Why do we prescribe ECT to schizophrenia patients? Improvement of psychiatric symptoms after electroconvulsive therapy in young adults with intractable first-episode schizophrenia and schizophreniform disorder. Public attitudes towards electroconvulsive therapy in the Chuvash Republic Leicester ECT trial: results in schizophrenia. Double-blind randomized controlled study showing symptomatic and cognitive superiority of bifrontal over bitemporal electrode placement during electroconvulsive therapy for schizophrenia Effect of Antidepressant Medication Resistance on Short-term Response to Electroconvulsive Therapy Continuation electroconvulsive therapy vs pharmacotherapy for relapse prevention in major depression: a multisite study from the Consortium for Research in Electroconvulsive Therapy (CORE). Long-term efficacy of electroconvulsive therapy combined with different antipsychotic drugs in previously resistant schizophrenia. Effect of concomitant pharmacotherapy on electroconvulsive therapy outcomes: short-term efficacy and adverse effects. Quality of life after electroconvulsive therapy in persons with treatment resistant schizophrenia Electroconvulsive therapy (ECT) and aerobic exercise training (AET) increased plasma BDNF and ameliorated depressive symptoms in patients suffering from major depressive disorder. Electroconvulsive therapy and aerobic exercise training increased BDNF and ameliorated depressive symptoms in patients suffering from treatment-resistant major depressive disorder. The efficacy of electroconvulsive therapy in the treatment of schizophrenia. A comparative study. Rapid Antidepressant Effect of Ketamine in the Electroconvulsive Therapy Setting Right Unilateral and Bifrontal Electroconvulsive Therapy in the Treatment of Depression: A Preliminary Study A randomized, controlled trial with 6-month follow-up of repetitive transcranial magnetic stimulation and electroconvulsive therapy for severe depression. Speed of response and remission in major depressive disorder with acute electroconvulsive therapy (ECT): a Consortium for Research in ECT (CORE) report. ECT FOR SCHIZOPHRENIA Antidepressant effects, of magnetic seizure therapy and electroconvulsive therapy, in treatment-resistant depression. The clinical effectiveness and cost of repetitive transcranial magnetic stimulation versus electroconvulsive therapy in severe depression: a multicentre pragmatic randomised controlled trial and economic analysis. A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities. Impact comparison of ketamine and sodium thiopental on anesthesia during electroconvulsive therapy in major depression patients with drug-resistant; a double-blind randomized clinical trial Effects of electroconvulsive therapy on amygdala function in major depression - a longitudinal functional magnetic resonance imaging study.
Electroconvulsive therapy ( ECT ) is prescribed for schizophrenia patients for various indications , in our country . However , official guidelines in other countries have been cautious in prescribing ECT for schizophrenia . To study the indications for which patients with schizophrenia receive ECT . We studied records of schizophrenia in patients receiving ECT in one year ( 2005 ) ( n=101 ) retrospectively , as well as the consecutive data of patients between May 2007 and June 2008 ( n=101 ) prospect ively . The various indications for ECT in schizophrenia were studied by frequency analysis . Of the 202 schizophrenia patients who received ECT  , the most common reason was ‘ to augment pharmacotherapy ’ in ( n=116 ) cases . The target symptoms for which ECT was prescribed the most was catatonia ( n=72 ) . The mean number of ECTs ( SD ) received was 8.4 ( 2.8 ) . Augmentation of pharmacotherapy was the most common indication of ECT in patients with schizophrenia Schizophrenia is a serious psychiatric disorder that develops mainly in young adults .  Electroconvulsive therapy ( ECT ) is known to be effective and safe in patients with schizophrenia with acute psychotic exacerbation . Because of the shortage of systematic studies , we conducted a prospect i ve naturalistic study to examine the short-term effects of acute ECT and its safety in young adults with medically intractable first-episode schizophrenia . Subjects were seven consecutive patients , 15 - 35 years of age , with first-episode schizophrenia or schizophreniform disorder ( Diagnostic and Statistical Manual of Mental Disorders , 4th edition ; DSM-IV ) , who had failed to respond to neuroleptics . The seven patients were treated with a first course of ECT , and their clinical symptoms were evaluated on the basis of the Brief Psychiatric Rating Scale ( BPRS ) ( 18 items , rated 0 - 6 ) and Global Assessment of Functioning ( GAF ) Scale . The GAF Scale is presented in DSM-IV as a means of assessing global functioning of a psychiatric patient . Scores range from 1 - 100 ; the higher GAF score indicates the higher global functioning . Adverse effects result ing from acute ECT were also evaluated . The total BPRS score 1 week after the final session improved significantly compared to the total pre-ECT BPRS score . The GAF score also improved significantly compared to the pre-ECT GAF score . There were no adverse effects during the acute ECT course , except for mild delirium . We conclude that ECT may be an effective and safe treatment option for young adults with intractable first-episode schizophrenia Background : Public attitudes towards a given medical procedure can have a significant influence on the employment of that method . Electroconvulsive therapy ( ECT ) is a medical procedure that has received an exceptionally ambiguous public reception since its inception . Aim : To survey the level of information about and attitudes towards ECT in a general population sample of the Chuvash Republic of the Russian Federation . Methods : A r and omly selected cohort of 5,373 people was contacted by telephone .  