Prediction of the Cognitive Effects of Electroconvulsive Therapy Via Machine Learning and Neuroimaging

NCT ID: NCT03490149

Last Updated: 2022-05-25

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

UNKNOWN

Total Enrollment

180 participants

Study Classification

OBSERVATIONAL

Study Start Date

2018-01-02

Study Completion Date

2022-12-01

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

The study aims to use machine learning to predict the occurrence of episodic and autobiographical memory deficits as well as treatment response following a course of electroconvulsive therapy. Additionally, the neurophysiological correlates of the cognitive effects after a course of ECT will be investigated.

Therefore, structural, resting-state and diffusion tensor images will be collected within one week before the first and after the last ECT treatment from severely depressed patients. Standard measures of cognitive function and specifically episodic as well as autobiographical memory will also be collected longitudinally and used for prediction. The study consists of 60 ECT receiving inpatients suffering from major unipolar or bipolar depression, 60 medication-only controls and 60 healthy controls.

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

Due to the immense disease burden of major depression and unsatisfactory response to standard pharmacological and psychological treatments, the need for treatment alternatives is evident. Electroconvulsive therapy (ECT) remains to be the most efficacious treatment known for treatment-resistant depression. However, although many studies show response rates above 70%, ECT can be considered vastly underused. Reasons contributing to this phenomenon may include stigma, regulatory restrictions, limited medical training, safety and side-effect concerns, or reluctance among professionals to recommend ECT. Most of these reasons have already been refuted or put into perspective by psychological and neuroscientific studies (e.g. ECT causes brain lesions) and most cognitive deficits related to the ECT course seem to fade after several weeks of discontinuation.

Still, in terms of the tolerability, memory disturbances remain the most problematic effect of ECT. Besides subjective reports from patients after a course of ECT, experimental studies have also found evidence of episodic and autobiographical memory impiarment attributable to ECT. The origins of these effects are still largely unknown and remain a goal for further research.

It has now been shown that structural T1 weighted MR-images can be used to predict the response to a course of ECT via machine learning. Therefore, this study aims to use machine learning to predict the occurrence of episodic and specifically autobiographical memory deficits arising within a course of electroconvulsive therapy based on MR-images collected within one week before the first ECT treatment from severely depressed patients. Additionally, the neurophysiological correlates of the cognitive effects modulated by a course of ECT will be investigated longitudinally through the use of structural, resting-state and diffusion tensor images. The study consists of 60 ECT receiving inpatients suffering from major unipolar or bipolar depression.

If successful, this line of research should lead to a better tolerability of ECT by aiding in the complex decision making process involved in prescribing ECT as well as the parameter setting within a treatment course (e.g. uni- vs. bilateral).

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

ECT Depression Cognitive Impairment Memory Impairment

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Observational Model Type

CASE_CONTROL

Study Time Perspective

PROSPECTIVE

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

ECT

Electroconvulsive Therapy

Intervention Type DEVICE

Series of electroconvulsive therapy for major depressive disorder

Medication - Treatment as usual

Medication - Treatment as usual

Intervention Type DRUG

Medication only sample - Treatment as usual

Healthy controls

No interventions assigned to this group

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

Electroconvulsive Therapy

Series of electroconvulsive therapy for major depressive disorder

Intervention Type DEVICE

Medication - Treatment as usual

Medication only sample - Treatment as usual

Intervention Type DRUG

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

* The duration of the current depressive episode is at least four weeks
* The duration of the current depressive episode is less than five years
* Inpatients of the psychiatric clinic of the University Hospital Bonn and eligible for ECT because of major depressive disorder or major depressive episode in bipolar disorder (according to DSM-5 criteria)
* Score on HDRS 28 ≥ 20
* Ability to understand the purpose of and procedures required for the study and willingness to consent to participation
* Meeting of standard medical prerequisites for ECT (judged by staff psychiatrist)
* Ability to speak and understand the german language

Exclusion Criteria

* No lifetime occurence of a personality disorder
* Current (or within the last year) posttraumatic stress disorder
* Schizophrenia or any other psychotic disorder except for psychotic depression
* Severe somatic or neurological condition (e.g. stroke)
* Head trauma resulting in unconsciousness for more than 5 minutes
* Pregnancy
* Maintenance ECT or ECT received during the last 6 month
* Subjects who do not consent to be informed of incidental findings that could have healthcare implications
* Drug or alcohol dependence (\<6 month before ECT)
* Is currently enrolled in a study with an investigational study drug
* Has any condition that, in the opinion of the investigator, would compromise the wellbeing of the subject or the study or prevent the subject from meeting or performing study requirements
Minimum Eligible Age

18 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

Maximilian Kiebs, M.Sc. - University Hospital Bonn (Department of Medical Psychology)

UNKNOWN

Sponsor Role collaborator

University Hospital, Bonn

OTHER

Sponsor Role lead

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

Rene Hurlemann

Prof. Dr. Dr.

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

Learn about the lead researchers overseeing the trial and their institutional affiliations.

Rene Hurlemann, Prof.

Role: STUDY_DIRECTOR

University Hospital, Bonn

Locations

Explore where the study is taking place and check the recruitment status at each participating site.

Klinik und Poliklinik für Psychiatrie und Psychotherapie

Bonn, North Rhine-Westphalia, Germany

Site Status RECRUITING

Countries

Review the countries where the study has at least one active or historical site.

Germany

Central Contacts

Reach out to these primary contacts for questions about participation or study logistics.

Maximilian Kiebs, M.Sc.

Role: CONTACT

0049228287 ext. 19710

Facility Contacts

Find local site contact details for specific facilities participating in the trial.

Maximilian Kiebs, M.Sc.

Role: primary

0228287 ext. 19710

References

Explore related publications, articles, or registry entries linked to this study.

Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, Charlson FJ, Norman RE, Flaxman AD, Johns N, Burstein R, Murray CJ, Vos T. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet. 2013 Nov 9;382(9904):1575-86. doi: 10.1016/S0140-6736(13)61611-6. Epub 2013 Aug 29.

Reference Type BACKGROUND
PMID: 23993280 (View on PubMed)

Sinyor M, Schaffer A, Levitt A. The sequenced treatment alternatives to relieve depression (STAR*D) trial: a review. Can J Psychiatry. 2010 Mar;55(3):126-35. doi: 10.1177/070674371005500303.

Reference Type BACKGROUND
PMID: 20370962 (View on PubMed)

UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet. 2003 Mar 8;361(9360):799-808. doi: 10.1016/S0140-6736(03)12705-5.

Reference Type BACKGROUND
PMID: 12642045 (View on PubMed)

Haq AU, Sitzmann AF, Goldman ML, Maixner DF, Mickey BJ. Response of depression to electroconvulsive therapy: a meta-analysis of clinical predictors. J Clin Psychiatry. 2015 Oct;76(10):1374-84. doi: 10.4088/JCP.14r09528.

Reference Type BACKGROUND
PMID: 26528644 (View on PubMed)

Sackeim HA. Modern Electroconvulsive Therapy: Vastly Improved yet Greatly Underused. JAMA Psychiatry. 2017 Aug 1;74(8):779-780. doi: 10.1001/jamapsychiatry.2017.1670. No abstract available.

Reference Type BACKGROUND
PMID: 28658461 (View on PubMed)

Slade EP, Jahn DR, Regenold WT, Case BG. Association of Electroconvulsive Therapy With Psychiatric Readmissions in US Hospitals. JAMA Psychiatry. 2017 Aug 1;74(8):798-804. doi: 10.1001/jamapsychiatry.2017.1378.

Reference Type BACKGROUND
PMID: 28658489 (View on PubMed)

Aoki Y, Yamaguchi S, Ando S, Sasaki N, Bernick PJ, Akiyama T. The experience of electroconvulsive therapy and its impact on associated stigma: A meta-analysis. Int J Soc Psychiatry. 2016 Dec;62(8):708-718. doi: 10.1177/0020764016675379. Epub 2016 Oct 26.

Reference Type BACKGROUND
PMID: 27798050 (View on PubMed)

Bailine S. Reimbursement and documentation issues in an ambulatory ECT program. J ECT. 1998 Dec;14(4):255-8.

