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Neuromodulation Therapies and Ketamine in Older Age Bipolar Disorder

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Bipolar Disorder in Older Age Patients

Abstract

Neuromodulation therapies are important alternatives for the management of treatment-resistant mood disorders in the elderly. Some of these therapies are relatively modern strategies such as the recently FDA-approved transcranial magnetic stimulation (TMS), vagal nerve stimulation (VNS), and deep brain stimulation (DBS), which is still undergoing extensive research. The use of electroconvulsive therapy (ECT) has evolved in its practice since the 1940s with a recent significant shift toward the use of right unilateral, ultra-brief-pulse width. Additionally, ECT is increasingly delivered in outpatient settings. The roles of the newer therapies have not been systematically studied in the geriatric population, and despite the fact that ECT has been widely used in the older population, there is limited evidence-based data about the use of ECT in the older adults. Older individuals are particularly vulnerable to polypharmacy given increasing medical comorbidity with advancing age. Neuromodulation techniques are not pharmacotherapies and, therefore, have the potential of limiting polypharmacy in older adults with psychiatric disorders. While the vast majority of neuromodulation therapy research focuses on unipolar depression, there is an increase in research examining the safety and efficacy of ECT for individuals with bipolar disorder. In this chapter, we will review the evidence-based data for electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), deep brain stimulation (DBS), transcranial direct current stimulation (tDCS), magnetic seizure therapy (MST), and focal electrically administered seizure therapy (FEAST) in older adults with psychiatric disorders. Relevant evidence for the use of ketamine during ECT and independent of ECT treatment will also be reviewed.

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References

  1. Hoyle S, Elliott L, Comer L. Available screening tools for adults suffering from bipolar affective disorder in primary care: an integrative literature review. J Am Assoc Nurse Pract. 2015;27(5):280–9.

    PubMed  Google Scholar 

  2. Forester BP, Ajilore O, Spino C, Lehmann SW. Clinical characteristics of patients with late life bipolar disorder in the community: data from the NNDC registry. Am J Geriatr Psychiatry. 2015;23(9):977–84.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Peterchev AV, Rosa MA, Deng ZD, Prudic J, Lisanby SH. Electroconvulsive therapy stimulus parameters: rethinking dosage. J ECT. 2010;26(3):159–74.

    Article  PubMed  PubMed Central  Google Scholar 

  4. van Schaik AM, Comijs HC, Sonnenberg CM, Beekman AT, Sienaert P, Stek ML. Efficacy and safety of continuation and maintenance electroconvulsive therapy in depressed elderly patients: a systematic review. Am J Geriatr Psychiatry. 2012;20(1):5–17.

    Article  PubMed  Google Scholar 

  5. Tew JD Jr, Mulsant BH, Haskett RF, Prudic J, Thase ME, Crowe RR, et al. Acute efficacy of ECT in the treatment of major depression in the old-old. Am J Psychiatry. 1999;156(12):1865–70.

    PubMed  Google Scholar 

  6. O’Connor MK, Knapp R, Husain M, Rummans TA, Petrides G, Smith G, et al. The influence of age on the response of major depression to electroconvulsive therapy: a CORE Report. Am J Geriatr Psychiatry Fall. 2001;9(4):382–90.

    Article  Google Scholar 

  7. Kerner N, Prudic J. Current electroconvulsive therapy practice and research in the geriatric population. Neuropsychiatry (London). 2014;4(1):33–54.

    Article  Google Scholar 

  8. Greenberg RM, Kellner CH. Electroconvulsive therapy: a selected review. Am J Geriatr Psychiatry. 2005;13(4):268–81.

    Article  PubMed  Google Scholar 

  9. Damm J, Eser D, Schule C, Obermeier M, Moller HJ, Rupprecht R, et al. Influence of age on effectiveness and tolerability of electroconvulsive therapy. J ECT. 2010;26(4):282–8.

    Article  PubMed  Google Scholar 

  10. Goldstein BI, Herrmann N, Shulman KI. Comorbidity in bipolar disorder among the elderly: results from an epidemiological community sample. Am J Psychiatry. 2006;163(2):319–21.

