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- Kronsell, Alexander, et al.
(author)
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Less memory complaints with reduced stimulus dose during electroconvulsive therapy for depression
- 2019
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In: Journal of Affective Disorders. - : Elsevier. - 0165-0327 .- 1573-2517. ; 259, s. 296-301
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Journal article (peer-reviewed)abstract
- 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.
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| 3. |
- Kronsell, Alexander, et al.
(author)
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Long-term follow-up on patient attitudes towards renewed ECT : A register-based cohort study
- 2024
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In: Journal of Psychiatric Research. - : Elsevier. - 0022-3956 .- 1879-1379. ; 177, s. 24-30
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Journal article (peer-reviewed)abstract
- Electroconvulsive therapy (ECT) is a safe and effective treatment for major depressive disorder (MDD). After receiving ECT for MDD there is a large risk of relapse within the first year. Patient attitudes towards renewed treatment could impact their decisions regarding future therapy. We conducted a nationwide cohort study, using data from Swedish registers. Patients with MDD who received ECT were followed up to six months after the initial ECT-series. We investigated if certain patient and treatment characteristics during the initial treatment were correlated to their attitude towards renewed ECT at the six-month follow-up. Logistic regression models were used to calculate adjusted odds ratios for predictors. The Bonferroni method was used to adjust significance levels for multiple testing. The study included 1917 patients. 51.1% of patients were positive, 27.6% were undecided and 21.3% were negative towards renewed treatment. Patients with response to treatment were less likely to have a negative attitude towards renewed ECT (odds ratio 0.32, 95% CI 0.25-0.41, P < 0.001). Moreover, patients with experience of ECT prior to the index series were less likely to have a negative attitude towards renewed ECT (odds ratio 0.44, 95% CI 0.34-0.58, P < 0.001). In order to minimize the risk of negative attitudes towards renewed ECT for MDD, treatment should primarily be reserved for patients that are likely to respond to ECT.
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| 4. |
- Kronsell, Alexander, et al.
(author)
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The effect of anaesthetic dose on response and remission in electroconvulsive therapy for major depressive disorder : nationwide register-based cohort study
- 2021
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In: BJPsych Open. - : Royal College of Psychiatrists. - 2056-4724. ; 7:2
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Journal article (peer-reviewed)abstract
- BACKGROUND: Electroconvulsive therapy (ECT) is a safe and effective treatment for major depressive disorder (MDD). ECT treatment effect relies on induced generalised seizures. Most anaesthetics raise the seizure threshold and shorten seizure duration. There are no conclusive studies on the effect of anaesthetic dose on response and remission rates with ECT for MDD.AIMS: We aimed to examine the effect of different dose intervals of anaesthetics on response and remission after ECT for MDD.METHOD: We conducted a nationwide cohort study, using data from Swedish registers. Low-, medium- and high-dose intervals, adjusted for age and gender, were constructed for each anaesthetic drug. Response and remission were measured with the Clinical Global Impression - Severity and Improvement scales (CGI-I and CGI-S), and a self-rated version of the Montgomery-Åsberg Depression Rating Scale (MADRS-S). Logistic regression models were used to calculate adjusted odds ratios for response and remission rates.RESULTS: The study included 7917 patients who received ECT for MDD during 2012-2018. Patients were given either thiopental (64.1%) or propofol (35.9%). Low-dose intervals of anaesthetics were associated with increased rates of response (CGI-I: odds ratio 1.22, 95% CI 1.07-1.40, P = 0.004; MADRS-S: odds ratio 1.31, 95% CI 1.09-1.56, P = 0.004) and remission (CGI-S: odds ratio 1.37, 95% CI 1.17-1.60, P ≤ 0.001; MADRS-S: odds ratio 1.31, 95% CI 1.10-1.54, P = 0.002).CONCLUSIONS: We found improved treatment outcomes with low- compared with high-dose anaesthetic during ECT for MDD. To enhance treatment effect, deep anaesthesia during ECT for MDD should be avoided.
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| 5. |
- Nygren, Adam, et al.
(author)
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Response to electroconvulsive therapy in treatment resistant depression : A nationwide register-based study
- 2022
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In: Pharmacoepidemiology and Drug Safety. - : John Wiley & Sons. - 1053-8569 .- 1099-1557. ; 31:Suppl. 2, s. 310-310
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Journal article (other academic/artistic)abstract
- Background: Electroconvulsive therapy (ECT) is often considered for patients with treatment resistant depression (TRD), as recommended by guidelines from several countries. However, previous studies have shown inconsistent results regarding the response to ECT in patients with TRD.Objectives: To assess and compare the response rate of ECT for patients with TRD to that of other patients with depression (i.e. non-TRD) in a large and clinically representative patient sample. We hypothesized that patients with TRD would have a lower ECTresponse rate than other patients with depression.Methods: Patients ≥18 years old, treated for a unipolar, non-psychotic depressive episode with at least one ECT session as part of a first-time, index ECT series between Jan. 1 2011 and Dec. 31 2017 were identified from the Swedish National Quality Register for ECT, and individually linked with other population-based registers. Patients with any life timediagnosis of bipolar disorder, manicor hypomanic episode, psychotic disorder, or dementia as well as those lacking registration of the primary out-come measure were excluded. Using the Prescribed Drug Register, we classified patients as having TRD if they had initiated a third consecutive trial of antidepressants or add-on medications before starting ECT. Remaining patients were considered to have other depression. The main outcome measure was response to ECT according to the Clinical Global Impressions–Improvement scale (CGI-I) assessed within a week after the ECT series, defined as a CGI-I assessment of ‘much' or ‘very much improved'. Outcome measures were compared between patients with TRD and with other depression using logistic regression to calculate odds ratios of response and corresponding confidence intervals, adjusting for potential confounders including sociodemographic and clinical covariates.Results: A total of 4244 patients were included. Of these, 1121 patients were classified as TRD (61.2% female, mean age 51.4 years) and 3123 (54.3 % female, mean age 50.4 years) patients had other depression. The CGI-I response rate after ECT among patients with TRD was 65.9% compared to 75.9% in other patients with depression (adjusted odds ratio 0.64 [95% CI 0.54–0.75]).Conclusions: A clear majority of patients with TRD as well as patients with other depression responded to ECT, although the response rate was lower in TRD.
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| 6. |
- Nygren, Adam, et al.
(author)
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Response to electroconvulsive therapy in treatment-resistant depression : nationwide observational follow-up study
- 2023
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In: BJPsych Open. - : Royal College of Psychiatrists. - 2056-4724. ; 9:2
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Journal article (peer-reviewed)abstract
- BACKGROUND: Previous studies have not investigated response rates after electroconvulsive therapy (ECT) in patients with non-psychotic treatment-resistant depression (TRD).AIMS: To assess and compare the response rate of ECT for patients with TRD and non-TRD, in a large and clinically representative patient sample.METHOD: Patients aged ≥18 years, who were treated for a unipolar, non-psychotic depressive episode with at least one ECT session as part of a first-time, index ECT series between 1 January 2011 and 31 December 2017 were included from the Swedish National Quality Register for ECT. Patients who had initiated a third consecutive trial of antidepressants or add-on medications before start of ECT were classified as having TRD. Patients not meeting criteria for TRD were classified as non-TRD. The main outcome was response to ECT according to the Clinical Global Impressions - Improvement Scale (CGI-I), scored as 1 or 2 ('very much' or 'much improved' after ECT, respectively). Logistic regression was used to compare outcome measures between TRD and non-TRD, adjusting for potential confounders.RESULTS: A total of 4244 patients were included. Of these, 1121 patients had TRD and 3123 patients had non-TRD. The CGI-I response rate was 65.9% in the TRD group compared with 75.9% in the non-TRD group (adjusted odds ratio 0.64, 95% CI 0.54-0.75). Older age and more severe depression were predictors of response in patients with TRD.CONCLUSIONS: A clear majority of patients with TRD, as well as patients with non-TRD, responded to ECT, although the response rate was somewhat lower for TRD.
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| 8. |
- Svensson, Jonas E., et al.
(author)
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Validity and reliability of extrastriatal [C-11]raclopride binding quantification in the living human brain
- 2019
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In: NeuroImage. - : ACADEMIC PRESS INC ELSEVIER SCIENCE. - 1053-8119 .- 1095-9572. ; 202
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Journal article (peer-reviewed)abstract
- [C-11]raclopride is a well established PET tracer for the quantification of dopamine 2/3 receptors (D2/3R) in the striatum. Outside of the striatum the receptor density is up to two orders of magnitude lower. In contrast to striatal binding, the characteristics of extrastriatal [C-11]raclopride binding quantification has not been thoroughly described. Still, binding data for e.g., neocortex is frequently reported in the scientific literature. Here we evaluate the validity and reliability of extrastriatal [C-11]raclopride binding quantification. Two sets of healthy control subjects were examined with HRRT and [C-11]raclopride: (i) To assess the validity of extrastriatal [C-11]raclopride binding estimates, eleven subjects were examined at baseline and after dosing with quetiapine, a D2/3R antagonist. (ii) To assess test-retest repeatability, nine subjects were examined twice. Non displaceable binding potential (BPND) was quantified using the simplified reference tissue model with cerebellum as reference. Quetiapine dosing was associated with decrease in [C-11]raclopride BPND in temporal cortex (18 +/- 17% occupancy) and thalamus (20 +/- 17%), but not in frontal cortex. Extrastriatal occupancy was lower than in putamen (51 +/- 4%). The mean absolute variation was 4-7% in the striatal regions, 17% in thalamus, and 13-59% in cortical regions. Our data indicate that [C-11]raclopride PET, quantified using cerebellum as reference, is not a suitable tool to measure D2/3R in extrastriatal regions.
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| 9. |
- Talemi, Soheil Rastgou, et al.
(author)
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Systems Level Analysis of the Yeast Osmo-Stat
- 2016
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In: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 6
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Journal article (peer-reviewed)abstract
- Adaptation is an important property of living organisms enabling them to cope with environmental stress and maintaining homeostasis. Adaptation is mediated by signaling pathways responding to different stimuli. Those signaling pathways might communicate in order to orchestrate the cellular response to multiple simultaneous stimuli, a phenomenon called crosstalk. Here, we investigate possible mechanisms of crosstalk between the High Osmolarity Glycerol (HOG) and the Cell Wall Integrity (CWI) pathways in yeast, which mediate adaptation to hyper- and hypo-osmotic challenges, respectively. We combine ensemble modeling with experimental investigations to test in quantitative terms different hypotheses about the crosstalk of the HOG and the CWI pathways. Our analyses indicate that for the conditions studied i) the CWI pathway activation employs an adaptive mechanism with a variable volume-dependent threshold, in contrast to the HOG pathway, whose activation relies on a fixed volume-dependent threshold, ii) there is no or little direct crosstalk between the HOG and CWI pathways, and iii) its mainly the HOG alone mediating adaptation of cellular osmotic pressure for both hyper- as well as hypo-osmotic stress. Thus, by iteratively combining mathematical modeling with experimentation we achieved a better understanding of regulatory mechanisms of yeast osmo-homeostasis and formulated new hypotheses about osmo-sensing.
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| 10. |
- Tangen, Ämma, et al.
(author)
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Associations between cognition and serotonin receptor 1B binding in patients with major depressive disorder : a pilot study
- 2017
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In: Psychiatry Research: Neuroimaging. - Stockholm : Karolinska Institutet, Dept of Clinical Neuroscience. - 0925-4927 .- 1872-7506.
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Journal article (peer-reviewed)abstract
- The neurotransmitter serotonin has been widely implicated in the pathophysiology of major depressive disorder (MDD). In animal studies and human neuroimaging studies, involvement of the serotonin receptor 1B (5-HT1BR) in MDD and memory performance has been reported. However, the role of the 5-HT1BR in cognitive functions affected in MDD remains to be clarified. Ten patients with MDD diagnosis were examined with positron emission tomography (PET) and a battery of cognitive tests before and after Internet-based Cognitive Behavioral Therapy (ICBT). The results were compared to ten matched control subjects in order to investigate putative changes in 5-HT1BR availability and cognitive performance. Patients treated with ICBT showed statistically significant improvement relative to baseline in Verbal fluency, both letter and category production. Significant correlations were found between improvement in letter production and changes in 5-HT1BR availability in ventral striatum, between category production and amygdala, as well as between the improvement in Trailmaking test B and change in 5-HT1BR binding in dorsal brainstem, in amygdala and in hippocampus. The results suggest an association between 5-HT1BR binding and improvement in cognitive functioning. Replications in larger-scale studies are required to confirm these findings.
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