Electroconvulsive Therapy in Denmark

1976 ◽  
Vol 128 (3) ◽  
pp. 241-245 ◽  
Author(s):  
Erik Roeder ◽  
Joergen Heshe
Keyword(s):  
Electroconvulsive Therapy ◽  
Tricyclic Antidepressants ◽  
Endogenous Depression ◽  
Fiscal Year ◽  
Reactive Depression ◽  
Indications For Treatment

SummaryDuring the fiscal year 1 April 1972 to 31 March 1973, 22,210 ECT treatments in 3,438 series were given in Denmark (6.46 treatments per series). Indications for treatment were: endogenous depression, acute delirium, mania, hysterical psychosis, reactive depression and schizophrenia. Unilateral ECT was used in more than half of the departments concerned. Two treatments were given weekly. The types of apparatus and anaesthesia techniques used are described. One death, which had questionable relation to the ECT, was reported, and other complications were few and mild. The advantages of ECT compared to tricyclic antidepressants are described, including the higher percentage of remissions or improvements in the treatment of endogenous depressions (about 80 per cent for ECT compared to about 60 per cent for tricyclic antidepressants). Little risk was found in out-patient administration of ECT. With present techniques and unilateral placement of electrodes out-patient ECT may be recommended for wider use than before.

A Survey of Practising Psychiatrists' Views on Treatment of the Depressions

1986 ◽  
Vol 149 (6) ◽  
pp. 742-750 ◽  
Author(s):  
M. S. Armstrong ◽  
G. Andrews
Keyword(s):  
Quality Assurance ◽  
Drug Therapy ◽  
Random Sample ◽  
Electroconvulsive Therapy ◽  
Tricyclic Antidepressants ◽  
Endogenous Depression ◽  
Treatment Recommendations ◽  
Quality Assurance Project ◽  
Treatment Plans ◽  
Psychotic Features

The views of practising psychiatrists on treatment of the depressions were investigated as part of a Quality Assurance Project. A one in six random sample of all Australian psychiatrists was mailed a questionnaire. This asked for treatment recommendations for each of five case descriptions of patients with depression. Respondents were asked to code their treatment plans from a glossary listing possible treatments for depression: 85% of the sample responded. Tricyclic antidepressants were the treatment of choice for two cases of endogenous depression, electroconvulsive therapy (ECT) being recommended when psychotic features were present or when drug therapy had failed. Psychotherapies were the treatment of choice for cases with neurotic features, drugs being recommended when Improvement with psychotherapy did not occur.

Fluoxetine Efficacy vs Comparative Drugs: An Overview

1988 ◽  
Vol 153 (S3) ◽  
pp. 51-58 ◽  
Author(s):  
Malcolm Lader
Keyword(s):  
Side Effects ◽  
Tricyclic Antidepressants ◽  
Antipsychotic Agents ◽  
Synaptic Cleft ◽  
Endogenous Depression ◽  
Acute Effects ◽  
Anticholinergic Effects ◽  
The Past ◽  
Chronic Effects ◽  
Clinical Action

The tricyclic antidepressants (TCAs) were discovered accidentally by pharmaceutical chemists seeking first, better antihistamines and then antipsychotic agents. Careful clinical assessment revealed the antidepressant properties and suggested that the closer the patient resembled the classical textbook description of ‘endogenous’ depression, the more likely was an adequate clinical response to occur (Kuhn, 1958). However, it was quickly realised that the TCAs possess a plethora of side-effects, particularly sedation and symptoms related to their anticholinergic effects.Despite much research over the past 25 years, it is unclear how TCAs effect clinical improvement. The two main neurotransmitters involved in some way are noradrenaline (Schildkraut, 1965) and 5-hydroxytryptamine (5-HT; serotonin; Van Praag, 1977). It was proposed that TCAs acted by blocking the reuptake of one or other or both of these neurotransmitters, thereby increasing their concentration in the synaptic cleft. However, as well as these acute effects, chronic effects, such as a decrease in the number of central beta-adrenoceptors (‘down-regulation’) occur, and these are probably more relevant to the clinical action.

scholarly journals Basic concepts of depression

2008 ◽  
Vol 10 (3) ◽  
pp. 279-289 ◽  
Keyword(s):  
Bipolar Disorder ◽  
Affective Disorders ◽  
Life Stress ◽  
Endogenous Depression ◽  
Modern Concept ◽  
Reactive Depression ◽  
The Core ◽  
Broad Concept ◽  
Basic Concepts ◽  
The 1960S

This paper reviews concepts of depression, including history and classification. The original broad concept of melancholia included all forms of quiet insanity. The term depression began to appear in the nineteenth century, as did the modern concept of affective disorders, with the core disturbance now viewed as one of mood. The 1980s saw the introduction of defined criteria into official diagnostic schemes. The modern separation into unipolar and bipolar disorder was introduced following empirical research by Angst and Perris in the 1960s. The partially overlapping distinctions between psychotic and neurotic depression, and between endogenous and reactive depression, started to generate debate in the 1920s, with considerable multivariate research in the 1960s. The symptom element in endogenous depression currently survives in melancholia or somatic syndrome. Life stress is common in various depressive pictures. Dysthymia, a valuable diagnosis, represents a form of what was regarded earlier as neurotic depression. Other subtypes are also discussed.

Antidepressants: uses and attitudes among consultant psychiatrists – A questionnaire study

1991 ◽  
Vol 8 (2) ◽  
pp. 167-170 ◽  
Author(s):  
Brian O'Shea
Keyword(s):  
Cognitive Therapy ◽  
Electroconvulsive Therapy ◽  
Tricyclic Antidepressants ◽  
Antidepressant Drugs ◽  
Questionnaire Study ◽  
Environmental Manipulation ◽  
Novel Treatment

AbstractAn audit of Consultant Psychiatrists' views on and uses of antidepressant drugs is reported. At present senior prescribers largely opt for the older tricyclic antidepressants despite a knowledge of their shortcomings. MAOIs are less popular and newer drugs are viewed cautiously and apprehensively. Lofepramine is largely viewed as an alternative to dothiepin and amitriptyline. Non-drug strategies in the management of depression consist largely of support, environmental manipulation and electroconvulsive therapy. The relatively novel treatment, cognitive therapy, has a strong minority following.

A Treatment Outline for Depressive Disorders

1983 ◽  
Vol 17 (2) ◽  
pp. 129-146 ◽  
Keyword(s):  
Quality Assurance ◽  
Treatment Outcome ◽  
Electroconvulsive Therapy ◽  
Depressive Disorders ◽  
Meta Analysis ◽  
Antidepressant Drugs ◽  
Endogenous Depression ◽  
Government Support ◽  
Sources Of Information ◽  
Quality Assurance Project

With College and Government support the Quality Assurance Project is developing a series of explicit and detailed treatment outlines of major psychiatric disorders for use in peer review. Three sources of information are used: a meta-analysis of the treatment outcome literature, the opinions of a sample of practising psychiatrists and the views of a panel of nominated experts. The present outline concerns the treatment of depressive disorders. The three sources of information were in agreement that tricyclic and allied antidepressants were the treatments of choice for endogenous depression and were also to be considered in persistent neurotic depressions. Electroconvulsive therapy was recommended in patients with endogenous depression who were severely ill, troubled by hallucinations and delusions or for whom the antidepressant drugs had not proven effective. The psychotherapies, both dynamic and behavioural, were regarded as the treatments of choice in neurotic depression.

Early Schizophrenia

1971 ◽  
Vol 16 (6) ◽  
pp. 487-497 ◽  
Author(s):  
John Varsamis ◽  
John D. Adamson
Keyword(s):  
Work Performance ◽  
Descriptive Study ◽  
Endogenous Depression ◽  
Good Prognosis ◽  
Complex State ◽  
Prodromal Phase ◽  
Reactive Depression ◽  
Sexual Drive ◽  
Diagnostic Use ◽  
Early Schizophrenia

This is a report of a phenomenological and descriptive study of forty-four patients seen early in their first hospitalization for schizophrenia. Most patients had a prodromal phase (median duration 30 months) during which the commonest symptoms were decreased drive and dysphoria. Symptomatology was often similar to that of a reactive depression; there was no instance resembling endogenous depression. A prodromal triad of deterioration in school or work performance, schizoid withdrawal and anergia was identified and this may have some diagnostic use. Twelve of the fifteen patients who exhibited this triad had also experienced disturbed flow of thought. Some patients experienced increased sexual drive, usually towards the end of the prodromal phase or in early overt psychosis. Some also reported regular fluctuations in symptomatology; these cycles, usually of a few good days and a few bad days, occurred in the prodromal phase and/or early overt psychosis. The transition to manifest psychosis was usually quite abrupt. An oneirophrenic experience, termed a ‘complex state”, was common either at the beginning of psychosis or soon thereafter. In the ‘complex state” a number of symptoms are experienced together or in such rapid succession that separating them is artificial. Perplexity and emotional arousal, usually dysphoric, are always present, and there is invariably at least one symptom of disturbed perception or delusion. Perceptual disturbances may affect any modality and often more than one; the perceptual alterations may be simple or complex. Disturbances of visual perception were reported more frequently than might have been expected, tending to be associated with good prognosis. Motor blocking, slowing or inco-ordination may occur, and although clouding of consciousness was experienced as part of the complex state, it was not possible to document this satisfactorily. Delusions usually developed within complex states or more commonly as explanations of them, so that the concept of primary delusion may be invalid. These findings were further discussed with particular reference to the work of Conrad and Chapman.

The GH response to clonidine in endogenous as compared with reactive depression

1984 ◽  
Vol 14 (4) ◽  
pp. 773-777 ◽  
Author(s):  
S. A. Checkley ◽  
I. B. Glass ◽  
C. Thompson ◽  
T. Corn ◽  
P. Robinson
Keyword(s):  
Growth Hormone ◽  
Paired Comparison ◽  
Endogenous Depression ◽  
Reactive Depression ◽  
Age And Sex ◽  
Neuroendocrine Systems

SynopsisThe growth hormone (GH) response to clonidine was measured in 10 patients meeting standardized criteria for ‘endogenous’ depression and in 10 patients individually matched for age and sex but meeting the corresponding criteria for ‘reactive’ depression. In a paired comparison of patients with reactive and endogenous depression (matched for age and sex), the GH response to clonidine was less in the endogenous member of the pair in 8 out of 10 cases. These findings are interpreted as evidence of a defect at alpha2 adrenoceptors in neuroendocrine systems in endogenous as compared with reactive depression.

Short-Term Cognitive Effects of Unilateral and Bilateral ECT

1985 ◽  
Vol 146 (3) ◽  
pp. 308-311 ◽  
Author(s):  
Michael Alan Taylor ◽  
Richard Abrams
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Performance ◽  
Clinical Improvement ◽  
Electroconvulsive Therapy ◽  
Endogenous Depression ◽  
Cognitive Effects ◽  
Short Term ◽  
Cognitive Changes ◽  
Significant Clinical Improvement ◽  
Neuropsychological Tasks

SummaryWe administered an extensive battery of primarily non-memory neuropsychological tasks to 37 patients with endogenous depression, randomly assigned to either bilateral (B/ECT) or unilateral (U/ECT) electroconvulsive therapy. Testing was done prior to therapy and again shortly after the sixth induced seizure. The two groups did not significantly differ in cognitive impairment, either before or after treatment, and within-group cognitive changes following treatment were small. We conclude that neither B/ECT nor U/ECT substantially worsen non-memory cognitive performance in depressed patients, yet both result in significant clinical improvement.

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