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Popiolek, K., Bejerot, S., Brus, O., Hammar, Å., Landén, M., Lundberg, J., . . . Nordenskjöld, A. (2019). Electroconvulsive therapy in bipolar depression: effectiveness and prognostic factors. Acta Psychiatrica Scandinavica, 140(3), 196-204
Open this publication in new window or tab >>Electroconvulsive therapy in bipolar depression: effectiveness and prognostic factors
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2019 (English)In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 140, no 3, p. 196-204Article in journal (Refereed) Published
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: ECT 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.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2019
Keywords
Bipolar disorders, bipolar depression, electroconvulsive therapy, prognosis
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-75577 (URN)10.1111/acps.13075 (DOI)000480263900003 ()31334829 (PubMedID)2-s2.0-85070454601 (Scopus ID)
Available from: 2019-08-09 Created: 2019-08-09 Last updated: 2019-08-29Bibliographically approved
Kronsell, A., Nordenskjöld, A. & Tiger, M. (2019). Less memory complaints with reduced stimulus dose during electroconvulsive therapy for depression. Journal of Affective Disorders, 259, 296-301
Open this publication in new window or tab >>Less memory complaints with reduced stimulus dose during electroconvulsive therapy for depression
2019 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 259, p. 296-301Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Electroconvulsive therapy (ECT) is an effective treatment for depression, but there is risk of cognitive adverse events. This risk has been partially attributed to electrical charge, thus the optimal electrical stimulus dose is still under discussion. The aim of this study was to evaluate how the risk of subjective memory worsening was changed after lowering stimulus dose during ECT for patients with major depression.

METHOD: A retrospective register-based intervention study of the effects of reduced electrical charges for patients receiving ECT for depression was conducted. The primary outcome was subjective memory worsening and the secondary outcome change in effect on depressive symptoms.

RESULTS: A total of 154 patients were enrolled in the study (High dosage group: n = 57; Lower dosage group: n = 97). Subjective memory worsening after ECT occurred in 44% of patients in the high dosage group and in 25% of patients in the lower dosage group(p = 0.014). There was no significant between-group difference in the anti-depressive effect of ECT.

LIMITATIONS: The study was register-based and the two groups were not randomized. A large portion of patients were initially excluded due to missing data in the register. The study lacks a long-term follow up.

CONCLUSION: After implementing a change of treatment protocol, that lowered ECT stimulus doses from high to moderate, the occurrence of subjective memory worsening was significantly reduced without compromising treatment results.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Electroconvulsive therapy, Major depressive disorder, Memory
National Category
Clinical Medicine Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:oru:diva-75993 (URN)10.1016/j.jad.2019.08.064 (DOI)31450138 (PubMedID)
Available from: 2019-09-01 Created: 2019-09-01 Last updated: 2019-09-06Bibliographically approved
Brus, O., Cao, Y., Hammar, Å., Landén, M., Lundberg, J., Nordanskog, P. & Nordenskjöld, A. (2019). Lithium for suicide and readmission prevention after electroconvulsive therapy for unipolar depression: population-based register study. BJPsych Open, 5(3), Article ID e46.
Open this publication in new window or tab >>Lithium for suicide and readmission prevention after electroconvulsive therapy for unipolar depression: population-based register study
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2019 (English)In: BJPsych Open, E-ISSN 2056-4724, Vol. 5, no 3, article id e46Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Electroconvulsive therapy (ECT) is effective for unipolar depression but relapse and suicide are significant challenges. Lithium could potentially lower these risks, but is used only in a minority of patients.AimsThis study quantifies the effect of lithium on risk of suicide and readmission and identifies factors that are associate with readmission and suicide.

METHOD: This population-based register study used data from the Swedish National Quality Register for ECT and other Swedish national registers. Patients who have received ECT for unipolar depression as in-patients between 2011 and 2016 were followed until death, readmission to hospital or the termination of the study at the end of 2016. Cox regression was used to estimate hazard ratios (HR) of readmission and suicide in adjusted models.

RESULTS: Out of 7350 patients, 56 died by suicide and 4203 were readmitted. Lithium was prescribed to 638 (9%) patients. Mean follow-up was 1.4 years. Lithium was significantly associated with lower risk of suicide (P = 0.014) and readmission (HR 0.84 95% CI 0.75-0.93). The number needed to be treated with lithium to prevent one readmission was 16. In addition, the following factors were statistically associated with suicide: male gender, being a widow, substance use disorder and a history of suicide attempts. Readmission was associated with young age, being divorced or unemployed, comorbid anxiety disorder, nonpsychotic depression, more severe symptoms before ECT, no improvement with ECT, not receiving continuation ECT or antidepressants, usage of antipsychotics, anxiolytics or benzodiazepines, severity of medication resistance and number of previous admissions.

CONCLUSIONS: More patients could benefit from lithium treatment.Declaration of interestNone.

Place, publisher, year, edition, pages
Royal College of Psychiatrists, 2019
Keywords
Depressive disorders, antidepressants, electroconvulsive therapy, inpatient treatment, lithium, suicide
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-75090 (URN)10.1192/bjo.2019.37 (DOI)31189487 (PubMedID)
Available from: 2019-07-11 Created: 2019-07-11 Last updated: 2019-08-07Bibliographically approved
Rönnqvist, I., Brus, O., Hammar, Å., Landén, M., Lundberg, J., Nordanskog, P. & Nordenskjöld, A. (2019). Rehospitalization of Postpartum Depression and Psychosis After Electroconvulsive Therapy: A Population-Based Study With a Matched Control Group. Journal of ECT
Open this publication in new window or tab >>Rehospitalization of Postpartum Depression and Psychosis After Electroconvulsive Therapy: A Population-Based Study With a Matched Control Group
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2019 (English)In: Journal of ECT, ISSN 1095-0680, E-ISSN 1533-4112Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVES: Electroconvulsive therapy (ECT) is used in some cases of postpartum depression (PPD) and postpartum psychosis (PPP). The risk of relapse for PPD and PPP after ECT is unknown. This study compared the relapse rate after ECT between women who had been treated for PPD and/or PPP and women who had been treated for depression and/or psychosis outside the postpartum period.

METHODS: The Swedish National Quality Register for ECT and the Swedish National Patient Register were used to identify women with PPD and/or PPP who had been treated with ECT within 6 months after delivery. For each case, a control (treated with ECT but not postpartum) patient was also selected. A Kaplan-Meier estimator was used to calculate the relapse rate (defined as rehospitalization or suicide) after ECT. Cox regression was used to identify variables associated with relapse.

RESULTS: A total of 180 patients were included in each group. The proportions of patients who suffered relapse after 6 months, 1 year, and 2 years were 28%, 31%, and 40% for the postpartum group and 39%, 50%, and 55% for the nonpostpartum group. Treatment with benzodiazepines, several previous psychiatric admissions, and the absence of improvement after ECT were associated with relapse.

CONCLUSIONS: The risk of relapse after ECT is lower for patients with PPD and/or PPP than for patients outside the postpartum period, but the risk is nonetheless substantial in both groups.This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2019
Keywords
Postpartum disorders, postpartum depression, postpartum psychosis, electroconvulsive therapy, relapse
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-75089 (URN)10.1097/YCT.0000000000000578 (DOI)30807499 (PubMedID)
Available from: 2019-07-11 Created: 2019-07-11 Last updated: 2019-08-09Bibliographically approved
Svensson, A. F., Khaldi, M., Engström, I., Matusevich, K. & Nordenskjöld, A. (2019). Remission rate of transcranial magnetic stimulation compared with electroconvulsive therapy: a case-control study. Nordic Journal of Psychiatry, 72(7), 471-476
Open this publication in new window or tab >>Remission rate of transcranial magnetic stimulation compared with electroconvulsive therapy: a case-control study
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2019 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 72, no 7, p. 471-476Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To compare the rate of remission, rate of response, change in depressive symptoms, and adverse effects between repetitive transcranial magnetic stimulation (rTMS) and electroconvulsive therapy (ECT).