    Article  PubMed  Google Scholar 

  11. Virupaksha HS, Shashidhara B, Thirthalli J, Kumar CN, Gangadhar BN. Comparison of electroconvulsive therapy (ECT) with or without anti-epileptic drugs in bipolar disorder. J Affect Disord. 2010;127(1–3):66–70.

    Article  PubMed  Google Scholar 

  12. American Psychiatric Association Group. The practice of electroconvulsive therapy: recommendations for treatment, training, and privileging. A Task Force Report of the American Psychiatric Association. 2nd ed. Washington, DC: APA; 2001.

    Google Scholar 

  13. Scott A. College guidelines on electroconvulsive therapy: an update for prescribers. 2005;11:150–6.

    Google Scholar 

  14. Royal College of Psychiatrists. The ECT Handbook. 2005. (The Third Report of the Royal College of Psychiatrists’ Special Committee on ECT (Council Report CR128)).

    Google Scholar 

  15. Thirthalli J, Rakesh G, Gangadhar BN. Antiepileptic drugs-ECT combination: need for systematic studies. World J Biol Psychiatry. 2010;11(7):919–20.

    Article  PubMed  Google Scholar 

  16. Rubner P, Koppi S, Conca A. Frequency of and rationales for the combined use of electroconvulsive therapy and antiepileptic drugs in Austria and the literature. World J Biol Psychiatry. 2009;10(4 Pt 3):836–45.

    Article  PubMed  Google Scholar 

  17. Mukherjee S. Combined ECT and lithium therapy. Convuls Ther. 1993;9(4):274–84.

    PubMed  Google Scholar 

  18. Lee J, Arcand L, Narang P, Lippmann S. ECT-induced Mania. Innov Clin Neurosci. 2014;11(11–12):27–9.

    PubMed  PubMed Central  Google Scholar 

  19. Li DJ, Li HJ, Lin CH. Electroconvulsive therapy-induced manic episode for a patient with bipolar depression: a case report. J ECT. 2015;31(2):e30–1.

    Article  PubMed  Google Scholar 

  20. Ghaemi SN. Antidepressants in bipolar depression: the clinical debate. Aust NZ J Psychiatry. 2012;46(4):298–301.

    Article  Google Scholar 

  21. Medda P, Perugi G, Zanello S, Ciuffa M, Cassano GB. Response to ECT in bipolar I, bipolar II and unipolar depression. J Affect Disord. 2009;118(1–3):55–9.

    Article  CAS  PubMed  Google Scholar 

  22. Semkovska M, Landau S, Dunne R, Kolshus E, Kavanagh A, Jelovac A, et al. Bitemporal versus high-dose unilateral twice-weekly electroconvulsive therapy for depression (EFFECT-Dep): a pragmatic, randomized non-inferiority trial. Am J Psychiatry. 2016;173(4):408–17.

    Article  PubMed  Google Scholar 

  23. Ota M, Noda T, Sato N, Okazaki M, Ishikawa M, Hattori K, et al. Effect of electroconvulsive therapy on gray matter volume in major depressive disorder. J Affect Disord. 2015;1(186):186–91.

    Article  Google Scholar 

  24. Tendolkar I, van Beek M, van Oostrom I, Mulder M, Janzing J, Voshaar RO, et al. Electroconvulsive therapy increases hippocampal and amygdala volume in therapy refractory depression: a longitudinal pilot study. Psychiatry Res. 2013;214(3):197–203.

    Article  PubMed  Google Scholar 

  25. Verwijk E, Comijs HC, Kok RM, Spaans HP, Tielkes CE, Scherder EJ, et al. Short- and long-term neurocognitive functioning after electroconvulsive therapy in depressed elderly: a prospective naturalistic study. Int Psychogeriatr. 2014;26(2):315–24.

    Article  PubMed  Google Scholar 

  26. Joshi SH, Espinoza RT, Pirnia T, Shi J, Wang Y, Ayers B, et al. Structural plasticity of the hippocampus and amygdala induced by electroconvulsive therapy in major depression. Biol Psychiatry. 2016;79(4):282–92.

    Article  PubMed  Google Scholar 

  27. Kessler U, Schoeyen HK, Andreassen OA, Eide GE, Malt UF, Oedegaard KJ, et al. The effect of electroconvulsive therapy on neurocognitive function in treatment-resistant bipolar disorder depression. J Clin Psychiatry. 2014;75(11):e1306–13.

    Article  PubMed  Google Scholar 

  28. Reti IM, Krishnan A, Podlisky A, Sharp A, Walker M, Neufeld KJ, et al. Predictors of electroconvulsive therapy postictal delirium. Psychosomatics. 2014;55(3):272–9.

    Article  PubMed  Google Scholar 

  29. Hassamal S, Pandurangi A, Venkatachalam V, Levenson J. Delayed onset and prolonged ECT-related delirium. Case Rep Psychiatry. 2013;2013:840425.

    PubMed  PubMed Central  Google Scholar 

  30. Perera T, George MS, Grammer G, Janicak PG, Pascual-Leone A, Wirecki TS. The clinical TMS society consensus review and treatment recommendations for TMS therapy for major depressive disorder. Brain Stimul. 2016;9(3):336–46.

    Article  PubMed  Google Scholar 

  31. George MS. Transcranial magnetic stimulation for the treatment of depression. Expert Rev Neurother. 2010;10(11):1761–72.

    Article  PubMed  Google Scholar 

  32. Riva-Posse P, Hermida AP, McDonald WM. The role of electroconvulsive and neuromodulation therapies in the treatment of geriatric depression. Psychiatr Clin North Am. 2013;36(4):607–30.

    Article  PubMed  Google Scholar 

  33. Cohen RB, Brunoni AR, Boggio PS, Fregni F. Clinical predictors associated with duration of repetitive transcranial magnetic stimulation treatment for remission in bipolar depression: a naturalistic study. J Nerv Ment Dis. 2010;198(9):679–81.

    Article  PubMed  Google Scholar 

  34. Grisaru N, Yaroslavsky Y, Belmaker RH. Is TMS an antibipolar treatment? In: George MS, Belmaker RH, editors. Transcranial magnetic stimulation in neuropsychiatry. 1st ed. DC: American Psychiatric Press; 2000. p. 201–7.

    Google Scholar 

  35. Grisaru N, Chudakov B, Yaroslavsky Y, Belmaker RH. Transcranial magnetic stimulation in mania: a controlled study. Am J Psychiatry. 1998;155(11):1608–10.

    Article  CAS  PubMed  Google Scholar 

  36. Kaptsan A, Yaroslavsky Y, Applebaum J, Belmaker RH, Grisaru N. Right prefrontal TMS versus sham treatment of mania: a controlled study. Bipolar Disord. 2003;5(1):36–9.

    Article  PubMed  Google Scholar 

  37. Saba G, Rocamora JF, Kalalou K, Benadhira R, Plaze M, Lipski H, et al. Repetitive transcranial magnetic stimulation as an add-on therapy in the treatment of mania: a case series of eight patients. Psychiatry Res. 2004;128(2):199–202.

    Article  PubMed  Google Scholar 

  38. Michael N, Erfurth A. Treatment of bipolar mania with right prefrontal rapid transcranial magnetic stimulation. J Affect Disord. 2004;78(3):253–7.

    Article  PubMed  Google Scholar 

  39. Loo CK, McFarquhar TF, Mitchell PB. A review of the safety of repetitive transcranial magnetic stimulation as a clinical treatment for depression. Int J Neuropsychopharmacol. 2008;11(1):131–47.

    Article  PubMed  Google Scholar 

  40. Rapinesi C, Bersani FS, Kotzalidis GD, Imperatori C, Del Casale A, Di Pietro S, et al. Maintenance deep transcranial magnetic stimulation sessions are associated with reduced depressive relapses in patients with unipolar or bipolar depression. Front Neurol. 2015;9(6):16.

    Google Scholar 

  41. Xia G, Gajwani P, Muzina DJ, Kemp DE, Gao K, Ganocy SJ, et al. Treatment-emergent mania in unipolar and bipolar depression: focus on repetitive transcranial magnetic stimulation. Int J Neuropsychopharmacol. 2008;11(1):119–30.

    Article  PubMed  Google Scholar 

  42. Dolberg OT, Schreiber S, Grunhaus L. Transcranial magnetic stimulation-induced switch into mania: a report of two cases. Biol Psychiatry. 2001;49(5):468–70.

    Article  CAS  PubMed  Google Scholar 

  43. Vitek JL. Mechanisms of deep brain stimulation: excitation or inhibition. Mov Disord. 2002;17(Suppl 3):S69–72.

    Article  PubMed  Google Scholar 

  44. Malone DA Jr, Dougherty DD, Rezai AR, Carpenter LL, Friehs GM, Eskandar EN, et al. Deep brain stimulation of the ventral capsule/ventral striatum for treatment-resistant depression. Biol Psychiatry. 2009;65(4):267–75.

    Article  PubMed  Google Scholar 

  45. Mayberg HS, Lozano AM, Voon V, McNeely HE, Seminowicz D, Hamani C, et al. Deep brain stimulation for treatment-resistant depression. Neuron. 2005;45(5):651–60.

    Article  CAS  PubMed  Google Scholar 

  46. Schlaepfer TE, Bewernick BH, Kayser S, Madler B, Coenen VA. Rapid effects of deep brain stimulation for treatment-resistant major depression. Biol Psychiatry. 2013;73(12):1204–12.

    Article  PubMed  Google Scholar 

  47. Schlaepfer TE, Cohen MX, Frick C, Kosel M, Brodesser D, Axmacher N, et al. Deep brain stimulation to reward circuitry alleviates anhedonia in refractory major depression. Neuropsychopharmacology. 2008;33(2):368–77.

    Article  PubMed  Google Scholar 

  48. Holtzheimer PE, Kelley ME, Gross RE, Filkowski MM, Garlow SJ, Barrocas A, et al. Subcallosal cingulate deep brain stimulation for treatment-resistant unipolar and bipolar depression. Arch Gen Psychiatry. 2012;69(2):150–8.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Coenen VA, Amtage F, Volkmann J, Schlapfer TE. Deep brain stimulation in neurological and psychiatric disorders. Dtsch Arztebl Int. 2015;112(31–32):519–26.

    PubMed  PubMed Central  Google Scholar 

  50. Ugurlu TT, Acar G, Karadag F, Acar F. Manic episode following deep brain stimulation of the subthalamic nucleus for Parkinson’s disease: a case report. Turk Neurosurg. 2014;24(1):94–7.

    PubMed  Google Scholar 

  51. Moreines JL, McClintock SM, Holtzheimer PE. Neuropsychologic effects of neuromodulation techniques for treatment-resistant depression: a review. Brain Stimul. 2011;4(1):17–27.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Cretaz E, Brunoni AR, Lafer B. Magnetic seizure therapy for unipolar and bipolar depression: a systematic review. Neural Plast. 2015;2015:521398.

    PubMed  PubMed Central  Google Scholar 

  53. Alexopoulos GS, Kelly RE Jr. Research advances in geriatric depression. World Psychiatry. 2009;8(3):140–9.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Galvez V, Ho KA, Alonzo A, Martin D, George D, Loo CK. Neuromodulation therapies for geriatric depression. Curr Psychiatry Rep. 2015;17(7):59.

    Article  PubMed  Google Scholar 

  55. Elder GJ, Taylor JP. Transcranial magnetic stimulation and transcranial direct current stimulation: treatments for cognitive and neuropsychiatric symptoms in the neurodegenerative dementias? Alzheimers Res Ther. 2014;6(9):74.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Nitsche MA, Cohen LG, Wassermann EM, Priori A, Lang N, Antal A, et al. Transcranial direct current stimulation: state of the art 2008. Brain Stimul. 2008;1(3):206–23.

    Article  PubMed  Google Scholar 

  57. Zaehle T, Sandmann P, Thorne JD, Jancke L, Herrmann CS. Transcranial direct current stimulation of the prefrontal cortex modulates working memory performance: combined behavioural and electrophysiological evidence. BMC Neurosci 2011;12:2-2202-12-2.

    Google Scholar 

  58. Antal A, Nitsche MA, Kruse W, Kincses TZ, Hoffmann KP, Paulus W. Direct current stimulation over V5 enhances visuomotor coordination by improving motion perception in humans. J Cogn Neurosci. 2004;16(4):521–7.

    Article  PubMed  Google Scholar 

  59. Tortella G, Casati R, Aparicio LV, Mantovani A, Senco N, D’Urso G, et al. Transcranial direct current stimulation in psychiatric disorders. World J Psychiatry. 2015;5(1):88–102.

