Dataset Information

Computer-Assisted Cognitive Behavior Therapy to Prevent Relapse Following Electroconvulsive Therapy.

ABSTRACT: The goal of this study was to explore the feasibility and potential efficacy of providing computer-assisted cognitive behavior therapy (CCBT) after an index course of electroconvulsive therapy (ECT) to prevent relapse.In an open-label trial, subjects with major depressive episode who achieved response or remission after an acute treatment with ECT were recruited to enroll in a 9-module CCBT course. Subjects completed the CCBT modules in their own home at their own pace, but were asked to do at least 1 lesson per week, such that all 9 lessons would be completed in the first 2 months. Depression severity and relapse were monitored during the 6 months after ECT.Fifteen subjects (10 responders and 5 remitters) enrolled in the study and logged onto the CCBT course. The mean (SD) number of online lessons completed was 7.6 (1.7) or 84% of the total lessons and the mean (SD) time spent working online was 8.4 (3.9) hours. During the first 2 months (the prescribed time period), the mean (SD) number of lessons completed was 6.5 (1.8), or 72% and the mean (SD) time spent working online was 6.8 (3.2) hours. Of the entire sample of responders and remitters (n = 15), 5 (33%) relapsed at 6 months. Of the 5 remitters, none relapsed during this time period.Our results provide preliminary evidence that CCBT is feasible following ECT. Large controlled trials are needed to definitively assess whether this strategy is efficacious in preventing relapse.

SUBMITTER: Wilkinson ST

PROVIDER: S-EPMC5315599 | biostudies-literature | 2017 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Computer-Assisted Cognitive Behavior Therapy to Prevent Relapse Following Electroconvulsive Therapy.

Wilkinson Samuel T ST Ostroff Robert B RB Sanacora Gerard G

The journal of ECT 20170301 1

<h4>Objective</h4>The goal of this study was to explore the feasibility and potential efficacy of providing computer-assisted cognitive behavior therapy (CCBT) after an index course of electroconvulsive therapy (ECT) to prevent relapse.<h4>Methods</h4>In an open-label trial, subjects with major depressive episode who achieved response or remission after an acute treatment with ECT were recruited to enroll in a 9-module CCBT course. Subjects completed the CCBT modules in their own home at their o ...[more]

PMID: 27564424

Similar Datasets

Project description:Electroconvulsive therapy (ECT) employs the elective induction of generalizes seizures as a potent treatment for severe psychiatric illness. As such, ECT provides an opportunity to rigorously study the recovery of consciousness, reconstitution of cognition, and electroencephalographic (EEG) activity following seizures. Fifteen patients with major depressive disorder refractory to pharmacologic therapy will be enrolled (Clinicaltrials.gov, NCT02761330). Adequate seizure duration will be confirmed following right unilateral ECT under etomidate anesthesia. Patients will then undergo randomization for the order in which they will receive three sequential treatments: etomidate + ECT, ketamine + ECT, and ketamine + sham ECT. Sessions will be repeated in the same sequence for a total of six treatments. Before each session, sensorimotor speed, working memory, and executive function will be assessed through a standardized cognitive test battery. After each treatment, the return of purposeful responsiveness to verbal command will be determined. At this point, serial cognitive assessments will begin using the same standardized test battery. The presence of delirium and changes in depression severity will also be ascertained. Sixty-four channel EEG will be acquired throughout baseline, ictal, and postictal epochs. Mixed-effects models will correlate the trajectories of cognitive recovery, clinical outcomes, and EEG metrics over time. This innovative research design will answer whether: (1) time to return of responsiveness will be prolonged with ketamine + ECT compared with ketamine + sham ECT; (2) time of restoration to baseline function in each cognitive domain will take longer after ketamine + ECT than after ketamine + sham ECT; (3) postictal delirium is associated with delayed restoration of baseline function in all cognitive domains; and (4) the sequence of reconstitution of cognitive domains following the three treatments in this study is similar to that occurring after an isoflurane general anesthetic (NCT01911195). Sub-studies will assess the relationships of cognitive recovery to the EEG preceding, concurrent, and following individual ECT sessions. Overall, this study will lead the development of biomarkers for tailoring the cogno-affective recovery of patients undergoing ECT.

