ABSTRACT
Electroconvulsive therapy (ECT) is effective in treatment-resistant depression (TRD). It may act through intracellular process modulation, but its exact mechanism is still unknown. Animal research supports a neurotrophic effect for ECT. We aimed to investigate the association between changes in serum brain-derived neurotrophic factor (sBDNF) levels and clinical improvement following ECT in patients with TRD. Twenty-one patients with TRD (2 men, 19 women; mean age, 63.5 years; S.D., 11.9) were assessed through the Hamilton Depression Rating Scale (HDRS), the Brief Psychiatric Rating Scale (BPRS), and the Clinical Global Impressions scale, Severity (CGIs) before and after a complete ECT cycle. At the same time-points, patients underwent blood withdrawal for measuring sBDNF levels. ECT significantly reduced HDRS, BPRS, and CGIS scores, but not sBDNF levels. No significant correlation was found between sBDNF changes, and each of HDRS, BPRS, and CGIs score changes. sBDNF levels in TRD patients were low both at baseline and post-ECT. Our results do not support that improvements in TRD following ECT are mediated through increases in sBDNF levels.
Subject(s)
Brain-Derived Neurotrophic Factor/blood , Depressive Disorder, Treatment-Resistant/therapy , Electroconvulsive Therapy , Aged , Depressive Disorder, Treatment-Resistant/blood , Female , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
PRIMARY OBJECTIVE: Early treatment of epilepsy is warranted to avoid possible severe consequences. This study aimed to assess the value of treatment in a patient who developed epilepsy after major brain surgery. DESIGN: Case description. A 51 years-old man had a history of putative petit mal seizures since adolescence and left frontotemporal lobectomy after a major traffic accident at age 17. He subsequently developed quickly generalizing partial complex seizures, associated with severe behavioural alterations and personality changes; the condition was left untreated. A further seizure-related loss of consciousness led to another traffic accident at age 47. METHODS AND PROCEDURES: The patient was administered 200 mg/day topiramate, 600 mg/day quetiapine, 1000 mg/day valproate, 1200 mg/day gabapentin and 800 mg/day carbamazepine. MAIN OUTCOMES AND RESULTS: The instituted anti-epileptic treatment reduced seizure frequency and severity, but did not affect psychiatric symptomatology, which even worsened. An association between anti-epileptic drugs with mood stabilizing properties and an atypical anti-psychotic dramatically improved psychiatric symptoms, but did not prevent the patient from needing long-term healthcare. CONCLUSIONS: Long-term untreated epilepsy may expose to accident proneness and further psychiatric deterioration. Early diagnosis and treatment of epilepsy may help in avoiding a potentially lethal vicious circle.
Subject(s)
Accidents, Traffic , Aggression , Anticonvulsants/therapeutic use , Brain Injuries/physiopathology , Epilepsy/diagnosis , Epilepsy/drug therapy , Personality Disorders/physiopathology , Accidents, Traffic/psychology , Aggression/psychology , Amines/therapeutic use , Anterior Temporal Lobectomy/adverse effects , Brain Injuries/complications , Brain Injuries/drug therapy , Brain Injuries/psychology , Carbamazepine/therapeutic use , Cyclohexanecarboxylic Acids/therapeutic use , Dibenzothiazepines/therapeutic use , Disease Progression , Early Diagnosis , Epilepsy/etiology , Epilepsy/physiopathology , Epilepsy/psychology , Fructose/analogs & derivatives , Fructose/therapeutic use , Gabapentin , Humans , Italy , Male , Middle Aged , Personality Disorders/drug therapy , Personality Disorders/etiology , Personality Disorders/psychology , Quetiapine Fumarate , Time Factors , Topiramate , Treatment Outcome , Valproic Acid/therapeutic use , gamma-Aminobutyric Acid/therapeutic useABSTRACT
BACKGROUND: Craving for alcohol is associated with abnormal activation in the dorsolateral prefrontal cortex. Deep transcranial magnetic stimulation (dTMS) has shown promise in the treatment of depression. There are few treatment options for treatment-resistant dysthymic disorder comorbid with alcohol use disorder. OBJECTIVE: To investigate the possible anticraving efficacy of bilateral dorsolateral prefrontal cortex high-frequency dTMS in 3 patients with comorbid long-term DSM-IV-TR dysthymic disorder and alcohol use disorder. METHOD: Three patients with alcohol use disorder with dysthymic disorder in their detoxification phase (abstaining for > 1 month) underwent twenty 20-minute sessions of 20 Hz dTMS over the dorsolateral prefrontal cortex over 28 days between 2011 and 2012. Alcohol craving was rated with the Obsessive Compulsive Drinking Scale and depressive symptoms with the Hamilton Depression Rating Scale. RESULTS: All 3 patients responded unsatisfactorily to initial intravenous antidepressant and antianxiety combinations but responded after 10 dTMS sessions, improving on both anxiety-depressive symptoms and craving. This improvement enabled us to reduce antidepressant dosages after dTMS cycle completion. DISCUSSION: High-frequency bilateral dorsolateral prefrontal cortex dTMS with left prevalence was found to produce significant anticraving effects in alcohol use disorder comorbid with dysthymic disorder. The potential of dTMS for reducing craving in patients with substance use disorder deserves to be further investigated.
