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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

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
Baseline

MDD + TBI

ECT #6 Final ECT

ECT
Treatments

MDD w/out TBI

= Cognition and Depression Assessments


1 Mos Post
ECT

3 Mos Post
ECT

study design
ECT treatments

Baseline

ECT #6

1 Mos Post
ECT

Final ECT

No ECT
3 Mos Post
ECT

Depression + TBI

Depression Only

0


20

40

treatment of depression


traumatic brain injury (tbi)

• mild to moderate
• severe
• open vs. closed


ect is underutilized
Annual&Prevalence&of&MDD&(in&millions)&

MDD,#Rx#Responsive#
18#

3#

MDD,#Rx#Non4responsive#
ECT#

0.1#


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


theory of ect mechanisms

• “reboot
theory”
• neurotransm
itters

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
(hrealubi@ucsd.edu)
• David Printz, MD
(dprintz@ucsd.edu)
• Mark Jacobson, PhD
(mark.jacobson@va.gov)


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