The respondents were asked three closed and three open questions . Results : The response rate was 74.7 % . Only 35.2 % of those interviewed said they knew anything about ECT . Health professionals and younger respondents were better informed . The two main sources of information about ECT were foreign films and the mass media . The main indication of ECT was thought to be schizophrenia . The majority ( 63.3 % ) of the respondents had negative opinions and emotions about ECT .  Conclusion : Limited information about and generally negative attitudes towards  ECT  were found in the general population of the Chuvash Republic . Gender , age , education level , employment in the health industry , and information source were found to be the determining factors in the knowledge of and attitudes towards ECT As part of the Leicester electroconvulsive therapy ( ECT ) study , the role of ECT in schizophrenia was investigated in a double-blind trial . The Present State Examination criteria for schizophrenia were fulfilled by 22 patients , of whom 19 gave consent and entered the trial . Neuroleptic medication was restricted during the trial period . Patients were r and omly allocated to eight real ECT or eight simulated ECT . At the end of the four-week trial period , patients receiving real ECT showed a significantly greater improvement when measured on the Montgomery-Asberg Schizophrenia Scale ( MASS ) , the visual analogue global psychopathology scale , and the depression scale . The differences on the MASS and visual analogue global psychopathology scale were not due to improvement in depressive symptoms . The superiority of real ECT was not demonstrated at the 12- and 28-week follow-up , when treatment was not controlled BACKGROUND Several studies show that bifrontal electrode placement produces relatively fewer cognitive adverse effects than bitemporal placement during electroconvulsive therapy ( ECT ) in depression . There are no reports comparing these electrode placements in schizophrenia . OBJECTIVES This study compared the clinical and cognitive effects of bifrontal and bitemporal electrode placements in schizophrenia patients referred for electroconvulsive therapy ( ECT ) .  METHODS 122 schizophrenia patients who were prescribed ECT were r and omized to receive ECT with either bifrontal ( BFECT ; n = 62 ) or bitemporal ( BTECT ; n = 60 ) placement . Their concomitant anti-psychotic medications and the number of ECT sessions were not controlled . Psychopathology was assessed using the Brief Psychiatric Rating Scale ( BPRS ) , Bush-Francis Catatonia Rating Scale ( BFCRS ) , and the Nurse Observation Scale for Inpatient Evaluation ( NOSIE ) . Cognitive functions were assessed 24-h after the final ECT using a battery of tests . Clinical improvement was compared using chi-square test , repeated measures ANOVA and analysis of covariance ( ANCOVA ) . Cognitive adverse effects were compared using t-test . RESULTS At the end of 2 weeks ( after 6 ECT sessions ) 63 % and 13.2 % of BFECT and BTECT patients respectively had met the response criterion for BPRS ( 40 % reduction in total score ; OR = 20.8 ; 95 % CI = 3.61 - 34.33 ) . BFECT patients showed significantly faster clinical response on BPRS ( Time × Group interaction effect : P = 0.001 ) , BFCRS ( P < 0.001 ) and the NOSIE total assets score ( P = 0.003 ) . ANCOVA using baseline scores as covariates and treatment-resistance status as between-subject factor showed that BFECT patients had significantly greater improvement in all measures . BFECT patients had significantly higher PGI-memory-scale total score than BTECT patients ( t = 5.16 ; P < 0.001 ) . They also showed superior performance in other cognitive measures . CONCLUSIONS BFECT results in superior clinical and cognitive outcomes than BTECT in schizophrenia patients referred for ECT Abstract : This prospect i ve study assessed the influence of resistance to antidepressant pharmacotherapy on the short-term response to subsequent electroconvulsive therapy ( ECT ) . Previous research has shown that patients with medication resistance were less likely to respond to ECT . This finding may be applicable to the population of depressed in patients in The Netherl and s , where ECT is often preceded by several medication trials . Eighty-five patients ( 61 female and 24 male patients ) with DSM-IV criteria for depressive disorder , both with and without mood congruent psychotic features , were included for analysis . Medication resistance was rated with the Antidepressant