Udvalgte videnskabelige artikler om ECT (“Elektrochock”)

Dødelighed efter ECT & Om Magnetstimulation

  • En meget stor Dansk undersøgelse af dødeligheden efter ECT. En undersøgelse af samtlige patienter behandlet med ECT gennem 25 år: Undersøgelsen viser at dødeligheden efter ECT er lavere end for andre psykiatriske patienter generelt
  • Forsøg med om Magnetstimulation kan erstatte ECT. Desværre holder effekten af magnetstimulation ikke.

Kognitive bivirkninger efter ECT

  • Undersøgelse af 3000 patienters hukommelse og andre intellektuelle funktioner efter ECT. Undersøgelsen viser, at for manges vedkommende er hukommelsen og de intellektuelle evner bedret efter 15 dage efter behandlingen i forhold til, hvad den var, da de var deprimerede
  • Sackeims undersøgelse af såkaldt autobiografisk hukommelse ("huller i ens erindringer"). Ca. 10 % af alle der har fået ECT oplever "huller" i deres hukommelse. Men mange blev behandlet med forældet apparatur, som vides at give svære bivirkninger og som derfor blev forladt i Danmark for 30 år siden.

En meget stor Dansk undersøgelse af dødeligheden efter ECT.

En undersøgelse af samtlige patienter behandlet med ECT gennem 25 år:

Munk-Olsen T, Laursen TM, Videbech P, Mortensen PB, Rosenberg R. All-cause mortality among recipients of electroconvulsive therapy: register-based cohort study.Br J Psychiatry. 2007 May;190:435-9.

Studies investigating mortality secondary to electroconvulsive therapy (ECT) are few.
To assess the risk of mortality from natural and unnatural causes among ECT recipients compared with other psychiatric in-patients over a 25-year period.
Register-based cohort study of all in-patients admitted to a psychiatric hospital from 1976 to 2000. Cause-specific mortality was analysed using log-linear Poisson regression.
There were 783 deceased in-patients who had received ECT compared with 5781 who had not. Patients who had received ECT had a lower overall mortality rate from natural causes (RR=0.82, 95% CI 0.74-0.90) but a slightly higher suicide rate (RR=1.20, 95% CI 0.99-1.47), especially within the first 7 days after the last ECT treatment (RR=4.82, 95% CI 2.12-10.95).
Further investigation of the effect of ECT on physical health and the observed increased suicide rate immediately following treatment are needed, although the last finding is likely to result from selection bias.
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En stor Dansk undersøgelse af om ECT kan erstattes med Magnetstimulation.

Hansen PE, Ravnkilde B, Videbech P, Clemmensen K, Sturlason R, Reiner M, Parner E, Rosenberg R, Vestergaard P. Low-frequency repetitive transcranial magnetic stimulation inferior to electroconvulsive therapy in treating depression. J ECT. 2011 Mar;27(1):26-32.

Repetitive transcranial magnetic stimulation (rTMS) is a potential new antidepressant method and alternative to electroconvulsive therapy (ECT). The efficacy of right prefrontal low-frequency rTMS was shown in a previous placebo-controlled, randomized study but has never been compared with ECT. The aim of this study was to compare the antidepressant efficacy and adverse effects of right prefrontal low-frequency rTMS with that of ECT.
Sixty inpatients with major depression were randomized to 15 days of 1-Hz right prefrontal rTMS or 9 unilateral ECTs. Depressive symptoms and adverse effects were recorded using the Hamilton Scale for Depression and the Udvalg for Kliniske Undersøgelser side effect scale, supplied by neuropsychological assessment of cognitive functions.
Repetitive transcranial magnetic stimulation was significantly less effective than ECT. The intention-to-treat analysis revealed a 26% (confidence interval, 3%-51%) higher rate of partial remission (P = 0.035) by the end of week 3. There was no difference found between the 2 methods on the Udvalg for Kliniske Undersøgelser rating scale. However, psychological examination revealed ECT to have more adverse effects on cognitive functions, whereas the rTMS group improved particularly with respect to visual memory.
Repetitive transcranial magnetic stimulation was significantly less effective than ECT, but ECT had more adverse effects on cognitive function. The outcome does not point to right frontal low-frequency rTMS using the present stimulus design as a first-line substitute for ECT, but rather as a treatment option for patients with depression who are intolerant to other types of treatment or not accepting ECT.

