Search Results (96)

Background/Objectives: Evidence regarding the relationship between thyroid function tests (TFTs) and severe or treatment-resistant depression in euthyroid individuals remains limited. We aimed to investigate thyroid function tests (TFTs) in euthyroid patients with depression undergoing electroconvulsive therapy (ECT), evaluate associations with ECT response and depression severity, and explore whether clinically meaningful subgroups with differential thyroid function patterns can be identified. Methods: In this retrospective cohort study, we screened 107 inpatients who received ECT for severe or treatment-resistant depression (major depressive disorder [MDD] or bipolar disorder [BD]). Seventy-six euthyroid patients were analyzed. Clinical data, Hamilton Depression Rating Scale (HAMD) scores, and TFTs (TSH, free-T3, and free-T4) were assessed. Logistic regression, multiple linear regression and unsupervised hierarchical cluster analyses were performed. The cluster analysis used clinical and demographic variables, excluding TFTs to avoid circularity and allow thyroid parameters to be examined as secondary biological correlates. Results: The TFT results were not significantly associated with ECT response in euthyroid patients. The multiple linear regression revealed that the baseline HAMD scores were positively associated with free-T4 (β = 0.797, p = 0.001). Hierarchical clustering identified two subgroups; one group characterized by male sex, psychotic features, and MDD diagnosis exhibited lower TSH levels (2.12 vs. 1.49 mlU/L, Cohen’s d = 0.56) despite similar ECT response rates. Conclusions: Subtle TFT variations were not associated with ECT response but were related to depression severity and clinical phenotypes. These findings suggest that normal-range thyroid hormone variability may reflect state-related neuroendocrine patterns rather than predictors of treatment outcome. Our results should be regarded as hypothesis-generating and underline the need for prospective studies to clarify the clinical significance of thyroid function variability in severe depression. Full article

The metabolism of the four major substances—glucose, lipids, amino acids, and nucleotides—constitutes the most prominent metabolic phenotype of schizophrenia. The pathological axis shared by these substances involves energy pathway imbalances, redox stress, immune-inflammatory activation, and abnormalities in neurotransmitter synthesis/degradation. Existing research confirms that key metabolites within these pathways hold potential as biomarkers for diagnosis or progression monitoring. In recent years, electroconvulsive therapy (ECT) has been shown to improve psychotic symptoms while exerting broad regulatory effects on neurogenesis, immune homeostasis, and the hypothalamic–pituitary–target gland axis, though its precise mechanisms remain unclear. Recent studies indicate that ECT treatment can also regulate changes in brain and peripheral metabolism. We propose an integrated “metabolism-immunity-neuroendocrine” hypothesis to systematically elucidate how metabolic reprogramming during ECT treatment cascades sequentially to the immune, neural, and endocrine systems, thereby revealing the molecular basis of its antipsychotic effects. Furthermore, we conduct a comparative analysis of the effects of antipsychotic drugs on the same metabolic network and explore the universality and specificity of metabolic regulation in other physical therapies (such as rTMS, tDCS) and psychiatric disorders like depression and bipolar disorder. This research aims to provide novel biomarkers and intervention targets for the precision diagnosis and treatment of schizophrenia. Full article

Background/Objectives: The aim of this study was to simultaneously evaluate alterations in apoptosis-related biomarker gene expression accompanied by electroconvulsive therapy (ECT) in treatment-resistant depression (TRD) patients. Methods: A total of 25 subjects (15 healthy controls; 10 TRD patients) were initially tested for baseline values of relative mRNA expression of apoptosis-related markers (Bax, Bcl-2, p53, and cytochrome c) in peripheral blood samples and MADRS score. Results: Healthy subjects showed significantly lower values in MADRS, and Bax and p53, with increased Bcl-2 expression. The four-week ECT protocol (bitemporal, three sessions per week, with MADRS evaluation and blood sampling after each week) in TRD patients resulted in a concomitant significant decrease in MADRS, Bax, and p53 and an increase in Bcl-2 expression. Conclusions: Our results confirmed that the benefits observed by clinical outcome may also be attributed to the anti-apoptotic impact of ECT. Full article