MATERIALS AND METHODS: In this retrospective case-control study, 35 patients treated for depression with rTMS (left dorsolateral prefrontal cortex, 90% observed motor threshold, 10 Hz, 2000 pulses/session, 15 sessions) at Örebro University Hospital, Sweden (cases), were compared with a matched group of 35 patients treated for depression with ECT (controls). Data on controls were obtained from the Swedish National Quality Register for ECT (Q-ECT). Severity of depression was evaluated using the Montgomery-Åsberg Depression rating scale (MADRS).

RESULTS: Remission rate was 26% for cases and 43% for controls (p = .3). Response rate was 40% for cases and 51% for controls (p = .63). The median decrease in MADRS was 11 (IQR 3-19) vs. 17 (IQR 6-27; p = .10) for rTMS and ECT, respectively. There was no statistically significant difference in any measure of treatment effect between rTMS and ECT. More than half of the patients of the rTMS group experienced scalp discomfort and 11% of the ECT group had memory disturbances.

CONCLUSIONS: All measures of therapeutic efficacy were numerically inferior in the rTMS group compared to the ECT group. The differences were not statistically significant, probably because the sample size was small. More studies are required to find the optimal place for rTMS within the Swedish health care system. Such studies could be facilitated by inclusion of rTMS in the Q-ECT.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
Major depressive disorder, electroconvulsive therapy, repetitive transcranial magnetic stimulation, treatment outcome
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-69891 (URN)10.1080/08039488.2018.1481998 (DOI)000456435500003 ()30359165 (PubMedID)2-s2.0-85055553308 (Scopus ID)
Note

Funding Agency:

Region Örebro county

Available from: 2018-11-06 Created: 2018-11-06 Last updated: 2019-02-07Bibliographically approved
Kellner, C. H. & Nordenskjöld, A. (2019). "Treatment Resistance" in Electroconvulsive Therapy (ECT) Patients: Time to Move On [Letter to the editor]. Acta Psychiatrica Scandinavica
Open this publication in new window or tab >>"Treatment Resistance" in Electroconvulsive Therapy (ECT) Patients: Time to Move On
2019 (English)In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447Article in journal, Letter (Refereed) Epub ahead of print
Abstract [en]

The concept of "treatment resistance" has become all the rage in depression research. It is used to define populations in research studies and in treatment algorithms as a rationale for moving on from standard antidepressants to other therapies. In such algorithms, electroconvulsive therapy (ECT) is often bundled improperly with less effective neurostimulation-methods and experimental pharmacotherapies.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2019
National Category
Clinical Medicine Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:oru:diva-75994 (URN)10.1111/acps.13091 (DOI)31437306 (PubMedID)
Available from: 2019-09-01 Created: 2019-09-01 Last updated: 2019-09-06Bibliographically approved
Rundgren, S., Brus, O., Båve, U., Landén, M., Lundberg, J., Nordanskog, P. & Nordenskjöld, A. (2018). Improvement of postpartum depression and psychosis after electroconvulsive therapy: A population-based study with a matched comparison group. Journal of Affective Disorders, 235, 258-264
Open this publication in new window or tab >>Improvement of postpartum depression and psychosis after electroconvulsive therapy: A population-based study with a matched comparison group
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2018 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 235, p. 258-264Article in journal (Refereed) Published
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.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Puerperal disorders, Postpartum depression, Postpartum psychosis, Electroconvulsive therapy treatment outcome
National Category
Psychiatry Neurology
Identifiers
urn:nbn:se:oru:diva-66965 (URN)10.1016/j.jad.2018.04.043 (DOI)000432686900040 ()29660641 (PubMedID)2-s2.0-85045276002 (Scopus ID)
Note

Funding Agency:

Region Örebro County

Available from: 2018-05-17 Created: 2018-05-17 Last updated: 2018-09-18Bibliographically approved
Popiolek, K., Brus, O., Elvin, T., Landen, M., Lundberg, J., Nordanskog, P. & Nordenskjöld, A. (2018). Rehospitalization and suicide following electroconvulsive therapy for bipolar depression: A population-based register study. Journal of Affective Disorders, 226, 146-154
Open this publication in new window or tab >>Rehospitalization and suicide following electroconvulsive therapy for bipolar depression: A population-based register study
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2018 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 226, p. 146-154Article in journal (Refereed) Published
Abstract [en]

Background: Electroconvulsive therapy (ECT) is effective in bipolar depression, but relapse is common. The aim of the study was (i) to identify prognostic factors (ii) and to determine the impact of pharmacological approaches on the risk for rehospitalization or suicide.