Treatment History Form . Medication resistance was predefined in accordance with the previous research in this field . When a reduction of at least 50 % on the 17-item version of the Hamilton Rating Scale for Depression ( HRSD ) between pre- and post-ECT is used as response criterion , medication-resistant patients were equally likely to respond to subsequent ECT ( 30/48 = 82.5 % ) than patients without medication resistance ( 30/37 = 81.1 % ) . Even when post-ECT HRSD score ≤7 was used ( full remission ) , there was no significant difference between medication-resistant patients ( 21/48 = 43.8 % ) and patients without medication resistance ( 15/37 = 40.5 % ) . When potential confounding variables were taken into account , these differences remain nonsignificant . In contrast to earlier research , medication resistance does not influence short-term response to subsequent ECT and it can still be of considerable efficacy BACKGROUND Although electroconvulsive therapy ( ECT ) has been shown to be extremely effective for the acute treatment of major depression , it has never been systematic ally assessed as a strategy for relapse prevention . OBJECTIVE To evaluate the comparative efficacy of continuation ECT ( C-ECT ) and the combination of lithium carbonate plus nortriptyline hydrochloride ( C-Pharm ) in the prevention of depressive relapse . DESIGN Multisite , r and omized , parallel design , 6-month trial performed from 1997 to 2004 . SETTING Five academic medical centers and their outpatient psychiatry clinics . PATIENTS Two hundred one patients with Structured Clinical Interview for DSM-IV-diagnosed unipolar depression who had remitted with a course of bilateral ECT .  INTERVENTIONS R and om assignment to 2 treatment groups receiving either C-ECT ( 10 treatments ) or C-Pharm for 6 months . MAIN OUTCOME MEASURE Relapse of depression , compared between the C-ECT and C-Pharm groups . RESULTS In the C-ECT group , 37.1 % experienced disease relapse , 46.1 % continued to have disease remission at the study end , and 16.8 % dropped out of the study . In the C-Pharm group , 31.6 % experienced disease relapse , 46.3 % continued to have disease remission , and 22.1 % dropped out of the study . Both Kaplan-Meier and Cox proportional hazards regression analyses indicated no statistically significant differences in overall survival curves and time to relapse for the groups . Mean + /- SD time to relapse for the C-ECT group was 9.1 + /- 7.0 weeks compared with 6.7 + /- 4.6 weeks for the C-Pharm group ( P = .13 ) . Both groups had relapse proportions significantly lower than a historical placebo control from a similarly design ed study . CONCLUSIONS Both C-ECT and C-Pharm were shown to be superior to a historical placebo control , but both had limited efficacy , with more than half of patients either experiencing disease relapse or dropping out of the study . Even more effective strategies for relapse prevention in mood disorders are urgently needed BACKGROUND In treatment-resistant schizophrenia a combination of ECT with antipsychotics has been reported to have superior outcomes compared to other strategies , however the results were inconsistent . We investigated the long-term effects of the combination of unilateral , non-dominant hemisphere ECT with three antipsychotics . SUBJECTS AND METHODS The clinical study was a naturalistic , prospect i ve , open-labeled , active-controlled study in adult out patients of both genders suffering from treatment-resistant schizophrenia with a follow up of 2 years . The patients received sulpiride ( n=17 , 100 - 400mg/day , PO ) , risperidone ( n=26 , 2 - 8 mg/day , PO ) or olanzapine ( n=27 , 5 - 10mg/day , PO ) . Unilateral ECT was applied in 1 unit ( 0.5A , 0.8 mS ) in six single applications , once a week and further according to the clinical need , in fortnight steps . Clinical efficacy was established using the PANSS and CGI psychometric scales . RESULTS According to the results , the most effective treatment mode was olanzapine plus ECT , then risperidone plus ECT , while sulpiride plus ECT had lower clinical efficacy . Olanzapine plus ECT was significantly superior in all scale scores vs sulpiride plus ECT , as well as risperidone plus ECT except for PANSS-P ( t=1.85 , p>0.05 ) . During the study , 38 of 70 patients were withdrawn due to treatment failure ( n=21 ) , side effects ( n=6 ) and non-compliance ( n=11 ) . CONCLUSION The combination of novel antipsychotics and ECT can be used safely and effectively in treatment-resistant schizophrenia CONTEXT Medication resistance is the leading indication for use of electroconvulsive therapy ( ECT ) in major depression . The practice of stopping antidepressant medications prior to ECT derived from studies in the 1960s and 1970s in nonresistant sample s. There is also continuing controversy regarding the relative efficacy and adverse effects of right unilateral and bilateral ECT . OBJECTIVE To test the hypotheses that , compared with placebo , concomitant treatment with nortriptline or venlafaxine during the ECT course enhances short-term efficacy without a meaningful effect on adverse effects and reduces the rate of post-ECT relapse , and to test the hypotheses that high-dose , right-sided , unilateral ECT is equivalent in efficacy to moderate-dosage bilateral ECT and retains advantages with respect to cognitive adverse effects . DESIGN Prospect i ve , r and omized , triple-masked , placebo-controlled study conducted from 2001 through 2005 . SETTING Three university-based hospitals . PATIENTS Of approximately 750 consecutive patients referred for ECT , 319 with a major depressive episode consented , were r and omized to pharmacological or ECT treatment conditions , and received at least 1 ECT treatment . MAIN OUTCOME MEASURES Scores on the Hamilton Rating Scale for Depression , remission rate following completion of ECT , and selective measures of cognitive adverse effects . RESULTS Treatment with nortriptyline enhanced the efficacy and reduced the cognitive adverse effects of ECT relative to placebo . Venlafaxine result ed in a weaker degree of improvement and tended to worsen cognitive adverse effects . High-dosage right unilateral ECT did not differ or was superior to bilateral ECT in efficacy and result ed in less severe amnesia . CONCLUSIONS The efficacy of ECT is substantially increased by the addition of an antidepressant medication , but such medications may differ in whether they reduce or increase cognitive adverse effects . High-dose , right-sided , unilateral ECT is at least equivalent to moderate-dosage bilateral ECT in efficacy , but retains advantages with respect to cognitive adverse effects Background & objectives : In recent years , health-related quality of life ( QOL ) has been regarded as the most important dimension of outcome in schizophrenia . Recent research has shown that atypical antipsychotics improve QOL in patients with schizophrenia . Importance of electroconvulsive therapy ( ECT ) has been demonstrated in restoring function and health related quality of life in depressed patients . However , there are no data on patients of schizophrenia . The objective of the present study was therefore , to assess the improvement in quality of life after ECT in treatment resistant schizophrenia . Methods : Thirty consecutive patients of treatment resistant schizophrenia were given ECT sessions twice a week and assessment s were made with Positive and Negative Syndrome Scale of Schizophrenia ( PANSS ) , WHO QOL Bref , Global Assessment of Functioning Scale and Clinical Global Impressions . Results : The group improved significantly on all the domains of quality of life scale except the domain named satisfaction with social relations . There was also significant change in the total score of PANSS after 6 ECT sessions ( mean at baseline = 86.7 , mean after 6 ECT = 65.5 , P < 0.001 ) as well as on different subscales of PANSS . The score on the global assessment of functioning also changed significantly ( mean 26.3 at baseline to 44.5 after 6 ECT sessions ) . Interpretation & conclusions : The present findings showed that ECT in addition to improvement in symptomatology led to improvement in QOL in patients of treatment resistant schizophrenia BACKGROUND To treat patients suffering from major depressive disorder ( MDD ) , research has focused on electroconvulsive therapy ( ECT ) and aerobic exercise training ( AET ) . Brain derived neurotrophic factor ( BDNF ) seems to be key in MDD . The aims of the present study were therefore two-fold , to investigate in a three-arm interventional study the differential effects of ECT , ECT plus AET , and AET alone in patients suffering from TR-MDD on 1 . depressive symptoms and 2 . plasma BDNF ( pBDNF ) . METHODS 60 patients with MDD ( mean age : 31 years ; 31.6 % female patients ) were r and omly assigned either to the ECT , ECT + AET , or AET condition . The AET condition consisted of treadmill exercise for 45 min , three times a week . Both depression severity and pBDNF levels were assessed at baseline and 4 weeks later . All patients were further treated with an SSRI st and ard medication . RESULTS pBDNF levels increased over time in all three study conditions , though , highest increase was observed in the ECT + EAT condition , and lowest increase was observed in the AET condition . Depressive symptoms decreased in all three conditions over time , though , strongest decrease was observed in the ECT + AET condition . The combination of ECT + AET led to significantly greater remission rates than in either the ECT or AET alone conditions . BDNF levels were not associated with symptoms of depression . CONCLUSIONS The pattern of results suggests that ECT , AET and particularly their combination are promising directions for the treatment of patients suffering from MDD , and that it remains unclear to what extent pBDNF is key and a reliable biomarker for MDD BACKGROUND To treat patients suffering from treatment-resistant major depressive disorder ( TR-MDD ) , research has focused on electroconvulsive therapy ( ECT ) and aerobic exercise training ( AET ) .  