Via Christi Women's Connection presentation on advance in depression treatment by Matthew Macaluso, DO, medical director of Via Christi Psychiatric Clinic.
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Via Christi Women's Connection presentation on advance in depression treatment by Matthew Macaluso, DO, medical director of Via Christi Psychiatric Clinic.
TREATMENT RESISTANT DEPRESSION IS A AREA THAT IS NOT EXPLORED MUCH, BUT IT REALLY NEEDS LOT OF ATTENTION AS IT IS ONE OF THE MOST COMMON OBSTACLE IN ACHIEVING COMPLETE REMISSION IN DEPRESSION
Depression and CV diseases: cardiologist perspectives Essam Mahfouz
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Supercharge your brain and ditch anxiety and depression for good!Patients Medical
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Goldman grand rounds, electroconvulsive therapy (ect)...mysterious rebootLisa E Goldman, MD, MSW
How does ECT work? Is it dangerous? Is it scary? Does it work? What mental health conditions can be effectively treated by ECT? Is it true that ECT works better than prescription antidepressants? What are common side effects of ECT and how are this managed? Has the practice of ECT changed over time? What patient factors are the best predictors of positive and negative outcomes of ECT treatment? Come with me on a journey as I present my grand rounds lecture for the department of psychiatry as I complete my 4th year of psychiatry residency at UTHSC Memphis. These are exciting times. Recovery is definitely an option.
Neuropathic pain poses a challenge to effective rehabilitation. Best practice, considerations & the use of Action Potential Simulation therapy to effectively treat neuropathic pain, sharing our results from a 2 year research project in people with MS.
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Depression and CV diseases: cardiologist perspectives Essam Mahfouz
The presentation discusses the epidemiology, mechanism, screening and diagnosis of depression and cardiovascular disease and how to mange this association
Supercharge your brain and ditch anxiety and depression for good!Patients Medical
Dr. Vivian DeNise of Patients Medical and Dr. Sandlin Lowe of The Amen Clinic New York explain the causes of anxiety and depression, the cutting-edge technology that can be used to diagnose deficiencies in the brain that cause these conditions and several non-invasive holistic medical approaches that we use to treat.
Goldman grand rounds, electroconvulsive therapy (ect)...mysterious rebootLisa E Goldman, MD, MSW
How does ECT work? Is it dangerous? Is it scary? Does it work? What mental health conditions can be effectively treated by ECT? Is it true that ECT works better than prescription antidepressants? What are common side effects of ECT and how are this managed? Has the practice of ECT changed over time? What patient factors are the best predictors of positive and negative outcomes of ECT treatment? Come with me on a journey as I present my grand rounds lecture for the department of psychiatry as I complete my 4th year of psychiatry residency at UTHSC Memphis. These are exciting times. Recovery is definitely an option.
Neuropathic pain poses a challenge to effective rehabilitation. Best practice, considerations & the use of Action Potential Simulation therapy to effectively treat neuropathic pain, sharing our results from a 2 year research project in people with MS.
Neuropathic pain poses a challenge to effective rehabilitation. Best practice, considerations & the use of Action Potential Simulation therapy to effectively treat neuropathic pain, sharing our results from a 2 year research project in people with MS.
Depression (also called major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how we feel, think, and handle daily activities, such as sleeping, eating, or working.
Depression is a common illness worldwide, with an estimated 3.8% of the population affected, including 5.0% among adults and 5.7% among adults older than 60 years. Approximately 280 million people in the world have depression
Similar to Crossroads_Gender and Efficacy of ECT for MDD (20)
Depression and Antidepressant By Muhammad Kamal Hossain.pptx
Crossroads_Gender and Efficacy of ECT for MDD
1. N A T A S H A B O W M A N
Q U E E N ’ S U N I V E R S I T Y
D E P A R T M E N T O F P S Y C H O L O G Y
K I N G S T O N , O N T A R I O
Gender and the Efficacy of
Electroconvulsive Therapy for
Major Depressive Disorder
5. Major Depressive Disorder (MDD)
Occurs along a continuum
Core symptoms of MDD:
Sad, irritable, or anxious mood
6. Major Depressive Disorder (MDD)
Occurs along a continuum
Core symptoms of MDD:
Sad, irritable, or anxious mood
Loss of interest or pleasure
7. Major Depressive Disorder (MDD)
Occurs along a continuum
Core symptoms of MDD:
Sad, irritable, or anxious mood
Loss of interest or pleasure
Impaired concentration and decision making
8. Major Depressive Disorder (MDD)
Occurs along a continuum
Core symptoms of MDD:
Sad, irritable, or anxious mood
Loss of interest or pleasure
Impaired concentration and decision making
Etc.
