. Supportive to earlier findings we also found the cognitive side-effects that are measurable after ECT to be transient. Furthermore, we found that a decreased frontal blood flow is of importance for the anti-depressive response to ECT.

    List of papers
    1. Electroconvulsive Therapy in Sweden 2013: Data From the National Quality Register for ECT
    Open this publication in new window or tab >>Electroconvulsive Therapy in Sweden 2013: Data From the National Quality Register for ECT
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    2015 (English)In: The Journal of ECT, ISSN 1095-0680, Vol. 31, no 4, p. 263-267Article in journal (Refereed) Published
    Abstract [en]

    Objectives: The use of electroconvulsive therapy (ECT) varies across countries. The aim of this study was to describe and explore the use of ECT in Sweden in 2013.

    Methods: The Swedish mandatory patient register of the National Board of Health and Welfare includes information on diagnoses and treatments, including ECT. All 56 hospitals that provide ECT in Sweden also report to the nonmandatory national quality register for ECT, which contains information on patient and treatment characteristics. In this study, we combined data from both registers. In addition, all hospitals responded to a survey concerning equipment and organization of ECT.

    Results: We identified 3972 unique patients who received ECT in Sweden in 2013. This translates into 41 ECT-treated individuals per 100,000 inhabitants. Of these patients, 85% opted to participate in the quality register. The median age was 55 years (range, 15-94 years), and 63% were women. The indication was depression in 78% of the treatment series. Of 4 711 hospitalized patients with severe depression, 38% received ECT. The median number of treatments per index series was 7. Unilateral treatment was used in 86% of the series.

    Conclusions: In Sweden, ECT is used at a relatively high rate as compared with other western countries, and the rate was unchanged from the last survey in 1975. However, there is room for improvement in the specificity of use and availability of ECT for disorders where ECT is considered a first-line treatment.

    Place, publisher, year, edition, pages
    Wolters Kluwer, 2015
    Keywords
    electroconvulsive therapy, depression, epidemiology
    National Category
    Psychiatry Neurology Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-121477 (URN)10.1097/YCT.0000000000000243 (DOI)000365687200013 ()25973769 (PubMedID)
    Available from: 2015-09-21 Created: 2015-09-21 Last updated: 2016-05-04Bibliographically approved
    2. Increase in Hippocampal Volume After Electroconvulsive Therapy in Patients With Depression: A Volumetric Magnetic Resonance Imaging Study
    Open this publication in new window or tab >>Increase in Hippocampal Volume After Electroconvulsive Therapy in Patients With Depression: A Volumetric Magnetic Resonance Imaging Study
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    2010 (English)In: JOURNAL OF ECT, ISSN 1095-0680, Vol. 26, no 1, p. 62-67Article in journal (Refereed) Published
    Abstract [en]

    Background: Major depression has traditionally been regarded as a neurochemical disease, but findings of a decreased hippocampal volume in patients with depression have turned the pathophysiological focus toward impairments in structural plasticity. The mechanisms of action of the most effective antidepressive treatment, electroconvulsive therapy (ECT), still remains elusive, but recent animal research has provided evidence for a cell proliferative effect in the hippocampus. The aim of this prospective study was to determine if hippocampal volume changes after ECT in patients with depression.

    Methods: Twelve patients with depression and ongoing antidepressive pharmacological treatment were investigated with clinical ratings and 3 T magnetic resonance imaging within 1 week before and after the ECT series. Each hippocampus was manually outlined on coronal slices, and the volume was calculated.

    Results: The left as well as the right hippocampal volume increased significantly after ECT.

    Conclusions: The hippocampal volume increases after ECT, supporting the hypothesis that hippocampus may play a central role in the treatment of depression.

    Keywords
    ECT, depression, hippocampus, MRI, neurogenesis
    National Category
    Psychiatry Neurology
    Identifiers
    urn:nbn:se:liu:diva-54702 (URN)10.1097/YCT.0b013e3181a95da8 (DOI)000275571000017 ()
    Available from: 2010-04-06 Created: 2010-04-06 Last updated: 2015-09-22Bibliographically approved
    3. Hippocampal volume in relation to clinical and cognitive outcome after electroconvulsive therapy in depression
    Open this publication in new window or tab >>Hippocampal volume in relation to clinical and cognitive outcome after electroconvulsive therapy in depression
    2014 (English)In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 129, no 4, p. 303-311Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE:

    In a previous magnetic resonance imaging (MRI) study, we found a significant increase in hippocampal volume immediately after electroconvulsive therapy (ECT) in patients with depression. The aim of this study was to evaluate hippocampal volume up to 1 year after ECT and investigate its possible relation to clinical and cognitive outcome.

    METHOD:

    Clinical and cognitive outcome in 12 in-patients with depression receiving antidepressive pharmacological treatment referred for ECT were investigated with the Montgomery-Asberg Depression Rating Scale (MADRS) and a broad neuropsychological test battery within 1 week before and after ECT. The assessments were repeated 6 and 12 months after baseline in 10 and seven of these patients, respectively. Hippocampal volumes were measured on all four occasions with 3 Tesla MRI.

    RESULTS:

    Hippocampal volume returned to baseline during the follow-up period of 6 months. Neither the significant antidepressant effect nor the significant transient decrease in executive and verbal episodic memory tests after ECT could be related to changes in hippocampal volume. No persistent cognitive side effects were observed 1 year after ECT.

    CONCLUSION:

    The immediate increase in hippocampal volume after ECT is reversible and is not related to clinical or cognitive outcome.

    Place, publisher, year, edition, pages
    United States: Wiley-Blackwell, 2014
    Keywords
    hippocampus, magnetic resonance imaging, depression, electroconvulsive therapy, cognition, longitudinal
    National Category
    Psychiatry Neurology
    Identifiers
    urn:nbn:se:liu:diva-104959 (URN)10.1111/acps.12150 (DOI)000332684900006 ()23745780 (PubMedID)
    Available from: 2014-03-04 Created: 2014-03-04 Last updated: 2017-12-05
    4. Relative decrease of frontal blood flow after electroconvulsive therapy in depression distinguishes remission: a perfusion MRI study
    Open this publication in new window or tab >>Relative decrease of frontal blood flow after electroconvulsive therapy in depression distinguishes remission: a perfusion MRI study
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Background: Understanding electroconvulsive therapy (ECT) is of importance not only for optimizing treatment, but could also provide important information about key features of the healing process in depression. Enhanced inhibition (the anticonvulsant hypothesis) is one of several suggested mechanisms of action of ECT. Earlier studies on cerebral blood flow during ECT have given diverging results. Our aim was to study changes in cerebral blood flow in depression treated with ECT and their relation to treatment outcome.

    Methods: We obtained MRI scans in 14 depressed subjects referred for ECT. Cerebral blood flow (CBF) was measured using dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) within 1 week before and 2 weeks after a course of ECT. The relative CBF was calculated from mean values in predefined regions of interest in relation to the mean value in the whole brain.

    Results: A significant relative CBF increase in the occipital region (p < 0.05) and a significant relative decrease in the right lateral temporal lobe (p < 0.05) were found in the entire study group. A significant decrease in the right frontal lobe, with a significant anteriorposterior and right-left gradient shift in relative CBF, was a distinguishing feature in patients with ECT-induced remission (n = 8).

    Limitations: This observational study is limited by the risk of random bias and its low number of participants.

    Conclusions: Our results suggest that a decreased relative blood flow in frontal regions may be a hallmark of treatment efficacy in depression treated with ECT.

    National Category
    Public Health, Global Health, Social Medicine and Epidemiology Psychiatry Neurology
    Identifiers
    urn:nbn:se:liu:diva-121478 (URN)
    Available from: 2015-09-21 Created: 2015-09-21 Last updated: 2015-09-21Bibliographically approved
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  • 9.
    Nordanskog, Pia
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Department of Medical and Health Sciences, Radiology. Linköping University, Faculty of Health Sciences.
    Dahlstrand, Ulf
    Lund University.
    R Larsson, Magnus
    Lund University.
    Larsson, Elna-Marie
    Aarhus University Hospital.
    Knutsson, Linda
    Lund University.
    Johanson, Aki
    Lund University.
    Increase in Hippocampal Volume After Electroconvulsive Therapy in Patients With Depression: A Volumetric Magnetic Resonance Imaging Study2010In: JOURNAL OF ECT, ISSN 1095-0680, Vol. 26, no 1, p. 62-67Article in journal (Refereed)
    Abstract [en]

    Background: Major depression has traditionally been regarded as a neurochemical disease, but findings of a decreased hippocampal volume in patients with depression have turned the pathophysiological focus toward impairments in structural plasticity. The mechanisms of action of the most effective antidepressive treatment, electroconvulsive therapy (ECT), still remains elusive, but recent animal research has provided evidence for a cell proliferative effect in the hippocampus. The aim of this prospective study was to determine if hippocampal volume changes after ECT in patients with depression.

    Methods: Twelve patients with depression and ongoing antidepressive pharmacological treatment were investigated with clinical ratings and 3 T magnetic resonance imaging within 1 week before and after the ECT series. Each hippocampus was manually outlined on coronal slices, and the volume was calculated.

    Results: The left as well as the right hippocampal volume increased significantly after ECT.

    Conclusions: The hippocampal volume increases after ECT, supporting the hypothesis that hippocampus may play a central role in the treatment of depression.

