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Psychiatry

UCLA study looks at mechanisms that make ECT a safe and effective treatment

12/08/2011

CUP-ECT Treatment Electroconvulsive therapy (ECT), a widely misunderstood treatment that uses electrical energy to stimulate the brain, is known to be highly effective at reversing treatment-resistant depression — depression that has not responded adequately to medication or psychotherapy trials. Innovated more than 70 years ago, the once-controversial treatment has undergone major advances in the way it is administered. But many misperceptions about ECT persist, namely that it is a treatment of last resort, done without anesthesia, and that it causes visible seizures and brain damage. In fact, modern ECT has been proven to be a safe and effective treatment, especially for individuals suffering from treatment-resistant depression.

How ECT is administered

ECT treatments involve passing a small electrical current between two electrodes placed on the head in order to produce a monitored, short-duration seizure affecting the entire brain. The electrodes may be placed on both temples, called “bilateral” placement, or on one temple and the top of the head, known as “unilateral” placement. In either case, patients undergoing ECT are always placed under anesthesia and do not suffer any visible seizures or subsequent brain damage from the treatment. Most patients undergo between six and 12 treatments. Side effects include a short period of disorientation, generally resolved in a day, and some memory problems, which tend to dissipate over the course of the treatment, although some patients may experience longer-lasting memory deficits that are not functionally impairing.

UCLA studies probing what makes ECT an effective therapy

While study after study has shown ECT to be an effective therapy for treatment-resistant depression, doctors do not yet know exactly how the treatment works. As the largest academic center on the West Coast that performs ECT, UCLA has been at the forefront of advancing medical understanding of the treatment. UCLA was recently awarded a five-year, $3.5 million grant from the National Institutes of Health to use sophisticated neuro imaging techniques to study brain changes that could explain how the treatment works. The study will involve 60 patients with major depression referred for a series of ECT treatments. Study subjects will receive several types of advanced brain scans at four times — before ECT, after the second treatment, one week after completion of the treatment series and six months post-treatment. Two other pilot studies incorporating gene expression and inflammatory biomarker analyses aim to better characterize how the brain responds to a course of ECT. Specifically, investigators will be seeking a greater understanding of ECT’s effects on neurochemistry, brain connectivity, brain perfusion and brain tissue micro-structures.
In addition to recruiting patients for this major study, UCLA’s ECT Program is available to all patients with treatment-resistant depression. Between 80 and 85 percent of patients undergoing ECT at UCLA report substantial improvement in depressive symptoms following the treatment, compared with an average of 50 percent at most community centers that offer ECT. The UCLA ECT program uses the latest techniques to maximize patient outcomes and minimize side effects, and has a dedicated staff of physicians and nurses to promote collaborative, high-quality care.

Predicting the response to treatment

“There are still a lot of miscon-ceptions about ECT, but it is actually the oldest and most well-documented therapy for major depression,” says Randall Espinoza, M.D., M.P.H., medical director of the Electroconvulsive Therapy Program at the Stewart and Lynda Resnick Neuropsychiatric Hospital at UCLA. “ECT is safe and effective for treatment-resistant depression.”

Dr. Espinoza and Katherine Narr, Ph.D., are principal investigators of a large, NIH-funded study that uses a variety of advanced brain imaging techniques to determine the mechanisms that make ECT an effective therapy for treatment-resistant depression. That study, along with two other pilot studies on ECT, all aim to one day define a “biosignature of depression” that would allow doctors to predict which patients would respond best to ECT or other treatments, Dr. Espinoza says. “Understanding why ECT works might lead us to understand how other therapies need to work or do work for patients who suffer from major depression,” Dr. Espinoza says. “These studies represent a revolutionary approach to understanding depressive illness, as well as specific treatment approaches.”

Participating Physicians

Randall Espinoza, M.D., M.P.H.
Medical Director, Electroconvulsive
Therapy Program
Stewart and Lynda Resnick Neuropsychiatric Hospital at UCLA
Clinical Professor
Division of Geriatric Psychiatry
Department of Psychiatry and Biobehavioral Sciences
David Geffen School of Medicine at UCLA

Katherine Narr, Ph.D.
Laboratory of Neuro Imaging
Assistant Professor Department of Neurology
David Geffen School of Medicine at UCLA

Contact Information
Electroconvulsive Therapy
(310) 267-9147 ECT Service
(800) 825-9989 Resnick NPH Access Center
http://depression.loni.ucla.edu/info-for-participants/





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