Background: Electroconvulsive therapy (ECT) is a well-established intervention for severe and treatment-resistant psychiatric disorders, yet its use in adolescents remains limited, particularly in Europe. Data on its safety and effectiveness in this population are scarce. This study aimed to evaluate the clinical outcomes and tolerability of ECT in adolescents diagnosed with schizophrenia and schizoaffective disorder. Methods: We conducted a retrospective observational case series of 22 adolescents (mean age 16.7 ± 1.3 years) treated with ECT between 2017 and 2024 at a university psychiatric department. Diagnoses included paranoid schizophrenia (n = 15), catatonic schizophrenia (n = 2), and schizoaffective disorder (n = 5). Symptom severity was assessed with the Positive and Negative Syndrome Scale (PANSS) before and after the ECT course. Adverse events were evaluated based on daily clinical monitoring and medical records. Results: The overall response rate, defined as ≥50% reduction in total PANSS score, was 82% (schizophrenia: 82%; schizoaffective disorder: 80%). Mean PANSS total score decreased from 158.0 ± 22.6 to 72.1 ± 20.7 (p < 0.0001). Improvements were most pronounced in the general psychopathology and positive symptom domains. No serious adverse events were observed. The most common transient side effects were headache (41%), memory complaints (27%), and somnolence (22%). Conclusions: ECT appears to be an effective and safe treatment option for adolescents with treatment-resistant schizophrenia and schizoaffective disorder. These findings add to the limited European evidence base and support considering ECT earlier in the treatment course of severe adolescent psychosis. Larger, prospective studies with long-term follow-up are warranted to confirm these results. Full article

Background: Treatment-resistant depression (TRD) affects up to 30–40% of patients with major depressive disorder and remains a major therapeutic challenge. Genetic and epigenetic factors are increasingly recognized as key contributors to both vulnerability and treatment response. Methods: We conducted a narrative review of studies published between 2021 and 2025, focusing exclusively on DNA- and RNA-based biomarkers of TRD. Twelve studies met the inclusion criteria, covering candidate gene analyses, genome-wide association studies (GWAS), neuroimaging–genetic approaches, and microRNA profiling. Results: Genetic investigations consistently implicate neuroplasticity-related genes (BDNF, NTRK2, PTEN, SYN1, MAPK1, and GSK3B) in the risk of TRD and its relapse. Variants in glutamatergic receptor genes (GRIN2A, GRIN2B, GRIA2, GRIA3) were predicted to result in a rapid and sustained response to ketamine. Genomic approaches further demonstrated that composite genetic panels outperform single-variant predictors. In parallel, microRNAs such as miR-1202, miR-16, miR-135, miR-124, miR-223, and miR-146a emerged as dynamic biomarkers of treatment response, particularly in cohorts treated with ketamine or electroconvulsive therapy. Conclusions: DNA- and RNA-based biomarkers provide promising avenues for improving the understanding and management of TRD. Their integration into clinical frameworks could support patient stratification, individualized treatment selection, and real-time monitoring of therapeutic efficacy. Future research should prioritize replication, methodological harmonization, and longitudinal validation to facilitate the translation of findings into precision psychiatry. Full article

Background/Objectives: Electroconvulsive therapy (ECT) is used for treatment-resistant depression (TRD). Despite high effectiveness, its most prevalent side effect is memory loss, particularly autobiographical memory deficits. Some patients and physicians might associate post-ECT improvement in depressive symptoms with a higher risk of autobiographical amnesia or even consider this side effect ECT’s mechanism of action. Here, we aimed to study the association between improvement in depressive symptoms and the severity of autobiographical amnesia, as well as identify factors associated with the degree of memory loss. Methods: In this prospective naturalistic observational pilot study, we included 20 patients who underwent ECT for TRD. Attending psychiatrists decided on the electrode placement. Electrical dosage was based on the seizure-titration procedure. Depressive symptoms (Hamilton Depression Scale-21) and autobiographical memory (AMI-SF) were assessed before and after the full course of ECT. The correlation between symptomatic improvements and severity of memory loss was studied using Spearman’s correlation. Demographic and clinical baseline data were examined to look for associations with the decline in autobiographical memory. Results: Symptomatic improvement was not correlated with autobiographical memory loss (r = −0.14, p = 0.58) or any of its domains. Suicidal ideation at baseline was associated with a stronger decline in autobiographical memory (r = −0.53, p = 0.016). Patients treated with bilateral electrode placement had worse amnesia than those treated with right unilateral treatment, though the difference was not significant (MD = −17.4 vs. −13.1, p = 0.2). Conclusions: ECT improved depressive symptoms irrespective of autobiographical amnesia severity. Patients with suicidal ideation at baseline might experience worse post-ECT amnesia than those without. Full article