  • 10.
    Nordanskog, Pia
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Hultén, Martin
    Psychiatric Neuromodulation Unit (PNU), Dept of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.
    Landén, Mikael
    Psychiatric Neuromodulation Unit (PNU), Dept of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.
    Lundberg, Johan
    Department of Clinical Neuroscience, Karolinska Institutet and Section for Affective Disorders, Northern Stockholm Psychiatry, Stockholm, Sweden.
    von Knorring, Lars
    Department of Neuroscience, Psychiatry, Uppsala university, Uppsala, Sweden.
    Nordenskjöld, Axel
    Department of Psychiatry, Faculty ofMedicine and Health, Örebro University, Örebro, Sweden.
    Electroconvulsive Therapy in Sweden 2013: Data From the National Quality Register for ECT2015In: The Journal of ECT, ISSN 1095-0680, Vol. 31, no 4, p. 263-267Article in journal (Refereed)
    Abstract [en]

    Objectives: The use of electroconvulsive therapy (ECT) varies across countries. The aim of this study was to describe and explore the use of ECT in Sweden in 2013.

    Methods: The Swedish mandatory patient register of the National Board of Health and Welfare includes information on diagnoses and treatments, including ECT. All 56 hospitals that provide ECT in Sweden also report to the nonmandatory national quality register for ECT, which contains information on patient and treatment characteristics. In this study, we combined data from both registers. In addition, all hospitals responded to a survey concerning equipment and organization of ECT.

    Results: We identified 3972 unique patients who received ECT in Sweden in 2013. This translates into 41 ECT-treated individuals per 100,000 inhabitants. Of these patients, 85% opted to participate in the quality register. The median age was 55 years (range, 15-94 years), and 63% were women. The indication was depression in 78% of the treatment series. Of 4 711 hospitalized patients with severe depression, 38% received ECT. The median number of treatments per index series was 7. Unilateral treatment was used in 86% of the series.

    Conclusions: In Sweden, ECT is used at a relatively high rate as compared with other western countries, and the rate was unchanged from the last survey in 1975. However, there is room for improvement in the specificity of use and availability of ECT for disorders where ECT is considered a first-line treatment.

  • 11.
    Nordanskog, Pia
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Knutsson, Linda
    Department of Medical Radiation Physics, Lund University, Lund, Sweden.
    Larsson, Elna-Marie
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden.
    Johanson, Aki
    Department of Psychiatry, Lund University, Lund, Sweden.
    Relative decrease of frontal blood flow after electroconvulsive therapy in depression distinguishes remission: a perfusion MRI studyManuscript (preprint) (Other academic)
    Abstract [en]

    Background: Understanding electroconvulsive therapy (ECT) is of importance not only for optimizing treatment, but could also provide important information about key features of the healing process in depression. Enhanced inhibition (the anticonvulsant hypothesis) is one of several suggested mechanisms of action of ECT. Earlier studies on cerebral blood flow during ECT have given diverging results. Our aim was to study changes in cerebral blood flow in depression treated with ECT and their relation to treatment outcome.

    Methods: We obtained MRI scans in 14 depressed subjects referred for ECT. Cerebral blood flow (CBF) was measured using dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) within 1 week before and 2 weeks after a course of ECT. The relative CBF was calculated from mean values in predefined regions of interest in relation to the mean value in the whole brain.

    Results: A significant relative CBF increase in the occipital region (p < 0.05) and a significant relative decrease in the right lateral temporal lobe (p < 0.05) were found in the entire study group. A significant decrease in the right frontal lobe, with a significant anteriorposterior and right-left gradient shift in relative CBF, was a distinguishing feature in patients with ECT-induced remission (n = 8).

    Limitations: This observational study is limited by the risk of random bias and its low number of participants.

    Conclusions: Our results suggest that a decreased relative blood flow in frontal regions may be a hallmark of treatment efficacy in depression treated with ECT.

  • 12.
    Nordanskog, Pia
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Larsson, M. R.
    Lund University, Sweden.
    Larsson, E.-M.
    Uppsala University, Sweden.
    Johansson, A.
    Lund University, Sweden.
    Hippocampal volume in relation to clinical and cognitive outcome after electroconvulsive therapy in depression2014In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 129, no 4, p. 303-311Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    In a previous magnetic resonance imaging (MRI) study, we found a significant increase in hippocampal volume immediately after electroconvulsive therapy (ECT) in patients with depression. The aim of this study was to evaluate hippocampal volume up to 1 year after ECT and investigate its possible relation to clinical and cognitive outcome.

    METHOD:

    Clinical and cognitive outcome in 12 in-patients with depression receiving antidepressive pharmacological treatment referred for ECT were investigated with the Montgomery-Asberg Depression Rating Scale (MADRS) and a broad neuropsychological test battery within 1 week before and after ECT. The assessments were repeated 6 and 12 months after baseline in 10 and seven of these patients, respectively. Hippocampal volumes were measured on all four occasions with 3 Tesla MRI.

    RESULTS:

    Hippocampal volume returned to baseline during the follow-up period of 6 months. Neither the significant antidepressant effect nor the significant transient decrease in executive and verbal episodic memory tests after ECT could be related to changes in hippocampal volume. No persistent cognitive side effects were observed 1 year after ECT.

    CONCLUSION:

    The immediate increase in hippocampal volume after ECT is reversible and is not related to clinical or cognitive outcome.

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  • 13.
    Nordensköld, Axel
    et al.
    Örebro university, Sweden.
    Nordanskog, Pia
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    ECT: Kliniska riktlinjer för elektrokonvulsiv behandling2014 (ed. 1)Book (Other (popular science, discussion, etc.))
    Abstract [sv]

    Mycket svåra psykiska sjukdomar medför stort lidande, sänker individens funktionsnivå påtagligt och påverkar anhöriga i hög grad. Obehandlade kan de i värsta fall leda till döden. Korrekt administrerad och på välvalda indikationer är elektrokonvulsiv terapi (ECT) en säker och effektiv behandling vid flera av dessa sjukdomar.Svenska Psykiatriska Föreningen har tagit initiativ till att skapa kliniska riktlinjer för ECT. Ambitionen är att tillhandahålla aktuell kunskap inom hela ECT-området och att vara ett stöd i användning och uppföljning av ECT. I riktlinjerna föreslås kvalitetsindikatorer som med stöd av kvalitetsregistret för ECT kan användas för att utveckla den egna verksamheten.Riktlinjerna vänder sig till behandlingsansvariga läkare, verksamhetschefer och till övrig personal inom psykiatrin i Sverige.Svenska Psykiatriska Föreningen har sedan 1996 utformat kliniska riktlinjer för en rad psykiatriska områden. ECT - kliniska riktlinjer för elektrokonvulsiv behandling är den femtonde skriften i serien Svensk Psykiatri.

  • 14.
    Ole, Brus
    et al.
    Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro.
    Nordanskog, Pia
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Ullvi, Båve
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Yang, Cao
    Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro; Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Åsa, Hammar
    Department of Biological and Medical Psychology, University of Bergen, Bergen Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
    Mikael, Landén
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm; Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg.
    Johan, Lundberg
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm.
    Axel, Nordenskjöld
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Subjective Memory Immediately Following Electroconvulsive Therapy2017In: Journal of ECT, ISSN 1095-0680, E-ISSN 1533-4112, Vol. 33, no 2, p. 96-103Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES

    The aims of the present study were to describe the short-term rate of subjective memory worsening (SMW) and identify factors of importance for SMW in a large clinical sample treated for depression with electroconvulsive therapy (ECT).

    METHODS

    This register-based study included 1212 patients from the Swedish National Quality Register for ECT. Subjective memory worsening was defined as a 2-point worsening on the memory item of the Comprehensive Psychopathological Rating Scale from before to within 1 week after treatment. Associations between patient characteristics and treatment factors were examined using logistic regression.

    RESULTS

    Subjective memory worsening was experienced in 26%. It was more common in women than in men (31% vs 18%; P < 0.001) and more common in patients aged 18 to 39 years than in patients 65 years or older (32% vs 22%; P = 0.008). Patients with less subjective memory disturbances before ECT had a greater risk of SMW. Patients in remission after ECT had a lower risk of SMW. A brief pulse width stimulus gave higher risk of SMW compared with ultrabrief pulse (odds ratio, 1.61; 95% confidence interval, 1.05-2.47).