    PubMed  PubMed Central  Google Scholar 

  60. Brunoni AR, Ferrucci R, Bortolomasi M, Vergari M, Tadini L, Boggio PS, et al. Transcranial direct current stimulation (tDCS) in unipolar vs. bipolar depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2011;35(1):96–101.

    Article  CAS  PubMed  Google Scholar 

  61. Chahine G, Short B, Spicer K, Schmidt M, Burns C, Atoui M, et al. Regional cerebral blood flow changes associated with focal electrically administered seizure therapy (FEAST). Brain Stimul. 2014;7(3):483–5.

    Article  PubMed  Google Scholar 

  62. Nahas Z, Short B, Burns C, Archer M, Schmidt M, Prudic J, et al. A feasibility study of a new method for electrically producing seizures in man: focal electrically administered seizure therapy [FEAST]. Brain Stimul. 2013;6(3):403–8.

    Article  PubMed  Google Scholar 

  63. Newport DJ, Carpenter LL, McDonald WM, Potash JB, Tohen M, Nemeroff CB, et al. Ketamine and other NMDA antagonists: early clinical trials and possible mechanisms in depression. Am J Psychiatry. 2015;172(10):950–66.

    Article  PubMed  Google Scholar 

  64. Fond G, Loundou A, Rabu C, Macgregor A, Lancon C, Brittner M, et al. Ketamine administration in depressive disorders: a systematic review and meta-analysis. Psychopharmacology. 2014;231(18):3663–76.

    Article  CAS  PubMed  Google Scholar 

  65. Salehi B, Mohammadbeigi A, Kamali AR, Taheri-Nejad MR, Moshiri I. Impact comparison of ketamine and sodium thiopental on anesthesia during electroconvulsive therapy in major depression patients with drug-resistant; a double-blind randomized clinical trial. Ann Card Anaesth. 2015;18(4):486–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Diazgranados N, Ibrahim L, Brutsche NE, Newberg A, Kronstein P, Khalife S, et al. A randomized add-on trial of an N-methyl-D-aspartate antagonist in treatment-resistant bipolar depression. Arch Gen Psychiatry. 2010;67(8):793–802.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  67. Zarate CA Jr, Brutsche NE, Ibrahim L, Franco-Chaves J, Diazgranados N, Cravchik A, et al. Replication of ketamine’s antidepressant efficacy in bipolar depression: a randomized controlled add-on trial. Biol Psychiatry. 2012;71(11):939–46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Stefansson T, Wickstrom I, Haljamae H. Hemodynamic and metabolic effects of ketamine anesthesia in the geriatric patient. Acta Anaesthesiol Scand. 1982;26(4):371–7.

    Article  CAS  PubMed  Google Scholar 

  69. Won Hee L, Lisanby SH, Laine AF, Peterchev AV. Stimulation strength and focality of electroconvulsive therapy and magnetic seizure therapy in a realistic head model. Conf Proc IEEE Eng Med Biol Soc. 2014;2014:410–3.

    Google Scholar 

  70. Loo CK, Katalinic N, Garfield JB, Sainsbury K, Hadzi-Pavlovic D, Mac-Pherson R. Neuropsychological and mood effects of ketamine in electroconvulsive therapy: a randomised controlled trial. J Affect Disord. 2012;142(1–3):233–40.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive NE, Atlanta, GA, 30329, USA

    Adriana P. Hermida

  2. Department of Psychiatry and Behavioral Medicine, East Carolina University, 905 Johns Hopkins Dr, Greenville, NC, 27834, USA

    Oliver M. Glass

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  1. Adriana P. Hermida
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Correspondence to Adriana P. Hermida .

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Editors and Affiliations

  1. School of Medicine, The Johns Hopkins University School of Medicine, BALTIMORE, Maryland, USA

    Susan W. Lehmann

  2. Department of Psychiatry, McLean Hospital Harvard Medical School, Belmont, Massachusetts, USA

    Brent P. Forester

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Hermida, A.P., Glass, O.M. (2017). Neuromodulation Therapies and Ketamine in Older Age Bipolar Disorder. In: Lehmann, S., Forester, B. (eds) Bipolar Disorder in Older Age Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-48912-4_8

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  • DOI: https://doi.org/10.1007/978-3-319-48912-4_8

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