The Aberdeen study about how electroconvulsive therapy (ECT) might work that has been dominating cyberspace recently was apparently funded by the Chief Scientist Office of Scotland. I couldn’t find any signs of it on the Chief Scientist Office website but that may be because I couldn’t even find a search facility on the website. What I did find, however, is that in June 2010 the same Aberdeen team (or some of them) were awarded a grant of £125,785 for research entitled “The use of Ketamine as an anaesthetic during electroconvulsive therapy (ECT) for depression: does it improve treatment outcome?”.
Ketamine is attracting quite a lot of attention in ECT circles at the moment, either as an alternative to ECT or to be used together with ECT, in addition to or instead of the regular anaesthetic, in order to make ECT more effective or less damaging or both. Professor Ian Muir Anderson at the University of Manchester has been awarded a grant of £1,002,385 (that is what it says – over a million pounds) by the National Institute for Health Research and the Medical Research Council to investigate “Ketamine augmentation of electroconvulsive therapy to improve outcomes in depression”. The researchers are testing the hypotheses that:
“1) Ketamine will prevent ECT-induced cognitive impairment and speed up the clinical response to ECT; 2) Ketamine will act by a) attenuating ECT-induced impairment of frontal cortex reactivity, b) preventing ECT-induced disruption of fronto-hippocampal connectivity.”
The Aberdeen research, where a reduction of connectivity was considered good, was only looking at connectivity between cortical areas, so presumably doesn’t contradict the Manchester researchers’ hypothesis that a reduction of frontal-hippocampal connectivity is bad, not good, since the hippocampus isn’t a cortical structure. At least that is what I am guessing.
In Australia, Professor Colleen Loo at the University of New South Wales in Sydney has been investigating the possibility that ketamine can reduce ECT’s effects on memory. Recent research in Iran tried replacing, rather than augmenting, ECT with ketamine but found that people had significantly better Hamilton depression rating scale scores with ECT. Japanese psychiatrists tried ketamine as an anaesthetic for ECT a few years ago and found that, compared to propofol, in the short term it improved scores on the Hamilton depression rating scale. In the US some psychiatrists have started using ketamine in the treatment of depression and not just in clinical trials. Drs Messer and Haller at the SMDC Medical Center in Duluth, Minnesota, for example published an article “Maintenance ketamine treatment produces long-term recovery from depression” in which they described giving ketamine to a woman who had already had 273 mostly bilateral ECTs. This is what the authors said about ECT:
“In addition to no significant recovery from her depression, the long-term use of ECT caused problems with memory loss and focused attention. She was unable to remember much of her history over the previous 15 years. Re-learning the information became futile since each course of ECT would eliminate what had been gained.”
That sounds rather different than the usual talk about “mild and transient” memory loss.