En undersøgelse af 3000 patienters cognitive bivirkninger (=intellektuelle bivirkninger) ved ECT

Semkovska M, McLoughlin DM. Objective cognitive performance associated with electroconvulsive therapy for depression: a systematic review and meta-analysis. Biol Psychiatry. 2010 Sep 15;68(6):568-77.

BACKGROUND: Electroconvulsive therapy (ECT) is the most acutely effective treatment for depression, but is limited by cognitive side effects. However, research on their persistence, severity, and pattern is inconsistent. We aimed to quantify ECT-associated cognitive changes, specify their pattern, and determine progression.

METHODS: MEDLINE, EMBASE, PsycArticles, PsychINFO, PsychLIT, and reference lists were systematically searched through January 2009. We included all independent, within-subjects design studies of depressed patients receiving ECT where cognition was assessed using standardized tests. Main outcome was change in performance after ECT relative to pretreatment scores with respect to delay between finishing ECT and cognitive testing. We explored potential moderators' influence, e.g., electrode placement, stimulus waveform.

RESULTS: Twenty-four cognitive variables (84 studies, 2981 patients) were meta-analyzed. No standardized retrograde amnesia tests were identified. Significant decreases in cognitive performance were observed 0 to 3 days after ECT in 72% of variables: effect sizes (ES) ranging from -1.10 (95% confidence interval [CI], -1.53 to -.67) to -.21 (95% CI, -.40 to .01). Four to 15 days post-ECT, all but one CI included zero or showed positive ES. No negative ES were observed after 15 days, with 57% of variables showing positive ES, ranging from .35 (95% CI, .07-.63) to .75 (95% CI, .43-1.08). Moderators did not influence cognitive outcomes after 3 days post-ECT.

CONCLUSIONS: Cognitive abnormalities associated with ECT are mainly limited to the first 3 days posttreatment. Pretreatment functioning levels are subsequently recovered. After 15 days, processing speed, working memory, anterograde memory, and some aspects of executive function improve beyond baseline levels.

Sackeims undersøgelse af det subjektive hukommelsestab hos mennesker behandlet med forskelligt ECT-udstyr

Sackeim HA, Prudic J, Fuller R, Keilp J, Lavori PW, Olfson M. The cognitive effects of electroconvulsive therapy in community settings. Neuropsychopharmacology. 2007 Jan;32(1):244-54.

Despite ongoing controversy, there has never been a large-scale, prospective study of the cognitive effects of electroconvulsive therapy (ECT). We conducted a prospective, naturalistic, longitudinal study of clinical and cognitive outcomes in patients with major depression treated at seven facilities in the New York City metropolitan area. Of 751 patients referred for ECT with a provisional diagnosis of a depressive disorder, 347 patients were eligible and participated in at least one post-ECT outcome evaluation. The primary outcome measures, Modified Mini-Mental State exam scores, delayed recall scores from the Buschke Selective Reminding Test, and retrograde amnesia scores from the Columbia University Autobiographical Memory Interview-SF (AMI-SF), were evaluated shortly following the ECT course and 6 months later. A substantial number of secondary cognitive measures were also administered. The seven sites differed significantly in cognitive outcomes both immediately and 6 months following ECT, even when controlling for patient characteristics. Electrical waveform and electrode placement had marked cognitive effects. Sine wave stimulation resulted in pronounced slowing of reaction time, both immediately and 6 months following ECT. Bilateral (BL) ECT resulted in more severe and persisting retrograde amnesia than right unilateral ECT. Advancing age, lower premorbid intellectual function, and female gender were associated with greater cognitive deficits. Thus, adverse cognitive effects were detected 6 months following the acute treatment course. Cognitive outcomes varied across treatment facilities and differences in ECT technique largely accounted for these differences. Sine wave stimulation and BL electrode placement resulted in more severe and persistent deficits.