    CONCLUSIONS

    Subjective memory worsening is reported by a minority of patients. However, young women are at risk of experiencing SMW. Ultrabrief pulse width stimulus could be considered for patients treated with unilateral electrode placement who experience SMW. Each patient should be monitored with regard to symptoms and adverse effects, and treatment should be adjusted on an individual basis to maximize the clinical effect and with efforts to minimize the cognitive adverse effects.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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    Subjective Memory Immediately Following Electroconvulsive Therapy
  • 15.
    Oltedal, Leif
    et al.
    University of Bergen, Norway; University of Calif San Diego, CA 92037 USA; University of Calif San Diego, CA 92093 USA; Haukeland Hospital, Norway.
    Bartsch, Hauke
    University of Calif San Diego, CA 92037 USA; University of Calif San Diego, CA 92093 USA.
    Evjenth Sorhaug, Ole Johan
    University of Bergen, Norway.
    Kessler, Ute
    University of Bergen, Norway; Haukeland Hospital, Norway.
    Abbott, Christopher
    University of New Mexico, NM 87131 USA.
    Dols, Annemieke
    VUmc Amsterdam, Netherlands.
    Stek, Max L.
    VUmc Amsterdam, Netherlands.
    Ersland, Lars
    Haukeland Hospital, Norway.
    Emsell, Louise
    Katholieke University of Leuven, Belgium.
    van Eijndhoven, Philip
    Donders Institute Brain Cognit and Behav, Netherlands.
    Argyelan, Miklos
    Feinstein Institute Medical Research, NY USA.
    Tendolkar, Indira
    Donders Institute Brain Cognit and Behav, Netherlands.
    Nordanskog, Pia
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Hamilton, Paul J.
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Balslev Jorgensen, Martin
    Psychiat Centre Copenhagen, Denmark.
    Sommer, Iris E.
    University of Medical Centre, Netherlands.
    Heringa, Sophie M.
    University of Medical Centre, Netherlands.
    Draganski, Bogdan
    University of Lausanne, Switzerland; Max Planck Institute Human Brain and Cognit Neurosci, Germany.
    Redlich, Ronny
    Department of Psychiatry, University of Münster, Germany.
    Dannlowski, Udo
    University of Munster, Germany; University of Marburg, Germany.
    Kugel, Harald
    University of Munster, Germany.
    Bouckaert, Filip
    Katholieke University of Leuven, Belgium.
    Sienaert, Pascal
    Katholieke University of Leuven, Belgium.
    Anand, Amit
    Cleveland Clin, OH 44106 USA.
    Espinoza, Randall
    University of Calif Los Angeles, CA USA.
    Narr, Katherine L.
    University of Calif Los Angeles, CA 90024 USA.
    Holland, Dominic
    University of Calif San Diego, CA 92037 USA; University of Calif San Diego, CA 92093 USA.
    Dale, Anders M.
    University of Calif San Diego, CA 92037 USA; University of Calif San Diego, CA 92093 USA; University of Calif San Diego, CA 92093 USA.
    Oedegaard, Ketil J.
    University of Bergen, Norway; Haukeland Hospital, Norway; KG Jebsen Centre Research Neuropsychiat Disorders, Norway.
    The Global ECT-MRI Research Collaboration (GEMRIC): Establishing a multi-site investigation of the neural mechanisms underlying response to electroconvulsive therapy2017In: NeuroImage: Clinical, E-ISSN 2213-1582, Vol. 14, p. 422-432Article in journal (Refereed)
    Abstract [en]

    Major depression, currently the worlds primary cause of disability, leads to profound personal suffering and increased risk of suicide. Unfortunately, the success of antidepressant treatment varies amongst individuals and can take weeks to months in those who respond. Electroconvulsive therapy (ECT), generally prescribed for the most severely depressed and when standard treatments fail, produces a more rapid response and remains the most effective intervention for severe depression. Exploring the neurobiological effects of ECT is thus an ideal approach to better understand the mechanisms of successful therapeutic response. Though several recent neuroimaging studies show structural and functional changes associated with ECT, not all brain changes associate with clinical outcome. Larger studies that can address individual differences in clinical and treatment parameters may better target biological factors relating to or predictive of ECT-related therapeutic response. We have thus formed the Global ECT-MRI Research Collaboration (GEMRIC) that aims to combine longitudinal neuroimaging as well as clinical, behavioral and other physiological data across multiple independent sites. Here, we summarize the ECT sample characteristics from currently participating sites, and the common data-repository and standardized image analysis pipeline developed for this initiative. This includes data harmonization across sites and MRI platforms, and a method for obtaining unbiased estimates of structural change based on longitudinal measurements with serial MRI scans. The optimized analysis pipeline, together with the large and heterogeneous combined GEMRIC dataset, will provide new opportunities to elucidate the mechanisms of ECT response and the factors mediating and predictive of clinical outcomes, which may ultimately lead to more effective personalized treatment approaches. (C) 2017 The Author(s). Published by Elsevier Inc.