Reference Type BACKGROUND
PMID: 9871847 (View on PubMed)

Case BG, Bertollo DN, Laska EM, Price LH, Siegel CE, Olfson M, Marcus SC. Declining use of electroconvulsive therapy in United States general hospitals. Biol Psychiatry. 2013 Jan 15;73(2):119-26. doi: 10.1016/j.biopsych.2012.09.005. Epub 2012 Oct 8.

Reference Type BACKGROUND
PMID: 23059049 (View on PubMed)

Wilhelmy S, Rolfes V, Grozinger M, Chikere Y, Schottle S, Gross D. Knowledge and attitudes on electroconvulsive therapy in Germany: A web based survey. Psychiatry Res. 2018 Apr;262:407-412. doi: 10.1016/j.psychres.2017.09.015. Epub 2017 Sep 11.

Reference Type BACKGROUND
PMID: 28923432 (View on PubMed)

Wilkinson D, Daoud J. The stigma and the enigma of ECT. Int J Geriatr Psychiatry. 1998 Dec;13(12):833-5. doi: 10.1002/(sici)1099-1166(1998120)13:123.0.co;2-r. No abstract available.

Reference Type BACKGROUND
PMID: 9884906 (View on PubMed)

Dwork AJ, Arango V, Underwood M, Ilievski B, Rosoklija G, Sackeim HA, Lisanby SH. Absence of histological lesions in primate models of ECT and magnetic seizure therapy. Am J Psychiatry. 2004 Mar;161(3):576-8. doi: 10.1176/appi.ajp.161.3.576.

Reference Type BACKGROUND
PMID: 14992989 (View on PubMed)

Semkovska M, McLoughlin DM. Objective cognitive performance associated with electroconvulsive therapy for depression: a systematic review and meta-analysis. Biol Psychiatry. 2010 Sep 15;68(6):568-77. doi: 10.1016/j.biopsych.2010.06.009. Epub 2010 Jul 31.

Reference Type BACKGROUND
PMID: 20673880 (View on PubMed)

Payne NA, Prudic J. Electroconvulsive therapy: Part I. A perspective on the evolution and current practice of ECT. J Psychiatr Pract. 2009 Sep;15(5):346-68. doi: 10.1097/01.pra.0000361277.65468.ef.

Reference Type BACKGROUND
PMID: 19820553 (View on PubMed)

Prudic J, Peyser S, Sackeim HA. Subjective memory complaints: a review of patient self-assessment of memory after electroconvulsive therapy. J ECT. 2000 Jun;16(2):121-32. doi: 10.1097/00124509-200006000-00004.

Reference Type BACKGROUND
PMID: 10868322 (View on PubMed)

Lisanby SH, Maddox JH, Prudic J, Devanand DP, Sackeim HA. The effects of electroconvulsive therapy on memory of autobiographical and public events. Arch Gen Psychiatry. 2000 Jun;57(6):581-90. doi: 10.1001/archpsyc.57.6.581.

Reference Type BACKGROUND
PMID: 10839336 (View on PubMed)

Sackeim HA. Autobiographical memory and electroconvulsive therapy: do not throw out the baby. J ECT. 2014 Sep;30(3):177-86. doi: 10.1097/YCT.0000000000000117.

Reference Type BACKGROUND
PMID: 24755727 (View on PubMed)

Sackeim HA. Memory and ECT: from polarization to reconciliation. J ECT. 2000 Jun;16(2):87-96. doi: 10.1097/00124509-200006000-00001. No abstract available.

Reference Type BACKGROUND
PMID: 10868319 (View on PubMed)

Redlich R, Opel N, Grotegerd D, Dohm K, Zaremba D, Burger C, Munker S, Muhlmann L, Wahl P, Heindel W, Arolt V, Alferink J, Zwanzger P, Zavorotnyy M, Kugel H, Dannlowski U. Prediction of Individual Response to Electroconvulsive Therapy via Machine Learning on Structural Magnetic Resonance Imaging Data. JAMA Psychiatry. 2016 Jun 1;73(6):557-64. doi: 10.1001/jamapsychiatry.2016.0316.

Reference Type BACKGROUND
PMID: 27145449 (View on PubMed)

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

CoEffECT - Study

Identifier Type: -

Identifier Source: org_study_id

More Related Trials

Additional clinical trials that may be relevant based on similarity analysis.

Brain Activity in Epilepsy
NCT05307146 RECRUITING NA