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  • Recent advances in electroconvulsive therapy and physical treatments for depression
  • I. Nicol Ferrier, Jonathan Waite, Vimal Sivasanker
  • Journal: BJPsych Advances / Volume 27 / Issue 5 / September 2021
  • Published online by Cambridge University Press: 09 March 2021, pp. 295-302
  • Print publication: September 2021
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    This article gives an update for practitioners on recent developments in the use of electroconvulsive therapy (ECT) and related treatment modalities in the contemporary treatment of depression in the UK. Details are provided on new information on the efficacy and side-effects of ECT both in research studies and in the real world, together with recent research on ECT's mode of delivery. There is a focus on the safe administration of ECT in clinical practice. An update on the regulatory framework for ECT in the UK is provided, together with up-to-date information on the legal situation regarding its prescription. Finally, brief summaries of the current position for other neuromodulatory treatment modalities are given.

  • Deep learning-based automated speech detection as a marker of social functioning in late-life depression
  • Bethany Little, Ossama Alshabrawy, Daniel Stow, I. Nicol Ferrier, Roisin McNaney, Daniel G. Jackson, Karim Ladha, Cassim Ladha, Thomas Ploetz, Jaume Bacardit, Patrick Olivier, Peter Gallagher, John T. O'Brien
  • Journal: Psychological Medicine / Volume 51 / Issue 9 / July 2021
  • Published online by Cambridge University Press: 16 January 2020, pp. 1441-1450
  • Print publication: July 2021
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    Background

    Late-life depression (LLD) is associated with poor social functioning. However, previous research uses bias-prone self-report scales to measure social functioning and a more objective measure is lacking. We tested a novel wearable device to measure speech that participants encounter as an indicator of social interaction.

    Methods

    Twenty nine participants with LLD and 29 age-matched controls wore a wrist-worn device continuously for seven days, which recorded their acoustic environment. Acoustic data were automatically analysed using deep learning models that had been developed and validated on an independent speech dataset. Total speech activity and the proportion of speech produced by the device wearer were both detected whilst maintaining participants' privacy. Participants underwent a neuropsychological test battery and clinical and self-report scales to measure severity of depression, general and social functioning.

    Results

    Compared to controls, participants with LLD showed poorer self-reported social and general functioning. Total speech activity was much lower for participants with LLD than controls, with no overlap between groups. The proportion of speech produced by the participants was smaller for LLD than controls. In LLD, both speech measures correlated with attention and psychomotor speed performance but not with depression severity or self-reported social functioning.

    Conclusions

    Using this device, LLD was associated with lower levels of speech than controls and speech activity was related to psychomotor retardation. We have demonstrated that speech activity measured by wearable technology differentiated LLD from controls with high precision and, in this study, provided an objective measure of an aspect of real-world social functioning in LLD.

  • Chapter 1 - The Place of ECT and Related Treatments in Contemporary UK Psychiatry
  • Edited by I. Nicol Ferrier, University of Newcastle upon Tyne, Jonathan Waite, University of Nottingham
  • Book: The ECT Handbook
  • Published online: 27 June 2019
  • Print publication: 04 July 2019, pp 1-12
  • View extract

    Summary

    The previous edition of The ECT Handbook was produced in 2013 and was well received. The current edition updates the 2013 one and attempts to find a similar balance between outlining the scientific literature relating to ECT and related treatment modalities and pragmatic and practical advice on their place in management and delivery in a UK context. This chapter concentrates on the guidelines in the UK for the use of ECT and related treatments. The recommendations of NICE for the use of ECT and related treatments are outlined first, followed by position statements from the Committee. Any differences (which are usually minor and of emphasis rather than substance) are highlighted. The position statements were generated in 2017 and have been ratified by the College. They can be found on the Royal College of Psychiatrists’

The ECT Handbook
  • The ECT Handbook
  • 4th edition
  • Edited by I. Nicol Ferrier, Jonathan Waite
  • Published online: 27 June 2019
  • Print publication: 04 July 2019
  • View description
    The fourth edition of this popular Handbook provides the latest guidance on prescribing and administering electroconvulsive therapy (ECT). Leading researchers and practitioners review new research on ECT and related treatments, including their efficacy in children and adolescents, and in those with bipolar disorder and neurological conditions. With a focus on safe provision and minimisation of side effects, it provides the reader with practical, evidence-based advice. The book has been substantially revised: references have been updated throughout; related treatment modalities such as rTMS, tCDS and ketamine are covered in greater depth; and current administrative and legal framework guidelines are clearly outlined. An essential reference manual for consultant and trainee clinical psychiatrists, as well as ECT practitioners. This guide will benefit clinical teams looking after complex cases of depression, as well as those involved in the care of other people for whom ECT may be recommended.
  • 14 - The use of ECT in the treatment of depression
  • Edited by Jonathan Waite, Andrew Easton
  • Book: The ECT Handbook
  • Published by: Royal College of Psychiatrists
  • Published online: 25 February 2017, pp 126-134
  • View extract

    Summary

    Depression remains the most frequent disorder for which ECT is required. This chapter summarises the evidence for the efficacy of ECT in depression and practical guidelines for its use. The Department of Health commissioned a systematic review of the safety and efficacy of ECT in depression (UK ECT Review Group, 2003), and for the NICE guidance on depression in adults, a further systematic review was undertaken (National Collaborating Centre for Mental Health, 2010: pp. 509–528.)

