According to an article published in the March issue of the American Journal of Medicine, cardiac troponin levels may rise in patients receiving electroconvulsive therapy (ECT).

Researchers at the Mayo Clinic measured cardiac troponin in 70 patients prior to and after “standard” ECT. Four patients had elevated levels prior to ECT and in three of these patients the elevations persisted. Additionally, four patients developed elevated levels during ECT therapy. Elevations occurred in a total of 11.5% of patients in this sample.

Of the four patients with high troponin levels at baseline, two died within three months of ECT.

Measuring cardiac troponin levels is considered the most superior method to detect cardiac muscle damage and raised cardiac troponin levels is accepted as the standard biochemical marker for the diagnosis of myocardial infarction.

This paper adds to the emerging research that central nervous insults can cause biochemical evidence of cardiac injury. This is the first study to systematically measure cardiac troponin levels with ECT. Other researchers have noted an association with dysfunction of the left ventricle following ECT therapy.

This paper does not establish a causal link between ECT and heart damage and certainly ECT is important treatment modality for treatment-resistant depression. However, further research is warranted such that ECT is conducted in the safest way possible.

Reference:
Martinez MW, Rasmussen KG, Mueller PS, Jaffe AS. Troponin elevations after electroconvulsive therapy: the need for caution. Am J Med 124:229-234, 2011.

Many patients seeking depression treatment as well as psychologists and psychiatrists ask about memory problems and TMS. It is interesting that this question comes up with TMS, because to date there have been no studies associating TMS with cognitive impairment or memory problems. Sacramento psychologists and other professionals likely have this question because of ECT and it’s association with memory problems.

Here are key questions you should ask your Sacramento Psychiatrist and Sacramento Psychologist prior to starting Sacramento ECT:

1) How is memory affected by Sacramento ECT?

Sacramento electroconvulsive therapy affects both anterograde memory and retrograde memory. When we have anterograde memory problems with ECT (anterograde amnesia) we have difficulty recalling events, names or faces that we encounter after the ECT has started. When we have retrograde memory problems (retrograde amnesia) we have difficulty recalling events, names or faces that we had in our memory prior to the ECT starting.

Although other cognitive functions such as reaction time leading to motor slowing have been documented with ECT, anterograde and retrograde memory problems are the cognitive function most consistently affected by ECT.

2) How will the electrodes be place during my Sacramento ECT treatment?

Studies show bilateral electrode placement is associated with retrograde personal memory loss and anterograde new memory impairment six months after the acute course of ECT treatment is completed.

3) What waveform will be used during my Sacramento ECT treatment?

Sine wave stimulation is associated with both anterograde and retrograde memory impairment. Sine wave stimulation when used bilaterally can also impair motor reaction time six months after the acute course of ECT treatment is completed.

4) Will objective measures to monitor memory be utilized during the ECT procedure and during follow-up?

There are objective measures that a Sacramento psychologist or Sacramento psychiatrist can utilize during electroconvulsive therapy to measure and monitor general cognitive and memory function.

Reference
Sackeim HA, Prudic J, Fuller R, Keilp J, Lavori PW, Olfson. The cognitive effects of electroconvulsive therapy in community settings. Neuropsychopharmacology. 2007 Jan;32(1):244-54.

How long do the beneficial effects of TMS last? Now Sacramento psychologists and Sacramento psychiatrists can answer this common question with some certainty. Two recent studies published at the American Psychiatric Association’s annual meeting in New Orleans show that relapse rates for patients with treatment-resistant depression were much lower following transcranial magnetic stimulation (TMS) than is normally seen with medications or electroconvulsive therapy.

The findings “suggest that the durability of effect for TMS is good,” according to Philip G. Janicak, MD, of Rush University Medical Center, who presented one of the studies during the meeting.

Janicak and colleagues followed 21 patients who achieved remission with sham TMS (placebo) and 99 patients who achieved remission with TMS for 6 months. During the study period each group was switched to an antidepressant medication. Those who received sham treatment had double the risk of relapse (22% vs 12%) during the 6 month follow up period.
Similar findings were reported at the meeting by Antonio Mantovani, MD, PhD, of Columbia University in New York City. In this study 61 patients who achieved remission with TMS for depression were followed for 6 months and seven patients relapsed (11.5%).

The relapse rate of 10% to 12% of patients achieving an initial remission with TMS compares favorably with relapse rates of 40% seen among patients with treatment resistant depression who achieve remission with antidepressant treatment. Relapse rates following electroconvulsive therapy (ECT) fall in a similar range.

References:
1. Janicak P, et al. Long-term durability of acute response to transcranial magnetic stimulation (TMS) in the treatment of pharmacoresistant major depression. APA 2010;Abstract NR7-46.

2. Mantovani A, et al. How long do the TMS clinical effects last? APA 2010;P154.

Transcranial Magnetic Stimulation (TMS) was named as one of the “Top 10 Breakthrough Innovations of 2009” by CNN. This exciting new therapy treats individuals with clinical depression who have seen no reprieve from conventional antidepressant medications and other treatments. The procedure is safe, noninvasive and FDA-cleared approved, which is perhaps why everyone is talking about it. Before you decide to come in for the 40-minute sessions five times per week for 4-6 weeks, you will need to find a Sacramento psychiatrist who knows all about the pros and cons of this treatment and who is willing to work with you to determine whether this is an ideal solution for your condition particular situation.

You can find more than one Sacramento psychiatrist specializing in Transcranial Magnetic Stimulation therapy at the Sacramento TMS division of Mindful Health Solutions. Since TMS is so newly available, there is only one Neurostar TMS device in all of Sacramento, with the next nearest device located in Berkeley. It’s not unusual to hear about people driving for hours just to reach a treatment center.

Here you may speak with Richard A. Bermudes, M.D., an associated physician who earned his medical degree from the University of California – San Diego and completed his residency training at the University of Cincinnati. He has completed his fellowship in cognitive therapy and cognitive therapy supervision at The Academy of Cognitive Therapy in Philadelphia. He is certified by the American Board of Neurology and Psychiatry. Dr. Bermudes is more than just a Sacramento psychiatrist: he is a doctor you can trust.

Cognitive impairment and memory loss are the side effects that give ECT the worst stigma. Immediately following Sacramento ECT, patients report a period of confusion that lasts several minutes to several hours – occasionally several days. Patients may also have trouble remembering events that occurred prior to treatment. These lapses in memory occur because the shock affects the hippocampus region of the brain that stores memories, but over time, the vast majority of people regain their memories and full cognition back.

Patients who have considered Sacramento ECT should take a look at Transcranial Magnetic Stimulation first. The procedure is similar to Sacramento ECT in that it a brain stimulation therapy. However, instead of inducing a seizure in the entire brain with direct electrical current, Transcranial Magnetic Stimulation uses a magnetic field to delivers electrical currents to the brain to excite neuronal activity and restore one’s natural chemical balance and feeling of wellbeing. However, TMS is different than Sacramento ECT in several key ways:

1. The electrical currents are more mild, below the seizure thresholdThere are no electrical currents applied to the brain or body and no seizures are induced
2. No anesthesia, hospital stays, injections, sedation or IVs are necessary. Patients can drive to and from treatments by themselves.
3. No anesthesia, hospital stays, injections, sedation or IVs are necessary. Patients can drive to and from treatments by themselves.
4. The Tonly possible side effect is a slight headache and there is no memory loss or impairment, post-treatment confusion or care required.