  • 16.
    Ousdal, Olga Therese
    et al.
    Haukeland Hosp, Norway.
    Argyelan, Miklos
    Feinstein Inst Med Res, NY USA.
    Narr, Katherine L.
    Univ Calif Los Angeles, CA 90024 USA.
    Abbott, Christopher
    Univ New Mexico, NM 87131 USA.
    Wade, Benjamin
    Univ Calif Los Angeles, CA 90024 USA.
    Vandenbulcke, Mathieu
    Katholieke Univ Leuven, Belgium.
    Urretavizcaya, Mikel
    Univ Barcelona, Spain; Univ Barcelona, Spain; Carlos III Hlth Inst, Spain.
    Tendolkar, Indira
    Radboud Univ Nijmegen, Netherlands; Ctr Cognit Neuroimaging, Netherlands; Univ Duisburg Essen, Germany; Univ Duisburg Essen, Germany.
    Takamiya, Akihiro
    Keio Univ, Japan; Komagino Hosp, Japan.
    Stek, Max L.
    Geestelijke GezondheidsZorg InGeest Specialized M, Netherlands; Vrije Univ Amsterdam, Netherlands.
    Soriano-Mas, Carles
    Univ Barcelona, Spain; Univ Autonoma Barcelona, Spain; Carlos III Hlth Inst, Spain.
    Redlich, Ronny
    Univ Munster, Germany.
    Paulson, Olaf B.
    Rigshosp, Denmark; Univ Copenhagen, Denmark.
    Oudega, Mardien L.
    Geestelijke GezondheidsZorg InGeest Specialized M, Netherlands; Vrije Univ Amsterdam, Netherlands.
    Opel, Nils
    Univ Munster, Germany; Univ Munster, Germany.
    Nordanskog, Pia
    Linköping University, Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Psykiatricentrum, Psykiatriska kliniken i Linköping.
    Kishimoto, Taishiro
    Keio Univ, Japan.
    Kämpe, Robin
    Linköping University, Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Jorgensen, Anders
    Rigshosp, Denmark.
    Hanson, Lars G.
    Tech Univ Denmark, Denmark; Copenhagen Univ Hosp, Denmark.
    Hamilton, Paul
    Linköping University, Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Espinoza, Randall
    Univ Calif Los Angeles, CA 90024 USA.
    Emsell, Louise
    Katholieke Univ Leuven, Belgium.
    van Eijndhoven, Philip
    Radboud Univ Nijmegen, Netherlands; Ctr Cognit Neuroimaging, Netherlands.
    Dols, Annemieke
    Geestelijke GezondheidsZorg InGeest Specialized M, Netherlands; Vrije Univ Amsterdam, Netherlands.
    Dannlowski, Udo
    Univ Munster, Germany.
    Cardoner, Narcis
    Univ Autonoma Barcelona, Spain; Carlos III Hlth Inst, Spain; Univ Hosp Parc Tauli I3PT, Spain.
    Bouckaert, Filip
    Katholieke Univ Leuven, Belgium.
    Anand, Amit
    Cleveland Clin, OH 44106 USA.
    Bartsch, Hauke
    Univ Calif Los Angeles, CA USA; Ctr Multimodal Imaging and Genet, CA USA; Univ Calif San Diego, CA 92093 USA.
    Kessler, Ute
    Haukeland Hosp, Norway; Univ Bergen, Norway.
    Oedegaard, Ketil J.
    Haukeland Hosp, Norway; Univ Bergen, Norway.
    Dale, Anders M.
    Univ Calif Los Angeles, CA USA; Ctr Multimodal Imaging and Genet, CA USA; Univ Calif San Diego, CA 92093 USA; Univ Calif San Diego, CA 92093 USA.
    Oltedal, Leif
    Haukeland Hosp, Norway; Univ Bergen, Norway.
    Brain Changes Induced by Electroconvulsive Therapy Are Broadly Distributed2020In: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 87, no 5, p. 451-461Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Electroconvulsive therapy (ECT) is associated with volumetric enlargements of corticolimbic brain regions. However, the pattern of whole-brain structural alterations following ECT remains unresolved. Here, we examined the longitudinal effects of ECT on global and local variations in gray matter, white matter, and ventricle volumes in patients with major depressive disorder as well as predictors of ECT-related clinical response. METHODS: Longitudinal magnetic resonance imaging and clinical data from the Global ECT-MRI Research Collaboration (GEMRIC) were used to investigate changes in white matter, gray matter, and ventricle volumes before and after ECT in 328 patients experiencing a major depressive episode. In addition, 95 nondepressed control subjects were scanned twice. We performed a mega-analysis of single subject data from 14 independent GEMRIC sites. RESULTS: Volumetric increases occurred in 79 of 84 gray matter regions of interest. In total, the cortical volume increased by mean +/- SD of 1.04 +/- 1.03% (Cohens d = 1.01, p amp;lt; .001) and the subcortical gray matter volume increased by 1.47 +/- 1.05% (d = 1.40, p amp;lt; .001) in patients. The subcortical gray matter increase was negatively associated with total ventricle volume (Spearmans rank correlation rho = -.44, p amp;lt; .001), while total white matter volume remained unchanged (d = -0.05, p = .41). The changes were modulated by number of ECTs and mode of electrode placements. However, the gray matter volumetric enlargements were not associated with clinical outcome. CONCLUSIONS: The findings suggest that ECT induces gray matter volumetric increases that are broadly distributed. However, gross volumetric increases of specific anatomically defined regions may not serve as feasible biomarkers of clinical response.

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  • 17.
    Popiolek, K.
    et al.
    Orebro Univ, Sweden.
    Beierot, S.
    Orebro Univ, Sweden.
    Brus, O.
    Orebro Univ, Sweden.
    Hammer, A.
    Univ Bergen, Norway; Haukeland Hosp, Norway.
    Leaden, M.
    Gothenburg Univ, Sweden; Karolinska Inst, Sweden.
    Lundberg, J.
    Karolinska Inst, Sweden; Stockholm Cty Council, Sweden.
    Nordanskog, Pia
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Psykiatriska kliniken inkl beroendekliniken.
    Nordenskjold, A.
    Orebro Univ, Sweden.
    Electroconvulsive therapy in bipolar depression - effectiveness and prognostic factors2019In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 140, no 3, p. 196-204Article in journal (Refereed)
    Abstract [en]

    Objective Electroconvulsive therapy (ECT) is used in patients with severe forms of bipolar depression. ECT is effective but not all patients respond. The aim of this study was to determine prognostic factors for response to ECT in patients hospitalized for bipolar depression. Methods Data were obtained from several national Swedish registers. All patients with bipolar depression treated with ECT in any hospital in Sweden between 2011 and 2016 for whom information about ECT response was available were included (n = 1251). Response was defined as a score on the Clinical Global Impression - Improvement scale of one or two. Univariate and multivariate logistic regression were conducted to investigate associations between socio-demographic and clinical factors and response. Results Response was achieved in 80.2% patients. Older age was associated with higher response rate to ECT. Patients with comorbid obsessive-compulsive disorder or personality disorder, and patients previously treated with lamotrigine had lower response rate. Conclusion Electroconvulsive therapy for bipolar depression was associated with very high response rates. The strongest prognostic factors were higher age, absence of comorbid obsessive-compulsive disorder or personality disorder, and less prior pharmacologic treatment.

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  • 18.
    Rundgren, Sara
    et al.
    Orebro Univ, Sweden.
    Brus, Ole
    Orebro Univ, Sweden.
    Bave, Ullvi
    Karolinska Inst, Sweden; Stockholm Cty Council, Sweden.
    Landen, Mikael
    Karolinska Inst, Sweden; Gothenburg Univ, Sweden.
    Lundberg, Johan
    Karolinska Inst, Sweden; Stockholm Cty Council, Sweden.
    Nordanskog, Pia
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry. Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience.
    Nordenskjold, Axel
    Orebro Univ, Sweden.
    Improvement of postpartum depression and psychosis after electroconvulsive therapy: A population-based study with a matched comparison group2018In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 235, p. 258-264Article in journal (Refereed)
    Abstract [en]

    Introduction: Electroconvulsive therapy (ECT) is used to treat postpartum depression and psychosis based on clinical experience and small observational studies. Aims: The primary aim was to test the hypothesis that the response rate to ECT for depression and psychosis is higher during the postpartum period than outside this period. The secondary aim was to identify predictors of a response to ECT during the postpartum period. Materials and methods: Cases with postpartum depression and/or psychosis received ECT within 6 months of delivery. A matched comparison group with depression and/or psychosis (not within the postpartum period) was identified from the Swedish National Quality Register for ECT. The improvement 1 week after ECT was classified according to the Clinical Global Impressions Scale - Improvement scale (CGI-I) as responder (CGI-I score 1-2) or non-responder (CGI-I score 3-7). Results: 185 cases and 185 comparison group subjects were included (46% with psychosis in each groups). More cases (87.0%) than comparison group subjects (73.5%) responded to ECT (p = 0.001). Adjusted binary regression analysis revealed that more severe symptoms prior to treatment were the only statistically significant predictor of response. Limitations: There was no control group without ECT treatment. Conclusion: The response rate of those with postpartum depression and/or psychosis to ECT was high. The response rate of patients with psychosis or depression was higher during the postpartum period than outside it. This study supports the use of ECT for severe forms of postpartum depression and/or psychosis.

  • 19.
    Steinholtz, Linda
    et al.
    Uppsala Univ, Sweden.
    Reutfors, Johan
    Karolinska Inst, Sweden.
    Brandt, Lena
    Karolinska Inst, Sweden.
    Nordanskog, Pia
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Psykiatricentrum, Psykiatriska kliniken i Linköping. Linköping University, Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience.
    Thörnblom, Elin
    Uppsala Univ, Sweden.
    Persson, Jonas
    Uppsala Univ, Sweden.
    Bodén, Robert
    Uppsala Univ, Sweden.
    Response rate and subjective memory after electroconvulsive therapy in depressive disorders with psychiatric comorbidity2021In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 292, p. 276-283Article in journal (Refereed)
    Abstract [en]

    Background: Response rates after and tolerability of electroconvulsive therapy (ECT) in depressive disorders with psychiatric comorbidity are uncertain. Methods: Data on patients with a depressive episode and a first course of ECT were collected from the Swedish National Quality Register for ECT. Logistic regression analyses, adjusted for gender, age, and depressive episode severity, were used to compare patients with and without comorbidity. The clinical response assessment Clinical Global Impression - Improvement Scale was used in 4413 patients and the memory item from the Comprehensive Psychiatric Rating Scale was used for subjective memory impairment rating after ECT in 3497 patients. Results: In patients with depressive disorder and comorbid personality disorder or anxiety disorder, 62.7% and 73.5%, respectively, responded after ECT compared with 84.9% in patients without comorbidity [adjusted odds ratio (aOR) 0.43, 95% confidence interval (CI) 0.34-0.55, and aOR 0.61, 95% CI 0.51-0.73, respectively]. The proportion of responding patients with comorbid alcohol use disorder was 77.1%, which was not significantly different from that in patients without comorbidity (aOR 0.75, 95% CI 0.57-1.01). The impact of comorbidity decreased with higher age and depressive episode severity. Subjective ratings of memory impairment did not differ between patients with and without comorbidity. Limitations: Observational non-validated clinical data. Conclusions: The response rate after ECT in depression may be lower with concurrent personality disorder and anxiety disorder; however, the majority still respond to ECT. This implies that psychiatric comorbidity should not exclude patients from ECT.