    Efficacy of ECT in depression

    The UK ECT Review Group (2003) examined data from randomised controlled trials identified in an extensive search. The results were independently checked by two reviewers. Data from studies which met inclusion criteria were extracted by paired members of the review team. Identified trials were assessed for methodology, where appropriate and data from individual trials were summarised by meta-analyses.

    ECT v. ‘sham’ ECT

    Six randomised controlled trials comparing ECT with ‘sham’ ECT in the short-term treatment of depression were examined by the UK ECT Review Group (2003). They included data on a total of 256 patients (Wilson et al, 1963; Lambourn & Gill, 1978; Freeman et al, 1978; Johnstone et al, 1980; West, 1981; Gregory et al, 1985). Most participants were in-patients under the age of 70 with some form of depressive disorder. The depression ratings at the end of treatment showed the standardised effect size (SES) between real and simulated ECT to be –0.91 (95% CI –1.27 to –0.54), indicating a mean difference in the Hamilton Rating Scale for Depression (HRSD) of 9.67 (95% CI 5.72 to 13.53) in favour of ECT. There have been no trials comparing ECT with sham ECT since the last edition of the Handbook.

    ECT v. Pharmacotherapy

    In 18 randomised controlled trials with a total of 1144 patients, ECT was compared with antidepressant medication in the short-term treatment of depression. Of these, 13 trials contained sufficient data to contribute to a pooled analysis. The SES of these trials was –0.80 (95% CI –1.29 to –0.29). This equates to a mean difference of 5.2 (95% CI 1.37 to 8.87) on the HRSD in favour of ECT. None of these trials compared ECT with newer antidepressant medications such as SSRIs, mirtazepine or venlafaxine.

  • Processing of Facial Emotion in Bipolar Depression and Euthymia
  • Lucy J. Robinson, John M. Gray, Mike Burt, I. Nicol Ferrier, Peter Gallagher
  • Journal: Journal of the International Neuropsychological Society / Volume 21 / Issue 9 / October 2015
  • Published online by Cambridge University Press: 19 October 2015, pp. 709-721
  • View abstract

    Previous studies of facial emotion processing in bipolar disorder (BD) have reported conflicting findings. In independently conducted studies, we investigate facial emotion labeling in euthymic and depressed BD patients using tasks with static and dynamically morphed images of different emotions displayed at different intensities. Study 1 included 38 euthymic BD patients and 28 controls. Participants completed two tasks: labeling of static images of basic facial emotions (anger, disgust, fear, happy, sad) shown at different expression intensities; the Eyes Test (Baron-Cohen, Wheelwright, Hill, Raste, & Plumb, 2001), which involves recognition of complex emotions using only the eye region of the face. Study 2 included 53 depressed BD patients and 47 controls. Participants completed two tasks: labeling of “dynamic” facial expressions of the same five basic emotions; the Emotional Hexagon test (Young, Perret, Calder, Sprengelmeyer, & Ekman, 2002). There were no significant group differences on any measures of emotion perception/labeling, compared to controls. A significant group by intensity interaction was observed in both emotion labeling tasks (euthymia and depression), although this effect did not survive the addition of measures of executive function/psychomotor speed as covariates. Only 2.6–15.8% of euthymic patients and 7.8–13.7% of depressed patients scored below the 10th percentile of the controls for total emotion recognition accuracy. There was no evidence of specific deficits in facial emotion labeling in euthymic or depressed BD patients. Methodological variations—including mood state, sample size, and the cognitive demands of the tasks—may contribute significantly to the variability in findings between studies. (JINS, 2015, 21, 709–721)

  • Corpus callosum changes in euthymic bipolar affective disorder
  • Adrian J. Lloyd, Heba E. Ali, David Nesbitt, P. Brian Moore, Allan H. Young, I. Nicol Ferrier
  • Journal: The British Journal of Psychiatry / Volume 204 / Issue 2 / February 2014
  • Published online by Cambridge University Press: 02 January 2018, pp. 129-136
  • Print publication: February 2014
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    Background

    Changes in corpus callosum area and thickness have been reported in bipolar disorder. Imaging and limited neuropathological data suggest possible abnormalities in myelination and/or glial function.

    Aims

    To compare corpus callosum area, thickness and magnetic resonance imaging (MRI) T1 signal intensity in patients with bipolar disorder and healthy controls.

    Method

    A total of 48 patients with euthymic bipolar disorder and 46 healthy controls underwent MRI analysis of callosal midsagittal area, callosal thickness and T1 signal intensity.

    Results

    The bipolar group had smaller overall and subregional callosal areas and correspondingly reduced callosal width than the control group. Age correlated negatively with callosal area in the control group but not in the bipolar group. Signal intensity was higher in women than in men in both groups. Signal intensity was reduced in women, but not in men, in the bipolar group.