Mental health disorders are increasingly being recognized as a major global challenge. In the Arabic-speaking Middle East and North Africa (MENA) region, this challenge is compounded by sociocultural stigma, political instability, and limited mental health infrastructure, all of which restrict access to effective care. While neurostimulation modalities such as electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) have proven effective and are gaining traction, their use in the MENA region remains limited and underexplored. This narrative review aims to bridge critical gaps by examining knowledge levels, attitudes, perceptions, and the clinical application and accessibility of ECT and rTMS across Arabic-speaking countries. We searched multiple databases using keywords related to neurostimulation and psychiatry, covering all 22 Arabic-speaking MENA countries. Studies were included if they were published in English and were related to psychiatric applications of ECT or rTMS. Findings were categorized by geography and grouped into four thematic domains: knowledge, perception, availability, and clinical use. The findings revealed an uneven distribution of neurostimulation research and services across the region; ECT is more established than rTMS. Additionally, public awareness remains low, and high levels of stigma persist. Among clinicians, psychiatrists tend to support neurostimulation, while general medical staff show mixed opinions. rTMS is gaining clinical interest but remains limited in accessibility due to high costs and limited infrastructure. Although neurostimulation should be more widely implemented in psychiatry in the MENA region, it is still underrecognized and underused. Region-specific strategies addressing stigma, training gaps, and policy standardization are essential to optimize neurostimulation use and its public acceptance. Full article

Objectives: Recently, we modified the method of dosing charge in daily practice for patients undergoing bilateral electroconvulsive treatment (BL ECT). The aim of this study is to compare the effectiveness of two charges’ dosing protocols—High-Charge Protocol (HCP; based on the modified age-based method) and Dose Titration Protocol (DTP) in BL ECT for the treatment of patients with a depressive episode. Methods: The retrospective analysis compared the outcomes of BL ECT between patients receiving either HCP or DTP treatments. Patients’ mental status was assessed retrospectively using the Clinical Global Impression-Severity (CGI-S) and Clinical Global Impression-Improvement (CGI-I) scales. EEG parameters, including seizure duration and EEG ictal activity were analyzed. Results: When compared to DTP, the HCP group was older (55 years ± SD 15 vs. 41 years ± SD 17), had lower initial CGI-S (5 [IQR 5–6] vs. 6 [IQR 5–6]) and longer disease duration (15 years [IQR 7–20] vs. 9 years [IQR 3–18]). The DTP group had a higher percentage of remission (n = 17 [77.3%]) compared to the HCP group (n = 23 [43.4%]), with the same average number of sessions performed. In addition, the DTP group had significantly longer average seizure duration (68.6 s [IQR 52.7–84.7] vs. 38.4 s [IQR 33.8–47.1], adj. p < 0.001). Conclusions: Our results suggest that in BL ECT, administering high-charge protocols may have a detrimental impact on ECT effectiveness. Based on our findings, we propose adjusting the dosing in BL ECT according to the individual seizure threshold and avoiding frequent charge increases during the course of treatment. Full article