Subject(s)
Depressive Disorder/therapy , Electroconvulsive Therapy , Factitious Disorders/therapy , Aged , Aged, 80 and over , Female , Humans , MaleABSTRACT
A 41-year-old man with comorbid binge-eating disorder, severe obesity, and bipolar disorder since the age of 20 years, resistant to drug and psychotherapy combinations, worsened progressively. Relentless weight gain forced him to immobility and dependence on others. He was hospitalized for a mixed-mood episode with anxiety, mystical delusions, and auditory hallucinations. To overcome treatment resistance, we suggested electroconvulsive therapy. After 1 electroconvulsive therapy cycle, psychological symptoms promptly improved. He received clozapine and lithium. After 2 years, he reached normal weight and fair psychopathological compensation.
Subject(s)
Binge-Eating Disorder/complications , Binge-Eating Disorder/therapy , Bipolar Disorder/complications , Bipolar Disorder/therapy , Electroconvulsive Therapy , Obesity, Morbid/complications , Obesity, Morbid/therapy , Adult , Affect , Antipsychotic Agents/therapeutic use , Anxiety/psychology , Anxiety/therapy , Binge-Eating Disorder/drug therapy , Bipolar Disorder/drug therapy , Clozapine/therapeutic use , Delusions/etiology , Delusions/therapy , Disease Progression , Drug Resistance , Hallucinations/therapy , Humans , Male , Obesity, Morbid/drug therapyABSTRACT
A 24-year-old man experiencing comorbid body dysmorphic disorder since age 16 years, complicated in recent months by a major depressive episode with psychotic features, showed resistance to various drug and psychotherapy combinations. We suggested electroconvulsive therapy (ECT) to overcome treatment resistance. After 1 ECT cycle, mood and anxiety symptoms improved significantly, delusional interpretations and ideas of reference subsided, and dysmorphophobic symptoms improved as well. Six months later, the patient was doing well with a mood stabilizer/antipsychotic combination. Electroconvulsive therapy may improve symptoms of comorbid body dysmorphic disorder along with mood improvement in treatment-resistant depressive disorder.
Subject(s)
Body Dysmorphic Disorders/therapy , Depressive Disorder, Major/therapy , Depressive Disorder, Treatment-Resistant/therapy , Electroconvulsive Therapy/methods , Antipsychotic Agents/therapeutic use , Body Dysmorphic Disorders/complications , Body Dysmorphic Disorders/psychology , Delusions/psychology , Depressive Disorder, Major/complications , Depressive Disorder, Major/psychology , Depressive Disorder, Treatment-Resistant/complications , Depressive Disorder, Treatment-Resistant/psychology , Humans , Male , Treatment Outcome , Young AdultABSTRACT
OBJECTIVES: To evaluate the effectiveness and safety of maintenance electroconvulsive therapy (mECT) in elderly patients with treatment-resistant Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition major depressive episode. METHODS: Seven elderly patients with treatment-resistant major depressive episode were treated with a complete ECT cycle. Thereafter, they received one monthly ECT session as maintenance for 1 year. Response to treatment was defined as at least a 50% drop from baseline on the Hamilton Depression Rating Scale (HamD) and remission as not meeting criteria for major depression, a HamD score of 7 or less, and Clinical Global Impressions-Severity of Illness score of 1. We compared their response with the response of 7 elderly patients with treatment-resistant major depression who were treated with a full cycle of ECT but did not receive mECT (non-mECT). We compared the 2 groups for the number of relapses or recurrences of major depressive episodes after remission was achieved; a relapse or a recurrence occurred when HamD scores were 14 or higher, or when Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision major depressive episode criteria were met, or when Clinical Global Impressions-Severity of Illness score was 3 or higher and increased by at least 2 points from response/remission. RESULTS: The mECT group (4 women and 3 men; mean age, 73 years) had significantly less mean relapses/recurrences (0 vs 1.57) and hospitalizations (0 vs 1) and received less drug treatment than the nonMECT group (similar for age and sex composition) during the 12-month follow-up period. All patients with mECT improved during treatment and did not relapse. CONCLUSIONS: Maintenance ECT protected elderly patients from recurrent depressive episodes from relapsing/recurring more than standard ECT.
Subject(s)
Depressive Disorder, Major/therapy , Electroconvulsive Therapy/methods , Aged , Antipsychotic Agents/therapeutic use , Benzodiazepines/therapeutic use , Depressive Disorder, Major/psychology , Diagnostic and Statistical Manual of Mental Disorders , Female , Hospitalization , Humans , Male , Olanzapine , Psychiatric Status Rating Scales , Secondary Prevention , Severity of Illness Index , Treatment OutcomeABSTRACT
A young woman with bipolar I disorder and comorbid catatonia on enteral nutrition from several months, developed a form of near-lethal catatonia with weight loss, pressure sores, muscle atrophy, electrolyte imbalance, and depression of vital signs. A compulsory treatment was necessary, and informed consent was obtained from her mother for electroconvulsive therapy (ECT). After 7 ECT sessions, the patient recovered and resumed feeding. ECT may save the life of a patient with catatonia provided that legal obstacles are overcome. Clinicians should carefully evaluate patients with near-lethal catatonia, taking into account the risk of pulmonary embolism and other fatal events. The medical-legal issues, which vary across state regulations, should be addressed in detail to avoid unnecessary and potentially harmful delay in intervention.
Subject(s)
Bipolar Disorder/therapy , Catatonia/therapy , Electroconvulsive Therapy , Adult , Bipolar Disorder/complications , Bipolar Disorder/diagnosis , Catatonia/diagnosis , Catatonia/etiology , Female , Humans , Parental Consent , Treatment OutcomeABSTRACT
A woman with bipolar disorder I, histrionic personality disorder, and suicidal ideation with repeated suicide attempts, who had been treated for 2 years with mood stabilizers, antipsychotics, and benzodiazepines, received a total of 8 bitemporal-biparietal electroconvulsive therapy sessions. Her suicidal ideation and self-harm behavior disappeared immediately after the first session and her psychopathology soon after. This supports the existence of a relatively independent suicidal syndrome and confirms data on its immediate responsiveness to electroconvulsive therapy. Electroconvulsive therapy must not be long withheld from patients with such characteristics to reduce unnecessary sufferance and suicidality.
Subject(s)
Bipolar Disorder/therapy , Electroconvulsive Therapy , Histrionic Personality Disorder/therapy , Suicidal Ideation , Adult , Anxiety/complications , Anxiety/therapy , Bipolar Disorder/complications , Bipolar Disorder/psychology , Combined Modality Therapy , Female , Histrionic Personality Disorder/complications , Histrionic Personality Disorder/psychology , Humans , Muscle Relaxants, Central , Psychotherapy , Self-Injurious Behavior/complications , Self-Injurious Behavior/psychology , Self-Injurious Behavior/therapy , Sleep Initiation and Maintenance Disorders/complications , Sleep Initiation and Maintenance Disorders/psychology , Suicide, AttemptedABSTRACT
A 36-year-old man with comorbid panic disorder with agoraphobia, major depression, and histrionic personality disorder since age 21 was resistant to combined drug and psychotherapy treatment. His conditions had progressively worsened with time, causing him to withdraw socially and to simultaneously require continuous physical restraint, which further worsened his functioning. He spent almost 3 consecutive years in restraint, until he consented to receive bilateral ECT treatment. He improved after 13 sessions in all areas (social and role functioning, and panic, depressive, and histrionic symptoms) and is well 3 months later with a lithium-atypical antipsychotic combination.