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  • 20.
    Takamiya, Akihiro
    et al.
    Keio Univ, Japan; Katholieke Univ Leuven, Belgium.
    Dols, Annemiek
    GGZ InGeest Specialized Mental Hlth Care, Netherlands; Vrije Univ Amsterdam, Netherlands.
    Emsell, Louise
    Katholieke Univ Leuven, Belgium.
    Abbott, Christopher
    Univ New Mexico, NM 87131 USA.
    Yrondi, Antoine
    Univ Toulouse, France.
    Mas, Carles Soriano
    Bellvitge Biomed Res Inst IDIBELL, Spain; Carlos III Hlth Inst, Spain; Univ Autonoma Barcelona, Spain.
    Jorgensen, Martin Balslev
    Psychiat Ctr Copenhagen, Denmark; Univ Copenhagen, Denmark.
    Nordanskog, Pia
    Linköping University, Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Psykiatricentrum, Psykiatriska kliniken i Linköping.
    Rhebergen, Didi
    GGZ Centraal, Netherlands.
    van Exel, Eric
    GGZ InGeest Specialized Mental Hlth Care, Netherlands; Vrije Univ Amsterdam, Netherlands.
    Oudega, Mardien L.
    GGZ InGeest Specialized Mental Hlth Care, Netherlands; Vrije Univ Amsterdam, Netherlands.
    Bouckaert, Filip
    Katholieke Univ Leuven, Belgium.
    Vandenbulcke, Mathieu
    Katholieke Univ Leuven, Belgium.
    Sienaert, Pascal
    Katholieke Univ Leuven, Belgium.
    Peran, Patrice
    Univ Toulouse, France.
    Cano, Marta
    Carlos III Hlth Inst, Spain; Univ Autonoma Barcelona, Spain; Parc Tauli Univ Hosp, Spain.
    Cardoner, Narcis
    Parc Tauli Univ Hosp, Spain.
    Jorgensen, Anders
    Psychiat Ctr Copenhagen, Denmark; Univ Copenhagen, Denmark.
    Paulson, Olaf B.
    Rigshosp, Denmark.
    Hamilton, Paul J.
    Linköping University, Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Kämpe, Robin
    Linköping University, Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Bruin, Willem
    Amsterdam UMC, Netherlands.
    Bartsch, Hauke
    Haukeland Hosp, Norway; Haukeland Hosp, Norway; Univ Bergen, Norway.
    Ousdal, Olga Therese
    Haukeland Hosp, Norway; Univ Bergen, Norway.
    Kessler, Ute
    Univ Bergen, Norway; Haukeland Hosp, Norway.
    van Wingen, Guido
    Amsterdam UMC, Netherlands.
    Oltedal, Leif
    Haukeland Hosp, Norway; Univ Bergen, Norway.
    Kishimoto, Taishiro
    Keio Univ, Japan.
    Neural Substrates of Psychotic Depression: Findings From the Global ECT-MRI Research Collaboration2022In: Schizophrenia Bulletin, ISSN 0586-7614, E-ISSN 1745-1701, Vol. 48, no 2, p. 514-523Article in journal (Refereed)
    Abstract [en]

    Psychotic major depression (PMD) is hypothesized to be a distinct clinical entity from nonpsychotic major depression (NPMD). However, neurobiological evidence supporting this notion is scarce. The aim of this study is to identify gray matter volume (GMV) differences between PMD and NPMD and their longitudinal change following electroconvulsive therapy (ECT). Structural magnetic resonance imaging (MRI) data from 8 independent sites in the Global ECT-MRI Research Collaboration (GEMRIC) database (n = 108; 56 PMD and 52 NPMD; mean age 71.7 in PMD and 70.2 in NPMD) were analyzed. All participants underwent MRI before and after ECT. First, cross-sectional whole-brain voxel-wise GMV comparisons between PMD and NPMD were conducted at both time points. Second, in a flexible factorial model, a main effect of time and a group-by-time interaction were examined to identify longitudinal effects of ECT on GMV and longitudinal differential effects of ECT between PMD and NPMD, respectively. Compared with NPMD, PMD showed lower GMV in the prefrontal, temporal and parietal cortex before ECT; PMD showed lower GMV in the medial prefrontal cortex (MPFC) after ECT. Although there was a significant main effect of time on GMV in several brain regions in both PMD and NPMD, there was no significant group-by-time interaction. Lower GMV in the MPFC was consistently identified in PMD, suggesting this may be a trait-like neural substrate of PMD. Longitudinal effect of ECT on GMV may not explain superior ECT response in PMD, and further investigation is needed.

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