Background: Systemic lupus erythematosus (SLE) is reported to be the most common rheumatological disorder associated with catatonia. To date, reports on catatonia manifestations in SLE patients are uncommon in published literature, which has often favored a fragmented vision. We performed a narrative review with the aim of identifying all published reports of catatonia in SLE patients to ascertain—in a comprehensive view—its clinical characteristics and to provide useful insights for daily clinical practice. Methods: Comprehensive literature searches were carried out on 10 March 2025 (subsequently repeated ahead of draft on 6 June) in all main bibliographic databases: MEDLINE and EMBASE (OVID interface); PsycINFO (ProQuest); and PubMed, to capture within-text references. All searches combined controlled (MESH, Entree, and APA Headings) and free-text elements for both areas under observation: systemic lupus erythematosus (SLE) AND catatonia, with primary focus on case reports and series. Sets of findings were reviewed separately by the authors, and the full text of selected items was sourced. Further useful references were retrieved through citation lists. Results: 39 cases of patients with SLE and catatonia were identified (35 females and 4 males), with a mean age of 22.64 years (range 11–46). Only three patients were over the age of 40; a total of 10 had catatonia at the same time of SLE onset and 5 within a month of SLE diagnosis. Antiphospholipid and anti-ribosomal P protein antibodies were rarely identified. Almost all the patients improved following treatment with lorazepam and/or electroconvulsive therapy. Only one case of malignant catatonia was reported. Finally, a large number of patients were Asian or Afro-American, at least in the reports where ethnicity was specified. Conclusions: Catatonia can occur in patients with SLE, and it may be its first clinical manifestation, especially in young patients. Its prognosis is mostly favorable. Full article

Electroconvulsive therapy (ECT) is a non-pharmacological biological treatment method used to treat major depression, bipolar disorder, schizophrenia, catatonia, and some other psychiatric conditions. Despite its high effectiveness, it is often used when other methods, such as pharmacotherapy and psychotherapy, fail to improve treatment outcomes. The refinement of this particular therapy may increase the popularity of this method, and among the currently studied therapy modifiers is protocolised hyperventilation. Hyperventilation is implemented to improve ventilation and gas exchange, reduce shortness of breath, improve blood oxygenation, and prevent hypoxia. Research suggests that hyperventilation during ECT may prolong the duration of epileptic seizures, potentially enhancing the effectiveness of the therapy. However, research on hyperventilation during ECT still poses many questions regarding its benefits and side effects. Innovative studies on ECT with concomitant hyperventilation focus on monitoring parameters such as CO₂, EEG, and cardiovascular responses. Current research directions worth exploring also include the utilisation of modern ECT devices or determining the neurotrophin concentration to better understand the mechanism of action at the neurochemical level. The personalization of therapy, including adjustment of ECT parameters to patients’ specific symptoms, can reduce the risk of failure and increase effectiveness. Full article

Electroconvulsive therapy (ECT) remains one of the most effective interventions for treatment-resistant psychiatric disorders, particularly major depressive disorder and bipolar disorder. Despite extensive clinical and preclinical investigations, the precise neurobiological mechanisms underlying ECT’s therapeutic effects are not fully understood. This review explores the molecular and cellular pathways involved in ECT, emphasizing its impact on neurotrophic signaling, oxidative stress, apoptosis, and neuroplasticity. Evidence suggests that ECT modulates brain-derived neurotrophic factor and other neurotrophic factors, promoting synaptic plasticity and neuronal survival. Additionally, ECT influences the hypothalamic–pituitary–adrenal axis, reduces neuroinflammation, and alters neurotransmitter systems, contributing to its antidepressant effects. Recent findings also highlight the role of mitochondrial function and oxidative stress regulation in ECT-induced neural adaptation. By synthesizing current molecular insights, this review provides a comprehensive perspective on the neurobiological mechanisms of ECT, offering potential directions for future research and therapeutic advancements in brain stimulation. Full article

We tried to synthesize the possibilities of predicting the response to clozapine treatment, which can significantly improve the efficacy of the active substance and reduce adverse reactions, and how the active substance acts at the D1 dopaminergic receptors D2, D3, D4, and D5, muscarinic M1, M2, M3, and M5, and the histamine and alpha 1 adrenergic receptor, as well as how it contributes to increased cerebral blood flow, the effect on ribosomal protein S6 function, or the effect on kynurenine 3-monooxygenase function. Clozapine is one of the most effective antipsychotics, and there is potential to improve performance by combining it with different compounds to limit adverse effects or by augmenting it with other antipsychotics (amisulpride, paliperidone), other active substances with different properties (minocycline, N-acetylcysteine, memantine), or alternative therapies (electroconvulsive therapy, repetitive transcranial magnetic stimulation). There are also significant steps in optimizing clozapine efficacy by predicting treatment response, which could be determined by testing the following: plasma levels of clozapine N-oxide and N-desmethylclozapine, serum levels of neurotrophins and glutamate, genetic testing, the polygenic risk score, morphometry, or even the identification and accurate determination of persistent negative symptoms. Full article

