PMID: 21103178
AUTHORS: John P O'Reardon, Pilar Cristancho, Andrew D Peshek
REFERENCE: Psychiatry (Edgmont) 2006 May 3(5):54-63
Neuromodulation appears to be emerging gradually as a new therapeutic
field in psychiatric treatment. It encompasses neuropsychiatric medical
devices, such as vagus nerve stimulation (VNS), transcranial magnetic
stimulation (TMS), deep brain stimulation (DBS), and electroconvulsive
therapy (ECT). As a therapeutic approach to affective disorders,
neuromodulation shifts the focus from the monoamine synapse to neural
circuitry of the brain, which is dysregulated in depression. This neural
circuitry has been elaborated on over the course of 15 years of
neuroimaging research in mood disorders and is now believed to encompass
disturbances in a frontolimbic network. These include reduced
metabolism and blood flow in the prefrontal cortex and anterior
cingulate and pathologically increased activity in the subgenual
cingulate and amygdala.VNS is an implanted device that has established
efficacy in pharmaco-resistant epilepsy. It was approved by the FDA for
the treatment of severe, recurrent unipolar and bipolar depression in
July of 2005. VNS adopts a bottom-up approach to modulating the neural
circuitry of depression by stimulating vagal afferent fibers in the neck
, which carry impulses to the brain stem to target there the locus
ceruleus and dorsal raphe nucleus. Now that VNS has moved beyond the
experimental phase and into the clinic, psychiatrists are faced with
deciding who is an appropriate patient for this surgical implant and how
to integrate VNS into existing treatment in order to optimize both
efficacy and safety.This review of VNS will assess the efficacy and
safety data that led to the FDA approval. We will also review for the
busy clinician how VNS is likely to translate into clinical practice as
a treatment option for patients in need who are suffering from severe
depression.
Showing posts with label ECT. Show all posts
Showing posts with label ECT. Show all posts
Aug 15, 2008
Vagus nerve stimulation a treatment option, but not for everyone
MayoClinic.com published a short summary on the current state of Vagus Nerve Stimulation (VNS) intended for patient information. Other interesting links on Neurostimulation from their site are:
Jul 17, 2008
Cost-effectiveness of transcranial magnetic stimulation vs. electroconvulsive therapy for severe depression: A multi-centre randomised controlled tria
PMID: 18262655
AUTHORS: Martin Knapp, Renee Romeo, Andrew Mogg, Savitha Eranti, Graham Pluck, Rick Purvis, Richard G Brown, Robert Howard, Michael Philpot, John Rothwell, Denzil Edwards, Declan M McLoughlin
AFFILIATION: Centre for the Economics of Mental Health, King's College London, Institute of Psychiatry, United Kingdom; Personal Social Services Research Unit, London School of Economics, United Kingdom.
REFERENCE: J Affect Disord 2008 Aug 109(3):273-85
BACKGROUND: Electroconvulsive therapy (ECT) has a long history of use in treating depression. Repetitive transcranial magnetic stimulation (rTMS ) has been introduced more recently to the treatment spectrum. Its cost- effectiveness has not been explored. METHOD: Forty-six right-handed people with severe depressive episodes referred for ECT were randomised to receive either ECT twice weekly or rTMS on consecutive weekdays. Health and other service use were recorded for retrospective periods of 3 months prior to initiation of treatment and during the 6 months following the end of allocated treatment. Costs were calculated for the treatment period and the subsequent 6 months, and comparisons made between groups after adjustment for any baseline differences. Cost- effectiveness analysis was conducted with incremental change on the 17- item Hamilton Rating Scale for Depression (HRSD) as the primary outcome measure, and quality-adjusted life years (based on SF6D-generated utility scores with societal weights) as secondary outcome, cost- effectiveness acceptability curves plotted.
RESULTS: Based on the HRSD scores and other outcome measures, rTMS was not as effective as ECT. The cost of a single session of rTMS was lower than the cost of a session of ECT, but overall there were no treatment cost differences. In the treatment and 6-month follow-up periods combined, health and other service costs were not significantly different between the two groups. Informal care costs were higher for the rTMS group. Total treatment, service and informal care costs were also higher for the rTMS group. The cost-effectiveness acceptability curves indicated a very small probability that decision-makers would view rTMS as more cost-effective than ECT.
