D. McLoughlin, Ireland

Trinity College Dublin Psychiatry
Declan M McLoughlin PhD MRCPI MRCPsych FTCD is Research Professor of Psychiatry in St Patrick's University Hospital and Trinity College Dublin, Ireland. He qualified from University College Dublin in 1986 and trained in general medicine and psychiatry in both Dublin and the Institute of Psychiatry, London. Recent research activities include randomised controlled trials of ECT (EFFECT-Dep Study) and ketamine (KEEP-WELL, KARMA-Dep) in severe depression, systematic reviews and meta-analyses, molecular biomarkers (e.g. mRNA, miRNA, telomere length) for depression, plus projects on molecular mechanisms of action of ECT. His work has been supported by the Alzheimer’s Society, Wellcome Trust, NHS Health Technology Assessment Programme, NARSAD, and the Health Research Board.

Moderator Of 1 Session

Clinical/Therapeutic
Date
Sun, 11.04.2021
Session Time
17:30 - 19:00
Room
Channel 7
Session Description
The Live Q&A of this session will take place in the Live Sessions auditorium. Please refer to the interactive programme for the exact time and channel.

Developed over 80 years ago, ECT continues to be the most powerful and acutely effective treatment available for severe, often treatment-resistant, depression. Its use is supported by data from randomised trials and meta-analyses. However, there is still a need to develop better strategies to optimise ECT practice, by identifying both patient-level and treatment-level characteristics that predict therapeutic benefit and minimise side effects. This symposium will be informed by our on-going, or recently completed, clinical studies and trials. We will discuss whether we should focus our attention on the ‘average’ ECT treatment technique that suits the majority of our patients (i.e. “one size fits all”) or tailor the treatment to the needs of individual patients. Pascal Sienaert will discuss the available evidence to guide clinicians in personalising electrode position, dosing strategies and parameter selection, and to make individualised adjustments during the ECT course. Linda van Diermen will identify key clinical elements that predispose to beneficial treatment effects, distinguishing between primary and secondary predictors, and formulate recommendations to aid in patient-treatment matching. Esmee Verwijk will address why outcome measures at the group level do not always fit individual patients and how patients can be helped by preventing and/or treating cognitive side effects. The relatively neglected issue of optimising speed of response to ECT and the role of electrode placement and other clinical factors will be discussed by Declan McLoughlin. Together, the sessions in this symposium will help participants to apply evidence-based methods to personalising ECT practice for their patients.

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Pre-Recorded with Live Q&A

Presenter Of 2 Presentations

Symposium: Personalising ECT for Depression (ID 133) No Topic Needed

Live Q&A

Session Icon
Pre-Recorded with Live Q&A
Date
Sun, 11.04.2021
Session Time
17:30 - 19:00
Room
Channel 7
Lecture Time
18:38 - 18:58
Symposium: Personalising ECT for Depression (ID 133) No Topic Needed

S0061 - Effect of Electrode Placement on Speed of Response to ECT

Session Icon
Pre-Recorded with Live Q&A
Date
Sun, 11.04.2021
Session Time
17:30 - 19:00
Room
Channel 7
Lecture Time
17:30 - 17:47

ABSTRACT

Abstract Body

OBJECTIVE: Electroconvulsive therapy (ECT) can be rapidly effective in treating severe depression. Right unilateral (RUL) or bitemporal (BT) electrode placement may affect the speed of ECT effectiveness although our current understanding of demographic and clinical factors for predicting predict speed of response and remission with ECT is limited. We investigated differences in improvement speed and also time to achieving response and remission criteria between brief-pulse moderate-dose (1.5 x seizure threshold) BT ECT and high-dose (6 x seizure threshold) RUL ECT. Additionally, we explored the influence of demographic and clinical characteristics.
METHODS: We analysed weekly 24-item Hamilton Depression Rating Scale scores obtained from severely depressed patients participating in the EFFECT-Dep trial (ISRCTN23577151). Improvement speeds in patients treated randomly with a course of either BT (n = 69) or RUL ECT (n = 69) were compared using independent sample t-tests. Weekly proportions of responders and remitters were compared using chi-square tests. Cox regression analyses were used to explore predictors of speed to achieve response and remission status.
RESULTS: We found no differences between RUL and BT ECT in speed of improvement or time to achieve response or remission. Exploratory analyses indicated that a wide variety of demographic and clinical features did not serve to predict speed of response and remission to ECT.
CONCLUSION: Electrode placement did not substantially influence speed of improvement, response and remission with twice-weekly brief-pulse ECT. Minimising the cognitive side-effects of ECT may be of more relevance when choosing between BT and RUL electrode placement for ECT.

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