Project description:BACKGROUND:Major depressive episode (MDE) is worldwide one of the most prevalent and disabling mental health conditions. In cases of persistent non-response to treatment, electroconvulsive therapy (ECT) is a safe and effective treatment strategy with high response rates. Unfortunately, longitudinal data show low sustained response rates with 6-month relapse rates as high as 50% using existing relapse prevention strategies. Cognitive side effects of ECT, even though transient, might trigger mechanisms that increase relapse in patients who initially responded to ECT. Among these side effects, reduced cognitive control is an important neurobiological driven vulnerability factor for depression. As such, cognitive control training (CCT) holds promise as a non-pharmacological strategy to improve long-term effects of ECT (i.e., increase remission, and reduce depression relapse). METHOD/DESIGN:Eighty-eight patients aged between 18 and 70?years with MDE who start CCT will be included in this randomized controlled trial (RCT). Following (partial) response to ECT treatment (at least a 25% reduction of clinical symptoms), patients will be randomly assigned to a computer based CCT or active placebo control. A first aim of this RCT is to assess the effects of CCT compared to an active placebo condition on depression symptomatology, cognitive complaints, and quality of life. Secondly, we will monitor patients every 2 weeks for a period of 6 months following CCT/active placebo, allowing the detection of potential relapse of depression. Thirdly, we will assess patient evaluation of the addition of cognitive remediation to ECT using qualitative interview methods (satisfaction, acceptability and appropriateness). Finally, in order to further advance our understanding of the mechanisms underlying effects of CCT, exploratory analyses will be conducted using video footage collected during the CCT/active control phase of the study. DISCUSSION:Cognitive remediation will be performed following response to ECT, and an extensive follow-up period will be employed. Positive findings would not only benefit patients by decreasing relapse, but also by increasing acceptability of ECT, reducing the burden of cognitive side-effects. TRIAL REGISTRATION:The study is registered with ClinicalTrials.gov . Study ID: NCT04383509 Trial registration date: 12.05.2020.

Project description:BACKGROUND:Major depressive disorder is a common debilitating illness that is the second leading contributor to the global burden of disease. Unfortunately, about 30 % of patients do not respond to adequate trials of antidepressants and/or psychotherapies. About 45-60 % of such treatment-resistant patients will remit with electroconvulsive therapy (ECT). However, relapse rates are high following ECT-38 % after 6 months. There is a need for better relapse prevention strategies. One possibility is to use ketamine, a competitive glutamate receptor antagonist used for anaesthesia. A recent paradigm shift in treating depression and understanding its biology has been the finding that ketamine has a robust, rapid-onset, though short-lived, antidepressant effect that is possibly mediated through neuroplastic effects. However, ketamine has not previously been reported on for relapse prevention. METHODS/DESIGN:The main objective of this study is to conduct a randomised controlled pilot trial (n?=?40) of a 4-week course of once-weekly ketamine infusions for relapse prevention following ECT for depression to assess trial procedures that will inform a future definitive trial. Participants with unipolar depression will be recruited prior to commencing ECT and be assessed weekly during the ECT course using the primary clinical outcome, the 24-item Hamilton Rating Scale for Depression (HRSD-24). Those who meet standard response criteria will be invited, on completing ECT, to be randomised in a 1:1 ratio to a course of four once-weekly infusions of ketamine or an active comparator midazolam, which mimics some of the effects of ketamine and may improve blinding over inactive placebo. Participants will be followed up over 6 months using the HRSD-24 to assess for relapse. DISCUSSION:This is the first registered trial (NCT02414932, https://clinicaltrials.gov/ct2/show/NCT02414932) of ketamine for depression relapse prevention, an important possible use of this agent. The primary focus of the pilot trial is on feasibility. However, a 95 % confidence interval will be determined for the difference between ketamine and midazolam groups in 6-month relapse rates to help inform a future definitive trial. TRIAL REGISTRATION:https://clinicaltrials.gov/ NCT02414932 Secondary Identifying numbers: EudraCT number: 2014-000339-18 Sponsors' Reference, Sponsor: St. Patrick's Mental Health Services: 05/14 Research Ethics Committee Reference, Joint REC of St James' and Tallaght Hospitals, Dublin: 2014-08-19.

Dataset Information

Computer-Assisted Cognitive Behavior Therapy to Prevent Relapse Following Electroconvulsive Therapy.

Publications

Computer-Assisted Cognitive Behavior Therapy to Prevent Relapse Following Electroconvulsive Therapy.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets