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    ABSTRACT: Electroconvulsive therapy (ECT) is the most effective and most rapidly acting treatment for severe treatment resistant major depression, but its use is limited by its cognitive side effects. Magnetic seizure therapy (MST) is a new form of convulsive therapy using high-dosage repetitive transcranial magnetic stimulation (rTMS) to induce focal cortical seizures under anesthesia. MST is under study as a means of reducing the side effects of ECT through the enhanced control over the sites of seizure initiation and topography of seizure propagation afforded by the relative focality of rTMS. This review traces the stages in the development of MST, from device development, to preclinical testing, to clinical trials. The results of a study on the comparative safety of chronic MST and electroconvulsive shock in non-human primates support the safety of both interventions, and indicate that the seizures induced by MST are more focal and have less impact on deeper brain structures. This non-human primate model and a controlled clinical trial in patients with major depression, suggest that MST may induce fewer side effects and less amnesia than ECT. Ongoing work will yield the first data on the antidepressant efficacy of MST. If ultimately shown to be effective, MST could represent a new, less invasive option for patients with severe treatment resistant depression or other disorders who would otherwise require ECT.
    Clinical Neuroscience Research 07/2004; · 0.80 Impact Factor
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    ABSTRACT: Depression is one of the most frequently diagnosed psychiatric disorders in patients with dementia with a prevalence of up to 50%. The detrimental effects of depression in dementia include disability in daily living, worse quality of life, and faster cognitive decline. Although electroconvulsive therapy (ECT) is a well-established and effective treatment for depression in the elderly, it is currently an overlooked treatment option in the elderly with dementia and depression. The aim of this review was to provide a critical analysis of the efficacy and safety of ECT in depression superimposed on dementia by reviewing the current literature on this topic. Current evidence suggests that ECT is an effective treatment for depression in dementia, although the relatively small number of controlled studies hampers the comparison of effectiveness between healthy nongeriatric patients and those with dementia. Moreover, the systematic reports on cognitive side effects are very limited in number and currently only apply to moderately mild or mild dementia of nonvascular origin. Some studies do suggest that cognitive side effects are likely in later stages of dementia and in patients with vascular dementia. It is therefore of crucial relevance to prospectively study effects of ECT in different types and phases of dementia in controlled trials. From a clinical perspective, it is essential to inform and educate patients and family about the possible risks and benefits of ECT treatment for depression in dementia.
    The journal of ECT 03/2012; 28(1):34-8. · 1.19 Impact Factor
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    ABSTRACT: Depression in the elderly is a heterogeneous group of syndromes with many biologic and psychosocial antecedents. Recent studies support the notion that vascular processes may play a role in a subset of geriatric depressions. More recently, studies have attempted to delineate between 'vascular' and 'nonvascular' geriatric depression across many different measures. The authors review the recent literature of 'vascular depression' including outcome studies, poststroke depression, neuropsychological studies, and electroencephalographic studies. Some suggestions for future areas of study are forwarded.
    Current Opinion in Psychiatry 06/1999; 12(4):463-470. · 3.55 Impact Factor