Brain derived neurotrophic factor ( BDNF ) seems to be key in MDD . The aims of the present study were therefore two-fold , to investigate in a three-arm interventional study the differential effects of ECT , ECT plus AET , and AET alone in patients suffering from TR-MDD on 1 . depressive symptoms and 2 . BDNF METHODS 60 patients with TR-MDD ( mean age : 31 years ; 31.6 % female patients ) were r and omly assigned either to the ECT , ECT + AET , or AET condition . The AET condition consisted of treadmill exercise for 30 min , three times a week . Both depression severity and BDNF levels were assessed at baseline and 4 weeks later . All patients were further treated with an SSRI st and ard medication . RESULTS BDNF levels increased over time in all three study conditions . After completion of the intervention program , the ECT group showed significantly higher BDNF levels compared to the ECT + AET and the AET conditions . Depressive symptoms decreased in all three conditions over time . The combination of ECT + AET led to a significantly greater decrease than in either the ECT or AET alone conditions . BDNF levels were not associated with symptoms of depression . CONCLUSIONS The pattern of results suggests that ECT , AET and particularly their combination are promising directions for treatment patients suffering from TR-MDD , and that it remains unclear to what extent BDNF is key and a reliable biomarker for TR-MDD The efficacy of ECT was investigated in a double-blind trial . Twenty-two patients with schizophrenia received trifluoperazine and were r and omly allocated to receive eight real or eight simulated ECTs . In the first eight weeks , the group receiving real ECTs showed significantly more improvement as measured on the Brief Psychiatric Rating Scale . However , the groups showed no significant differences from the twelfth week onwards . The superiority of real ECT was not confirmed at the end of six months Objectives Studies now provide strong evidence that the N-methyl-D-aspartate receptor antagonist ketamine possesses rapidly acting antidepressant properties . This study aim ed to determine if a low dose of ketamine could be used to expedite and augment the antidepressant effects of electroconvulsive therapy ( ECT ) treatments in patients experiencing a severe depressive episode . Material s and Methods Subjects with major depressive disorder or bipolar disorder referred for ECT treatment of a major depressive episode were r and omized to receive thiopental alone or thiopental plus ketamine ( 0.5 mg/kg ) for anesthesia before each ECT session . The Hamilton Depression Rating Scale ( HDRS ) was administered at baseline and at 24 to 72 hours after the first and sixth ECT sessions . Results Electroconvulsive therapy exerted a significant antidepressant effect in both groups ( F2,24 = 14.35 , P < 0.001 ) . However , there was no significant group effect or group-by-time interaction on HDRS scores . In addition , post hoc analyses of the time effect on HDRS showed no significant HDRS reduction after the first ECT session for either group . Conclusions The results of this pilot study suggest that ketamine , at a dose of 0.5 mg/kg , given just before ECT , did not enhance the antidepressant effect of ECT . Interestingly , the results further suggest that the coadministration of ketamine with a barbiturate anesthetic and ECT may attenuate the immediate antidepressant effects of the N-methyl-D-aspartate antagonist The short-term outcome of electroconvulsive therapy ( ECT ) was studied in 24 patients with a current major depressive episode ( DSM-IV ) . Patients were r and omized to high dose ( 400 % above the seizure threshold ) right unilateral ( RUL ) ECT , to moderate dose ( 150 % above seizure threshold ) RUL ECT , and to low dose ( just above seizure threshold ) bifrontal ( BF ) ECT . Primary outcome measures included number of treatments , Hamilton Depression Rating Scale score , and Mini-Mental State Examination score . High dose RUL ECT was associated with a significantly faster response to treatment than low dose BF ECT . Moreover , there was a tendency to a higher response rate with high dose RUL ECT compared with either moderate dose RUL ECT or BF ECT OBJECTIVE Repetitive transcranial magnetic stimulation ( rTMS ) has been reported to be as effective as electroconvulsive therapy ( ECT ) for major depression . The authors conducted a multicenter r and omized , controlled trial to test the equivalence of rTMS with ECT . METHOD Forty-six patients with major depression referred for ECT  were r and omly assigned to either a 15-day course of rTMS of the left dorsolateral prefrontal cortex ( N=24 ) or a st and ard course of ECT ( N=22 ) . The primary outcome measures were the score on the 17-item Hamilton Depression Rating Scale ( HAM-D ) and the proportion of patients with remissions ( Hamilton score , < or=8 ) at the end of treatment . Secondary outcomes included mood self-ratings on the Beck Depression Inventory-II and visual analogue mood scales , Brief Psychiatric Rating Scale ( BPRS ) score , and both self-reported and observer-rated cognitive changes . The patients were followed up after 6 months . RESULTS HAM-D scores at the end of treatment were significantly lower for ECT , with 13 patients ( 59.1 % ) achieving remission in the ECT group and four ( 16.7 % ) in the rTMS group . However , at 6 months the HAM-D scores did not differ between groups . Beck scale , visual analogue mood scale , and BPRS scores were lower for ECT at the end of treatment and remained lower after 6 months . Self- and observer-rated cognitive measures were similar in the two groups . CONCLUSIONS rTMS was not as effective as ECT , and ECT was substantially more effective for the short-term treatment of depression BACKGROUND Remission of illness in patients with major depressive disorder ( MDD ) is achieved in less than half of patients initially treated with medication . Electroconvulsive therapy ( ECT ) is another treatment option . We report the speed of response and remission rates in a cohort of depressed patients who received a course of acute-phase ECT in the initial phase of an ongoing multicenter r and omized trial of continuation ECT versus pharmacotherapy .  