Electroconvulsive therapy research presentation for Faculty Mentorship Program at University of California, San Diego 2013.

1. Safety & efficacy of
electroconvulsive therapy FOR
patients with depression w/
traumatic brain injury
howard realubit
pi: david printz, MD
CO-pi: mark Jacobson, phd
Thursday, November 21, 13

2. overview of ect
• Overall goal: determine if veterans with TBI
respond differently to treatment for depression
(ECT) compared to those with no TBI
• Why? Very little research completed on the
complications of ECT treatment for patients w/TBI
• Why Now? Large numbers of returning veterans
with concussions & mental health issues
• How? Compare levels of depression & cognitive
performance baseline, mid-treatment phase, after
ECT completion to understand group differences
Thursday, November 21, 13

3. history of
electroconvulsive therapy (ect)
• since 1938 - safely used
on pregnant women,
children, and the
elderly
• Mood Disorders
(Bipolar, Major
Depression), Catatonia
Thursday, November 21, 13
Ugo
Cerle)
(1877-­‐1963)

4. va & nih endorsement
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5. Text
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6. Study Design
Baseline
MDD + TBI
ECT #6 Final ECT
ECT
Treatments
MDD w/out TBI
= Cognition and Depression Assessments
Thursday, November 21, 13
1 Mos Post
ECT
3 Mos Post
ECT

7. study design
ECT treatments
Baseline
ECT #6
1 Mos Post
ECT
Final ECT
No ECT
3 Mos Post
ECT
Depression + TBI
Depression Only
0
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20
40

8. treatment of depression
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9. treatment of depression
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10. traumatic brain injury (tbi)
• mild to moderate
• severe
• open vs. closed
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11. ect is underutilized
Annual&Prevalence&of&MDD&(in&millions)&
MDD,#Rx#Responsive#
18#
3#
MDD,#Rx#Non4responsive#
ECT#
0.1#
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12. patient demographic
• influx of veteran population with
depression and TBI
• VA La Jolla has highest number of
returning veterans with concussion:
20,800 possible TBI <8 years.
Confirmed 1200. *Veterans Affairs TBI
Screening Data
• {statistical data
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13. ect procedure
• pad placements
• anesthesia/muscle relaxant
• EEG
• seizure duration
• recovery
• cognition & mood
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14. ECT Procedure
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15. ect procedure
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16. ect procedure
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17. ect procedure
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18. ect procedure
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19. theory of ect mechanisms
• EEG reading
• Ictal
therapeutic
seizure
reading
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20. ect procedure
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21. theory of ect mechanisms
• “reboot
theory”
• neurotransm
itters
reference: Electroconvulsive & Modulation Therapies (Swartz)
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22. gathering data
• SLUMS/QIDS test
• MOCA test
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23. Thursday, November 21, 13

24. data interpretation
• !!Overall!Design:!2!group,!observa4onal!(correla4onal)!study!
with!repeated!measures!(Baseline,!post?ECT,!Follow?up)!
• !Step%1:!Comparison!of!group!characteris3cs!to!establish!
similari3es/differences!in!demographic!variables!like!gender,!age,!
educa3on,!diagnoses,!etc.!!Differences!may!be!used!as!co?variates.!
• !!How?!Sta3s3cal!comparison!using!mostly!non?parametric!!!!!!!!!!!
2?sample!tests!given!qualita3ve/!ordinal!level!of!data:!!
• !Tested!with!Mann?Whitney!U!test,!or!Chi?Square!tests!for!similarity!of!
group!means!or!distribu3on!
• !Step%2:!Comparison!of! outcome !variables!like!Depression!
Scales,!or!Cogni3ve!Measures!(MoCA)!!!
• !How?!Repeated!Measures!Analysis!of!Variance!(ANOVA)!to!
iden3fy!if!performance!on!tests!and!ques3onnaires!varies!over!3!
3me!points,!and!if!they!differ!between?groups.!!
• !Tested!with!F!sta3s3c;!!Post?Hoc!follow!up!tes3ng!can!iden3fy!group!
by!3me!interac3ons,!trends.!
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25. The future
• less reliance on medication
• fast outpatient procedures
• more options for the veteran
• shorter hospital stays
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26. questions?
• Howard Realubit
(hrealubi@ucsd.edu)
• David Printz, MD
(dprintz@ucsd.edu)
• Mark Jacobson, PhD
(mark.jacobson@va.gov)
Thursday, November 21, 13