Images in Electroconvulsive Therapy: Pilot Impressions Suggesting That ECT Reduces Excitatory Synapses in the Basolateral Amygdala.

Images in electroconvulsive therapy: Pilot impressions suggesting that ECT reduces excitatory synapses in the basolateral amygdala.

Indian J Psychiatry. 2013 Apr; 55(2): 204-5
Khaleel N, Ravindranath R, Sagar BK, Andrade C

In animal models, stress and depression are associated with excitatory changes in the amygdala; this aberrant neuroplasticity may represent increased fear learning, explaining the anxiety, fear, and related symptoms that characterize clinical depression.In a pilot investigation, we treated adult, male, Wistar rats with sham electroconvulsive shocks (ECS; n=3), low-dose ECS (10 mC; n=3), and high-dose ECS (60 mC; n=3). The rats were sacrificed 1 month after the last of 6 once-daily ECS and, after dissection, sections of the basolateral amygdala were examined using transmission electron microscopy under low (×11,000) and high (×30,000) magnification.In each group, 4 fields were examined under low magnification and 6 fields under high magnification. The number of excitatory synapses and the ratio of excitatory to inhibitory synapses were both numerically lower with ECS than with sham ECS, and the effect was stronger in the high-dose ECS group (statistical analyses were not performed because this was a pilot study).By reducing the number of excitatory synapses and the ratio of excitatory to inhibitory synapses, ECT (especially high-dose ECT) may reduce stress-induced excitatory changes in the amygdala. These changes may help explain a part of the benefits observed with ECT in conditions such as depression and post-traumatic stress disorder. HubMed – depression


Tests, testing, and tested – we need to critically evaluate the meaning of tests in psychiatry.

Indian J Psychiatry. 2013 Apr; 55(2): 200-3
Berger DM

This article describes clinical pitfalls in our concepts of what it means for an illness, diagnosis, or evaluation and treatment methods to say that they have been “tested”. This articles begins with the problems encountered in newborn testing for Krabbe Disease of the nervous system in New York State over the last few years as an example of a test that did not live up to its promise to help the society. Next, the article gives 3 examples of testing in psychiatry, 1. Psychological testing to make treatment decisions in children with depression, 2. Patient’s and parents who have been told, or believe, that they have Asperger’s disorder, and 3. The conclusions made about the efficacy of cognitive behavioral therapy based on clinical studies. The article’s conclusion sums up these examples as reasons why we need to have a more practical and scientific approach to our understanding and implementation of tests used in our field. HubMed – depression


Intramuscular ketamine in acute depression: A report on two cases.

Indian J Psychiatry. 2013 Apr; 55(2): 186-8
Harihar C, Dasari P, Srinivas JS

It takes about 2 weeks for the onset of antidepressant action of drugs while electroconvulsive therapy though faster, is a cumbersome procedure requiring an anaesthetist and at least a minor operation theatre. Recent studies have shown that Ketamine, when given to severely depressed patients in the dose of 0.5 mg/kg as a slow intravenous infusion over 40 minutes, brought about acute relief from depression and amelioration of suicidal risk within a few hours. The improvement, however, was transient and lasted for up to a week but could be sustained by further weekly or biweekly injections. As the dose of ketamine administered was found to be safe, it was now tried in the intramuscular route in two severely depressed patients with similar rapid improvement. The cases are reported here which pave way for an easier mode of treating acute depression. HubMed – depression