ect presentation fmp copy

Safety & efficacy of electroconvulsive therapy FOR

patients with depression w/traumatic brain injury

howard realubitpi: david printz, MD

CO-pi: mark Jacobson, phd

Thursday, November 21, 13

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


history of electroconvulsive therapy (ect)

• since 1938 - safely used on pregnant women, children, and the elderly

• Mood Disorders (Bipolar, Major Depression), Catatonia

Ugo Cerle) (1877-‐1963)


va & nih endorsement


Text


Study Design

MDD + TBI

MDD w/out TBI

Baseline

= Cognition and Depression Assessments

1 Mos Post ECT

Final ECTECT #63 Mos Post

ECT

ECT Treatments


study design

Depression + TBI

Depression Only

0 20 40

ECT treatments No ECT

Baseline ECT #6 Final ECT1 Mos Post

ECT3 Mos Post

ECT


treatment of depression


traumatic brain injury (tbi)

• mild to moderate• severe• open vs. closed


ect is underutilized

18# 3#

0.1#

Annual&Prevalence&of&MDD&(in&millions)&

MDD,#Rx#Responsive#

MDD,#Rx#Non4responsive#

ECT#


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


ect procedure

• pad placements• anesthesia/muscle relaxant• EEG• seizure duration• recovery

• cognition & mood


ECT Procedure


ect procedure


theory of ect mechanisms

• EEG reading• Ictal

therapeutic seizure reading


ect procedure


theory of ect mechanisms

• “reboot theory”

• neurotransmitters

reference: Electroconvulsive & Modulation Therapies (Swartz)


gathering data

• SLUMS/QIDS test• MOCA test


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.!


The future

• less reliance on medication• fast outpatient procedures• more options for the veteran• shorter hospital stays


questions?

• Howard Realubit ([email protected])

• David Printz, MD ([email protected])

• Mark Jacobson, PhD ([email protected])


mailto:[email protected]






ect presentation fmp copy

Health & Medicine

depression ect

ect completion

complications of ect

mos post ect3 mos post

mos post ectfinal ectno

tbi va

depression assessmentsthursday

major depression