    Conclusions

    Observed differences probably relate to diagnosis rather than mood state and bipolar disorder appears to result in morphometric change that overrides changes seen in normal ageing. Intensity changes are consistent with possible altered myelination or glial function. A gender-dependent factor appears to operate and to interact with diagnosis.

  • 14 - The use of ECT in the treatment of depression
    • By Heinrich C. Lamprecht, Consultant Psychiatrist, Mental Health Services for Older People, Guiborough, Tees, Esk & Wear Valleys NHS Foundation Trust, I. Nicol Ferrier, Professor of Psychiatry, School of Neurology, Neurobiology and Psychiatry, University of Newcastle, Newcastle upon Tyne, Alan G. Swann, Consultant Psychiatrist in Old Age Psychiatry, Newcastle General Hospital, Newcastle upon Tyne, Jonathan Waite, Consultant Psychiatrist, Nottinghamshire Healthcare NHS Trust
  • Edited by Jonathan Waite, Andrew Easton
  • Book: The ECT Handbook
  • Published online: 02 January 2018
  • Print publication: 01 May 2013, pp 126-134
  • View extract

    Summary

    Depression remains the most frequent disorder for which ECT is required. This chapter summarises the evidence for the efficacy of ECT in depression and practical guidelines for its use. The Department of Health commissioned a systematic review of the safety and efficacy of ECT in depression (UK ECT Review Group, 2003), and for the NICE guidance on depression in adults, a further systematic review was undertaken (National Collaborating Centre for Mental Health, 2010: pp. 509–528.)

    Efficacy of ECT in depression

    The UK ECT Review Group (2003) examined data from randomised controlled trials identified in an extensive search. The results were independently checked by two reviewers. Data from studies which met inclusion criteria were extracted by paired members of the review team. Identified trials were assessed for methodology, where appropriate and data from individual trials were summarised by meta-analyses.

    ECT v. ‘sham’ ECT

    Six randomised controlled trials comparing ECT with ‘sham’ ECT in the short-term treatment of depression were examined by the UK ECT Review Group (2003). They included data on a total of 256 patients (Wilson et al, 1963; Lambourn & Gill, 1978; Freeman et al, 1978; Johnstone et al, 1980; West, 1981; Gregory et al, 1985). Most participants were in-patients under the age of 70 with some form of depressive disorder. The depression ratings at the end of treatment showed the standardised effect size (SES) between real and simulated ECT to be –0.91 (95% CI –1.27 to –0.54), indicating a mean difference in the Hamilton Rating Scale for Depression (HRSD) of 9.67 (95% CI 5.72 to 13.53) in favour of ECT. There have been no trials comparing ECT with sham ECT since the last edition of the Handbook.

    ECT v. pharmacotherapy

    In 18 randomised controlled trials with a total of 1144 patients, ECT was compared with antidepressant medication in the short-term treatment of depression. Of these, 13 trials contained sufficient data to contribute to a pooled analysis. The SES of these trials was –0.80 (95% CI –1.29 to –0.29). This equates to a mean difference of 5.2 (95% CI 1.37 to 8.87) on the HRSD in favour of ECT. None of these trials compared ECT with newer antidepressant medications such as SSRIs, mirtazepine or venlafaxine.

  • No psychiatry without psychopharmacology
  • Paul J. Harrison, David S. Baldwin, Thomas R. E. Barnes, Tom Burns, Klaus P. Ebmeier, I. Nicol Ferrier, David J. Nutt
  • Journal: The British Journal of Psychiatry / Volume 199 / Issue 4 / October 2011
  • Published online by Cambridge University Press: 02 January 2018, pp. 263-265
  • Print publication: October 2011
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    The use of psychotropic medication is an important part of most psychiatrists' clinical practice. We propose here that psychiatry needs to give more prominence to psychopharmacology in order to ensure that psychiatric drugs are used effectively and safely. The issue has several ramifications, including the future of psychiatry as a medical discipline.

Practical Management of Bipolar Disorder
  • Practical Management of Bipolar Disorder
  • Edited by Allan H. Young, I. Nicol Ferrier, Erin E. Michalak
  • Published online: 04 August 2010
  • Print publication: 20 May 2010
  • View description
    Bipolar disorder, or manic depression, is characterised by episodes of pathological mood states. The two poles are mania (with a predominant elated or irritable mood) and depression (with feelings of sadness, anxiety, guilt or hopelessness) but mixed states frequently occur. Episodes can last for many months and profoundly affect physical health, relationships and careers. Since diagnosis and management are difficult, this practical guide provides an overview of the disorder and detailed guidelines for treating the illness throughout its stages, from authors internationally renowned for their work in bipolar disorder. Also discussed are disease theories, mechanisms and key clinical trials, as well as chapters devoted to psychosocial treatments, substance misuse and insights from 'lived experience'. In-depth analyses of selected population groups, including youth, the elderly and women, complement guidelines for clinical approaches in managing bipolar disorder. Comprehensive and detailed, this guide will prove invaluable to clinicians, general practitioners, psychiatrists and psychologists.

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