Background/Objectives: Mental diseases are one of the leading groups of health disorders worldwide, with depressive and anxiety disorders being the most prevalent. Depressive disorders can be treated with pharmacotherapy, psychotherapy, or a combination of both. In cases where these approaches prove ineffective, electroconvulsive therapy may be considered as an alternative. The drugs of choice for treating depressive disorders are selective serotonin reuptake inhibitors (SSRIs). In the Republic of Serbia, commonly prescribed SSRIs include fluoxetine, citalopram, paroxetine, sertraline, and escitalopram. Methods: Data on drug sales for human medicine from the Agency for Medicines and Medical Devices of Serbia (ALIMS) were used for the analysis of consumption in the period 2018–2022. Data on drug consumption in other European countries were obtained from the respective national registers. Results: From 2018 to 2021, sertraline was the best-selling drug in this group, but with a statistically significant decrease (R² = 0.7948, p = 0.042), while escitalopram showed a statistically significant increase (p = 0.006) and became the best-selling drug in the SSRI group in 2022. Overall, SSRI group consumption fluctuated from 2018 to 2022, with the highest values in 2020. However, these variations were not statistically significant (p = 0.6223). Compared to Serbia, out of 12 European countries, 8 had higher and 4 had lower consumption in 2019 and 2020. A positive correlation was found between antidepressant consumption and GDP per capita. Conclusions: Sertraline was the most commonly prescribed SSRI drug in Serbia from 2018 to 2021. However, in 2022, escitalopram became the most commonly used drug in this group both in Serbia and worldwide, with a consistent increase in consumption. Full article

Background: Resistance to antipsychotic treatment in patients suffering from schizophrenia is linked to immune system disequilibrium. One effective therapeutic option for treatment-resistant schizophrenia is electroconvulsive therapy (ECT); however, its impact on cytokines remains poorly understood. The aim of this study is to evaluate the impact of ECT on cytokines (IL-1β, IP-10, IL-17, TNFα, IL-10, and soluble receptor for IL-2 (sIL-2R)) in TRS patients. Additionally, correlations between cytokine concentrations and schizophrenia symptoms severity are explored. Methods: Cytokine and receptor concentrations were measured in eight TRS patients before and after ECT and in 13 healthy participants from control group. The Positive and Negative Syndrome Scale (PANSS) was used to evaluate the severity of the symptoms. Results: Before ECT, TRS patients exhibited significantly higher concentrations of IL-1ß, IL-10, IL-17, and IP-10 compared to the control group, whereas no significant differences were observed in sIL-2R and TNF-α. In the TRS patients, ECT induced a significant reduction in IL-10, IL-17 and IP-10 levels, while IL-1β, TNF-α, and sIL-2R remained unchanged compared to pre-ECT. ECT also led to clinical improvement in schizophrenia symptoms, as measured by PANSS. Furthermore, correlations between cytokine levels and PANSS results were found. Conclusions: The above results suggest that clinical improvement in TRS patients following ECT is associated with immune modulation, especially with the steadiness between pro- and anti-inflammatory systems. However, further research is required to elucidate these mechanisms in greater detail. Full article

Perinatal depression affects approximately 1 in 5 women and is the leading cause of maternal mortality in the United States. In addition to evidence-based treatment with antidepressant medications, there has been a push to identify rapid-acting options for pregnant and postpartum individuals. This paper reviews the evidence behind new pharmacological agents (neurosteroids and ketamine) and non-pharmacological approaches (transcranial magnetic stimulation). The paper also highlights the risks and benefits of electroconvulsive therapy and selective serotonin reuptake inhibitors. Based on recent studies and research, the paper provides considerations when prescribing these modalities including: timing of symptom onset, severity of presentation, breastfeeding priorities, prior treatment response and treatment availability and cost. Full article