Methods: This register study analyzed data from individuals treated with inpatient ECT for bipolar depression. Subjects were identified using the Swedish National Patient Register between 2011 and 2014 and the Swedish National Quality Register for ECT. Other national registers provided data on psychopharmacotherapy, socio-demographic factors, and causes of death. The endpoint was the composite of rehospitalization for any psychiatric disorder, suicide attempt or completed suicide (RoS). Cox regression was used to calculate hazard ratios in univariate and multivariate models.

Results: Data from 1255 patients were analyzed. The mean period of follow-up was 346 days.

A total of 29%, 41%, and 52% of patients reached RoS at 3, 6, and 12 months post-discharge. A history of multiple psychiatric admissions, lower age, and post-discharge treatment with antipsychotics or benzodiazepines was associated with RoS.

Limitations: Indication bias may have affected the results.

Conclusions: A history of multiple hospital admissions and lower age are key predictors of the composite of rehospitalization or suicide in patients treated with ECT for bipolar depression. Lithium might be effective. By contrast, antipsychotics and benzodiazepines were associated with increased risk, but possibly this finding was influenced by indication bias.

Place, publisher, year, edition, pages
Elsevier, 2018
National Category
Neurology Psychiatry
Identifiers
urn:nbn:se:oru:diva-62810 (URN)10.1016/j.jad.2017.09.030 (DOI)000414329000020 ()28982047 (PubMedID)2-s2.0-85030308357 (Scopus ID)
Note

Funding Agency:

Region Örebro County 

Available from: 2017-11-24 Created: 2017-11-24 Last updated: 2018-08-16Bibliographically approved
Holm, J., Brus, O., Båve, U., Landen, M., Lundberg, J., Nordanskog, P., . . . Nordenskjöld, A. (2017). Improvement of cycloid psychosis following electroconvulsive therapy. Nordic Journal of Psychiatry, 71(6), 405-410
Open this publication in new window or tab >>Improvement of cycloid psychosis following electroconvulsive therapy
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2017 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 71, no 6, p. 405-410Article in journal (Refereed) Published
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 Fisher's 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 (p < 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.

Place, publisher, year, edition, pages
Taylor & Francis, 2017
Keywords
Cycloid psychosis; electroconvulsive therapy; treatment outcome; acute polymorphic disorder without symptoms of schizophrenia
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:oru:diva-57345 (URN)10.1080/08039488.2017.1306579 (DOI)000406723800001 ()28367711 (PubMedID)2-s2.0-85017033097 (Scopus ID)
Funder
Swedish Research Council, 523-2013-2982Swedish Foundation for Strategic Research , KF10-0039
Note

Funding Agency:

Region Örebro county

Available from: 2017-05-26 Created: 2017-05-26 Last updated: 2018-09-18Bibliographically approved
Brus, O., Cao, Y., Gustafsson, E., Hultén, M., Landén, M., Lundberg, J., . . . Nordenskjöld, A. (2017). Self-assessed remission rates after electroconvulsive therapy of depressive disorders. European psychiatry, 45, 154-160, Article ID S0924-9338(17)32917-6.
Open this publication in new window or tab >>Self-assessed remission rates after electroconvulsive therapy of depressive disorders
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2017 (English)In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 45, p. 154-160, article id S0924-9338(17)32917-6Article in journal (Refereed) Published
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-Åsberg 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≥0.50ms, 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.

Place, publisher, year, edition, pages
Elsevier Masson, 2017
Keywords
Mania and bipolar disorder; Unipolar depression; ECT
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-61681 (URN)10.1016/j.eurpsy.2017.06.015 (DOI)000414461300021 ()28865389 (PubMedID)2-s2.0-85028504905 (Scopus ID)
Funder
Swedish Research Council, 523-2013-2982Swedish Foundation for Strategic Research , KF10-0039
Note

Funding Agency:

Region Örebro county

Available from: 2017-11-14 Created: 2017-11-14 Last updated: 2018-08-10Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0001-7454-3065

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