ECT research in Iran

The Journal of Psychiatric Research has just published an article by Iraj Salehi and others with the title “Electroconvulsive therapy and aerobic exercise training increased BDNF and ameliorated depressive symptoms in patients suffering from treatment-resistant major depressive disorder” (volume 57, 2014, 117-124). The research was carried out at the Farshchian Hospital in Hamadan, Iran, on 60 patients being treated for depression. The patients were randomly assigned to 3 groups: electroconvulsive therapy (ECT); ECT and aerobic exercise (“thrice weekly sessions of cycling on a treadmill”); or aerobic exercise alone. According to the article’s abstract, the conclusion of the researchers was as follows:

“The pattern of results suggests that ECT, AET and particularly their combination are promising directions for treatment patients suffering from TR-MDD, and that it remains unclear to what extent BDNF is key and a reliable biomarker for TR-MDD”.

Unravelling the abbreviations, that means that they found that both ECT and exercise were effective and especially so in combination as a treatment for patients who had been diagnosed with treatment-resistant major depressive disorder (defined in this study as still being depressed after taking antidepressants for 6 months). The researchers also measured levels of brain-derived neurotrophic factor and found increases in all the groups, although these were not related to symptom reduction. (All the patients were taking an antidepressant during the trial.)

The results section of the article contains an interesting finding that was not highlighted in the abstract: the exercise group did better than the ECT group.

“Taking into account the categories of remission, the following pattern of results was observed: there was a significant association between condition and categories of remission (… ), with the highest remission rates in the ECT + AET condition and the lowest in the ECT condition.”

The mean age of patients was 31, and nearly 70 per cent of the patients were men. To a certain extent this was explained by the trial’s exclusion criteria (for example, patients over the age of 40 were excluded) but it would still suggest that there are cultural differences in the use of ECT.

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