13. Electroconvulsive therapy (ECT)
Cerebral seizure under general anesthesia
Do not respond to antidepressants
Referral determined by clinical features
14. Electroconvulsive therapy (ECT)
Cerebral seizure under general anesthesia
Do not respond to antidepressants
Referral determined by clinical features
+/- 12 treatments 3x per week
18. Efficacy of ECT
Community hospitals: less effective?
Mechanism of efficacy? hormones, dopamine,
serotonin, grey matter activity
19. Efficacy of ECT
Community hospitals: less effective?
Mechanism of efficacy? hormones, dopamine,
serotonin, grey matter activity
Speed of response: 60% remit by session #9
20. Efficacy of ECT
Community hospitals: less effective?
Mechanism of efficacy? hormones, dopamine,
serotonin, grey matter activity
Speed of response: 60% remit by session #9
Durability of response: maintenance treatment
indicated
22. Rationale for present research
Gender differences in the post-seizure release of
stress hormones
23. Rationale for present research
Gender differences in the post-seizure release of
stress hormones
Gender differences in ECT for schizophrenia
24. Rationale for present research
Gender differences in the post-seizure release of
stress hormones
Gender differences in ECT for schizophrenia
Gender differences in MDD
36. In conclusion ...
Confounding variables?
Age
Previous medication failure
37. In conclusion ...
Confounding variables?
Age
Previous medication failure
Comorbidities
38. In conclusion ...
Confounding variables?
Age
Previous medication failure
Comorbidities
Duration of depressive episode
39. In conclusion ...
Confounding variables?
Age
Previous medication failure
Comorbidities
Duration of depressive episode
Season of treatment
40. In conclusion ...
Confounding variables?
Age
Previous medication failure
Comorbidities
Duration of depressive episode
Season of treatment
Electrode placement
41. In conclusion ...
Confounding variables?
Age
Previous medication failure
Comorbidities
Duration of depressive episode
Season of treatment
Electrode placement
Maintenance drug therapy?
42. In conclusion ...
Confounding variables?
Age
Previous medication failure
Comorbidities
Duration of depressive episode
Season of treatment
Electrode placement
Maintenance drug therapy?
Very important!
43. In conclusion ...
Confounding variables?
Age
Previous medication failure
Comorbidities
Duration of depressive episode
Season of treatment
Electrode placement
Maintenance drug therapy?
Very important!
THANK YOU!!! ... Questions?
Editor's Notes
The present research aims to explore the nature of the relationship between gender and the efficacy of ECT in the treatment of MDD.
Depression occurs along a continuum. As the number of symptoms increases, patients report greater severity of depression, longer depressive episodes, and worse functioning.
The following symptoms were found to be present in 60 percent of patients and are thus regarded as core symptoms of MDD:
Electroconvulsive therapy (ECT) uses a small electric current to produce a cerebral seizure under general anesthesia.
The vast majority of patients receive ECT because they do not respond to or tolerate antidepressant medication.
Referral for ECT is determined by clinical features, such as severity and urgency of current symptoms. Clinicians consider ECT for patients who fail two or three antidepressant medication trials and remain severely depressed for several months.
Treatment guidelines at Providence Care recommend up to 12 treatments (spaced three times per week).
Meta-analyses have found that ECT is more efficacious than any other treatment used for severe major depression. It is estimated that remission occurs in 70 to 90 percent of patients who receive ECT.
The efficacy of ECT in community settings may be substantially less than that reported in clinical trials.