LIMITATIONS: Small sample size, some sample attrition and a relatively short follow-up period of 6 months for a chronic illness. Productivity losses could not be calculated.
CONCLUSIONS: ECT is more cost-effective than rTMS in the treatment of severe depression.
AUTHORS: Martin Knapp, Renee Romeo, Andrew Mogg, Savitha Eranti, Graham Pluck, Rick Purvis, Richard G Brown, Robert Howard, Michael Philpot, John Rothwell, Denzil Edwards, Declan M McLoughlin
AFFILIATION: Centre for the Economics of Mental Health, King's College London, Institute of Psychiatry, United Kingdom; Personal Social Services Research Unit, London School of Economics, United Kingdom.
REFERENCE: J Affect Disord 2008 Aug 109(3):273-85
BACKGROUND: Electroconvulsive therapy (ECT) has a long history of use in treating depression. Repetitive transcranial magnetic stimulation (rTMS ) has been introduced more recently to the treatment spectrum. Its cost- effectiveness has not been explored. METHOD: Forty-six right-handed people with severe depressive episodes referred for ECT were randomised to receive either ECT twice weekly or rTMS on consecutive weekdays. Health and other service use were recorded for retrospective periods of 3 months prior to initiation of treatment and during the 6 months following the end of allocated treatment. Costs were calculated for the treatment period and the subsequent 6 months, and comparisons made between groups after adjustment for any baseline differences. Cost- effectiveness analysis was conducted with incremental change on the 17- item Hamilton Rating Scale for Depression (HRSD) as the primary outcome measure, and quality-adjusted life years (based on SF6D-generated utility scores with societal weights) as secondary outcome, cost- effectiveness acceptability curves plotted.
RESULTS: Based on the HRSD scores and other outcome measures, rTMS was not as effective as ECT. The cost of a single session of rTMS was lower than the cost of a session of ECT, but overall there were no treatment cost differences. In the treatment and 6-month follow-up periods combined, health and other service costs were not significantly different between the two groups. Informal care costs were higher for the rTMS group. Total treatment, service and informal care costs were also higher for the rTMS group. The cost-effectiveness acceptability curves indicated a very small probability that decision-makers would view rTMS as more cost-effective than ECT.
LIMITATIONS: Small sample size, some sample attrition and a relatively short follow-up period of 6 months for a chronic illness. Productivity losses could not be calculated.
CONCLUSIONS: ECT is more cost-effective than rTMS in the treatment of severe depression.
Apr 16, 2008
Mood Disorders: Where Technology Meets Tradition
Annual Meeting & Scientific Program of the Ohio Psychiatric Physicians Association (OPPA
The meeting was held at the Hilton Cleveland East (Beachwood.) It was a well attending event with members from all over Ohio. It was exciting to see such a great resident turnout!
Here is a list of the great presentations we had this year:
"Neuroimaging and Psychiatry: Basic Principles and Possibilities" & "Neuroimaging and Neurocognitive Studies of Bipolar Disorder" by Jair C. Soares, MD
"Treatment Refractory Depression" by Stephen F. Pariser, MD
"Treatment Resistant Bipolar Disorder" by Prashant Gajwani, MD
"PET Imaging to Assess Acute and Chronic Effects of Vagus Nerve Stimulation on Treatment Resistant Depression" by Charles R. Conway, MD
"The Use of Deep Brain Stimulation in Psychiatric Disorders" by George E. Tesar, MD
"ECT for Treatment Resistant Mood Disorders" by Susan Kimmel, MD
Saturday, April 12th was the 2008 Spring/Annual Meeting for the OPPA: Mood Disorders: Where Technology Meets Tradition.
Here is a list of the great presentations we had this year:
"Neuroimaging and Psychiatry: Basic Principles and Possibilities" & "Neuroimaging and Neurocognitive Studies of Bipolar Disorder" by Jair C. Soares, MD
"Treatment Refractory Depression" by Stephen F. Pariser, MD
"Treatment Resistant Bipolar Disorder" by Prashant Gajwani, MD
"PET Imaging to Assess Acute and Chronic Effects of Vagus Nerve Stimulation on Treatment Resistant Depression" by Charles R. Conway, MD
"The Use of Deep Brain Stimulation in Psychiatric Disorders" by George E. Tesar, MD
"ECT for Treatment Resistant Mood Disorders" by Susan Kimmel, MD
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