METHOD Patients with MDD according to DSM-IV criteria received bilateral ECT 3 times weekly . Prior to each treatment , a 24-item Hamilton Rating Scale for Depression ( HAM-D-24 ) score was obtained by a clinical rater . Sustained response was defined as a > or = 50 % reduction in baseline HAM-D-24 score for at least 2 and all subsequent measurement occasions . Remission was defined as HAM-D-24 scores of < or = 10 for at least the last 2 consecutive assessment s. Data were collected from May 1997 through November 2000 . RESULTS Of the 253 patients who entered the study , 86 % ( N = 217 ) completed the acute course of  ECT .  Sustained response occurred in 79 % of the sample , and remission occurred in 75 % of the sample ( N = 253 ) ; 34 % ( 85/253 ) of patients achieved remission at or before ECT # 6 ( week 2 ) , and 65 % ( 164/253 ) achieved remission at or before ECT # 10 ( weeks 3 - 4 ) . Over half ( 54 % ; 136/253 ) had an initial first response by ECT # 3 ( end of week 1 ) . CONCLUSION ECT was associated with rapid response and remission in a high percentage of patients . ECT warrants early consideration in treatment algorithms for patients with MDD Electroconvulsive therapy ( ECT ) in the treatment of schizophrenia was evaluated in a double-blind trial ; the clinical change after ECT was compared with that after a treatment procedure identical to it but for two exceptions -- no electricity was used and no convulsion was induced . All patients had paranoid schizophrenia according to Present State Examination criteria and all received st and ard doses of neuroleptics for at least 2 weeks before r and om assignment to the two groups . 20 patients completed the trial : 10 had ECT and 10 were in the control group .  Treatment was given three times a week , with a minimum of eight treatments and a maximum of twelve . Clinical change was assessed by the Comprehensive Psychiatric Rating Scale . Both groups improved but the improvement of patients receiving ECT was significantly greater than that of controls both after six treatments ( p=0.02 ) and at the end of treatment ( p=0.004 ) . Thus the group receiving ECT gained a clear and early advantage compared with the control group , although by 16 weeks there was little difference between the two groups . Possible reasons for this are discussed Major depression is a common mental health problem and associated with significant morbidity and mortality , including impaired social and physical functioning and increased risk for suicide . Electroconvulsive therapy ( ECT ) is highly efficacious in treatment-resistant depressive disorders , but cognitive side effects are frequently associated with the treatment . Magnetic seizure therapy ( MST ) is a form of convulsive therapy , using magnetic fields in order to induce therapeutic seizures . First studies suggested that cognitive side effects of MST , including postictal recovery time , are more benign than those result ing from ECT treatment . In this open-label study we tested the hypothesis that MST is associated with clinical ly significant antidepressant effects in treatment-resistant depression ( TRD ) as an add-on therapy to a controlled pharmacotherapy . Twenty patients suffering from TRD were r and omly assigned to receive either MST or ECT  starting from July 2006 until November 2008 . Primary outcome measure was antidepressant response assessed by Montgomery Åsberg Depression Scale . Secondary outcome measures included Hamilton Depression Rating Scale , Hamilton Anxiety Scale , Beck Depression Inventory and 90-Item Symptom Checklist . Antidepressant response ( improvement of 50 % in MADRS ratings ) was statistically significant and of similar size in both treatment groups . Cognitive side effects were observed in neither group . Characteristics in MST- and ECT-induced seizures were comparable , especially regarding ictal activity and postictal suppression . Thus , MST may be a potential alternative to ECT if efficacy and safety are vali date d in larger clinical trials OBJECTIVE To investigate if repetitive transcranial magnetic stimulation ( rTMS ) was as effective as electroconvulsive therapy ( ECT ) in treating major depressive episodes and to perform a cost-effectiveness analysis . DESIGN A single-blind pragmatic multicentre r and omised controlled trial ( RCT ) with 6 months of follow-up to test equivalence of rTMS with ECT . SETTING The South London and Maudsley NHS Trust and Pembury Hospital in the Invicta Mental Health Trust in Kent . PARTICIPANTS Right-h and ed adult patients referred for ECT for treatment of a major depressive episode ( DSM-IV ) were assessed . During the 2.5-year trial period , 260 patients were referred for ECT , of whom 46 entered the trial . The main reason for not entering the trial was not consenting to ECT while being formally treated under the UK Mental Health Act 1983 . INTERVENTIONS Patients were r and omised to receive a 15-day course of rTMS of the left dorsolateral prefrontal cortex ( n = 24 ) or a course of ECT ( n = 22 ) . MAIN OUTCOME MEASURES Patients were assessed before r and omisation , at end of treatment and at the 6-month follow-up . Primary outcome measures were the 17-item Hamilton Rating Scale for Depression ( HRSD ) and proportion of remitters ( defined as HRSD score < or=8 ) at the end-of-treatment time point . Secondary outcomes included self-ratings for mood on the Beck Depression Inventory-II ( BDI-II ) and visual analogue mood scales ( VAMS ) , the Brief Psychiatric Rating Scale ( BPRS ) , plus subjective and objective side-effects . Low scores on the BDI-II , VAMS and BPRS are positive in terms of health . The results were analysed on an intention-to-treat basis . Cost data were collected using the Client Service Receipt Inventory and the Short Form with 36 Items was used to obtain quality of life measures . Health economic outcomes were cost of treatments , costs incurred during the 6-month follow-up period and gains in quality -adjusted life-years ( QALYs ) . RESULTS One patient was lost to follow-up at end of treatment and another eight at 6 months . The end-of-treatment HRSD scores were lower for ECT , with 13 ( 59 % ) achieving remission compared with four ( 17 % ) in the rTMS group . However , HRSD scores did not differ between groups at 6 months . BDI-II , VAMS and BPRS scores were lower for ECT  at end of treatment and remained lower after 6 months . Improvement in subjective reports of side-effects following ECT correlated with antidepressant response . There was no difference between the two groups before or after treatment on global measures of cognition . Although individual treatment session costs were lower for rTMS than ECT , the cost for a course of rTMS was not significantly different from that for a course of ECT as more rTMS sessions were given per course . Service costs were not different between the groups in the subsequent 6 months but informal care costs were significantly higher for the rTMS group and contributed substantially to the total cost for this group during the 6-month follow-up period . There also was no difference in gain in QALYs for ECT and rTMS patients . Analysis of cost-effectiveness acceptability curves demonstrated that rTMS has very low probability of being more cost-effective than ECT . CONCLUSIONS ECT is a more effective and potentially cost-effective antidepressant treatment than 3 weeks of rTMS as administered in this study . Optimal treatment parameters for rTMS need to be established for treating depression . More research is required to refine further the administration of ECT in order to reduce associated cognitive side-effects while maintaining its effectiveness . There is a need for large-scale , adequately powered RCTs comparing different forms of ECT . The next generation of r and omised trials of rTMS should also seek to compare treatment variables such as stimulus intensity , number of stimuli administered and duration of treatment , with a view to quantifying an effect size for antidepressant action BACKGROUND Controversy persists about the use of right unilateral ( RUL ) and bilateral ( BL ) electroconvulsive therapy ( ECT ) . While RUL ECT results in less severe short-term and long-term cognitive effects , there is concern that it is less efficacious than BL ECT . METHODS In a double-blind study , 80 depressed patients were r and omized to RULECT  , with electrical dosages 50 % , 150 % , or 500 % above the seizure threshold , or BL ECT , with an electrical dosage 150 % above the threshold . Depression severity and cognitive functioning were assessed before , during , immediately after , and 2 months after ECT . Compared with baseline , responders had at least a 60 % reduction in symptom scores 1 week after ECT , and were monitored for relapse for 1 year . RESULTS High-dosage RUL and BL ECT were equivalent in response rate ( 65 % ) and approximately twice as effective as low-dosage ( 35 % ) or moderate-dosage ( 30 % ) unilateral ECT . During the week after the r and omized phase , BL ECT result ed in greater impairment than any dosage of unilateral ECT in several measures of antero grade and retro grade memory . Two months after ECT , retro grade amnestic deficits were greatest among patients treated with BL ECT . Thirty-three ( 53 % ) of the 62 patients who responded to ECT relapsed , without treatment group differences . The relapse rate was greater in patients who had not responded to adequate pharmacotherapy prior to ECT and who had more severe depressive symptoms after ECT . CONCLUSION Right unilateral ECT at high dosage is as effective as a robust form of BL ECT , but produces less severe and persistent cognitive effects Background : Electroconvulsive therapy ( ECT ) is one of the available and the most effective therapies for the treatment of resistant depression . Considering the crucial role of seizure duration on therapeutic response in patients treated with ECT , this study aim ed to compare the effect of ketamine and sodium thiopental anesthesia during ECT for treatment of patients with drug-resistant major depression ( DRMD ) . Material s and Methods : In a double-blind r and omized clinical trial , 160 patients with DRMD were selected consequently and were assigned r and omly into two groups including ketamine 0.8 mg/kg and sodium thiopental 1.5 mg/kg . The seizure duration , recovery time , and the side effects of anesthesia were evaluated after 1-h after anesthesia . Data of recovery time and complication collected in 2nd , 4th , 6th , and 8th ECT . Depression was assessed by Hamilton depression scale . Results : The results indicated that ketamine and sodium thiopental had a significant effect on the reduction of depression scores in patients with DRMD ( P < 0.05 ) . Complications such as a headache , nausea , pain at the injection site , short-term delirium , and long-term delirium were higher in ketamine group ( P > 0.05 ) . But ketamine was more effective in improvement of depression score and increasing systolic and diastolic blood pressure ( P < 0.05 ) . The mean of seizure duration showed a decreasing trend and was significant between two study groups ( P < 0.05 ) . Conclusion : Anesthesia induced by ketamine during ECT therapy increased blood pressure and seizure duration . Therefore , due to lower medical complication and attack rate of seizure , ketamine is an appropriate option for anesthesia with ECT in patients with DRMD BACKGROUND Electroconvulsive therapy ( ECT ) is one of the most effective treatments for severe depression . However , little is known regarding brain functional processes mediating ECT effects . METHOD In a non-r and omized prospect i ve study , functional magnetic resonance imaging data during the automatic processing of subliminally presented emotional faces were obtained twice , about 6 weeks apart , in patients with major depressive disorder ( MDD ) before and after treatment with ECT ( ECT , n = 24 ) . Additionally , a control sample of MDD patients treated solely with pharmacotherapy ( MED , n = 23 ) and a healthy control sample ( HC , n = 22 ) were obtained . RESULTS Before therapy , both patient groups equally showed elevated amygdala reactivity to sad faces compared with HC . After treatment , a decrease in amygdala activity to negative stimuli was discerned in both patient sample s indicating a normalization of amygdala function , suggesting mechanisms potentially unspecific for ECT . Moreover , a decrease in amygdala activity to sad faces was associated with symptomatic improvements in the ECT sample ( r spearman = -0.48 , p = 0.044 ) , and by tendency also for the MED sample ( r spearman = -0.38 , p = 0.098 ) . However , we did not find any significant association between pre-treatment amygdala function to emotional stimuli and individual symptom improvement , neither for the ECT sample , nor for the MED sample . CONCLUSIONS In sum , the present study provides first results regarding functional changes in emotion processing due to ECT treatment using a longitudinal design , thus validating and extending our knowledge gained from previous treatment studies . A limitation was that ECT patients received concurrent medication treatment
RESULTS The most common indication for using ECT for schizophrenia patients was to augment pharmacotherapy , while the most common accompanying symptoms were , in order , catatonia , aggression and suicide .
Catatonic patients responded significantly better to ECT than patients with any other subtype of schizophrenia .
The combination of ECT with pharmacotherapy can be useful for drug-resistant patients .
The use of an ECT-risperidone combination or ECT-clozapine combination in patients non-responsive to prior pharmacotherapy was found to be most effective .
This review indicates that ECT , combined with pharmacotherapy , may be a viable option for a selected group of patients with schizophrenia .
In particular , the use of ECT is recommended for drug-resistant patients , for schizophrenic patients with catatonia , aggression or suicidal behavior  , and when rapid global improvement and reduction of acute symptomatology are required
BACKGROUND Electroconvulsive therapy ( ECT ) is a medical treatment that is most effective for mood disorders ( Bipolar Disorder and Major Depression ) .
It has also been shown to be an effective treatment for schizophrenia accompanied by catatonia , extreme depression , mania and other affective components .
ECT is currently under-used in many psychiatric setting s due to its stigmatized perception by patients and mental health professionals .
However , many unanswered questions remain regarding its role in the management of patients with schizophrenia .
AIM Evaluate the main indications of ECT in subjects suffering from schizophrenia .
OBJECTIVES Investigate the efficacy and the main indications of  ECT in the treatment of schizophrenic patients , evaluate its effects in the short-term and the long-term , compare ECT treatment with pharmacotherapy , and assess the effects of treatment with ECT .