Researchers cite post-seizure increase in stress hormones (cortisol and prolactin), activation of the dopamine system, enhancement of serotonergic neurotransmission, and increased grey matter activity as potential mechanisms of efficacy, but the cause of efficacy is ultimately unknown.
Major depression responds and remits quickly with ECT. Most patients (60%) remit after 9 ECT treatment sessions.
Continuation treatment with antidepressants was found to reduce the risk of relapse by 50 percent. Thus, maintenance treatment is nearly always indicated following a successful course of ECT.
The post-seizure prolactin response is significantly higher in female patients than in male patients. Because the hormonal effect of ECT has been indicated as a potential correlate of the treatment’s efficacy, gender differences in the efficacy of ECT treatment may exist.
ECT is significantly more effective in treating schizophrenia in females than it is in treating schizophrenia in males. As there is an area of overlap between schizophrenia and MDD (the two disorders are often treated with similar medications and preliminary research indicates that they may have a similar genetic etiology), gender differences observed in ECT treatment for schizophrenia might also exist in ECT treatment for MDD.
the clinical presentation of depression varies between males and females, as do depressive sybtypes. We speculated that gender differences in the presentation of MDD might translate into gender differences in the efficacy of treatment for MDD (including ECT).
We expected that ECT treatment would be more effective in female patients than in male patients.
We performed a chart review on the patient records of 157 adult patients (100 females and 57 males) who received ECT treatment at Providence Care in Kingston, Ontario between January 2004 and January 2014. Patients ranged in age from 18-65, and to be included in our analyses they must have received a diagnosis of major depressive disorder (as assessed by a psychiatrist). 96 patients were removed from the analysis due to physician errors in data entry. Consent was given verbally prior to treatment and no compensation was provided
The analyses that we have conducted at this point in time are preliminary and primarily investigative in nature. Our dataset is very large, and we are still in the process of organizing it and understanding it.
A one-way ANOVA was conducted to evaluate the relationship between gender and number of treatment sessions. By our logic, the number of treatment sessions indicated a general level of treatment efficacy: because treatment is stopped when the patient remits, we assumed that the higher the number of treatment sessions for a given patient, the less effective ECT is for that patient. We expected that females would receive fewer treatment sessions than males (indicating greater treatment efficacy).
However, the ANOVA was not significant at the .05 level, meaning that there were no significant difference between the mean number of ECT treatment sessions of men and women.
A one-sample chi-square test was conducted to assess whether there is a gender difference between patients who are either ECT treatment refractory or ECT treatment receptive. For the purposes of our analysis, patients who remitted after fewer than 13 treatments were considered to be treatment receptive, while patients who received 13+ treatments before remitting were considered to be treatment refractory. We based this distinction off of treatment guidelines at Providence Care and our review of the literature. In our sample, 37% of patients remitted after 12 (or fewer) treatment sessions. This disparity is explained by the fact that treatment took place in a community setting as opposed to the tightly controlled environment characteristic of clinical trials.
We expected that men would be more likely to belong to the “treatment refractory” group, and women would be more likely to belong to the “treatment receptive” group.
However, the results of the test were not significant at the .05 level, meaning that no differences were found between male and female patients.
While preliminary analyses seem to indicate that there is no gender difference in the efficacy of ECT treatment for MDD, I would caution you to take these results with a grain of salt because our work with this dataset is far from complete.
We intend to identify and exert statistical control over potentially confounding variables in the near future. Some variables which – based on a review of the literature – we hypothesize might be masking an effect of gender in this population include ...
comorbid psychiatric diagnoses (particularly BPD, psychotic depression, and atypical depression)
Because maintenance drug therapy with antidepressants has been found to reduce the risk of relapse by 50%, I think that it is particularly important for us to obtain information about – and exert statistical control over – patient drug history before drawing any firm conclusions about this population. We are currently working to obtain this information.
This is an important topic because MDD is a severely debilitating (and often life-threatening) illness. Developing an understanding of the various factors which might bolster or lessen the efficacy of MDD treatment is essential if physicians are expected to refer the appropriate patients to the appropriate treatments and maximize every patient’s chance of recovery.
