415 posts · 642,084 views
This is the personal blog of a Dutch psychiatrist working in a University hospital. His specialty in psychiatry is the treatment of depression. This explains his interest in electroconvulsive therapy and the development of new forms of neurostimulation for the treatment of depression. He is also involved in medical education. He does research in the treatment and neuroscience of depression. He mostly writes about these topics on this blog for fun and to keep up with recent developments. Besides writing about his work he also writes about other subjects that (neuro)stimulates him such as chocolate, computer gaming, gadgets, and Internet. The postings are based on what I want to write about and what I feel will be interesting to read.
Dr Shock MD PhD
415 posts
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- February 21, 2008
- 09:00 AM
- 916 views
Vagus Nerve Stimulation, an Update
by Dr Shock in Dr Shock MD PhD
The short history of Vagus Nerve Stimulation (VNS) in treatment resistant depression is hampered by some drawbacks. Scientifically the results of a double-blind randomized sham controlled trial with no definitive evidence of short-term efficacy for adjunctive VNS in treatment resistant depression were of major importance. Of human interest was the undisclosed background of Dr Nemeroff, then editor in chief of the journal in which he published a review about VNS for treatment resistant depression. Not only did he not disclose his position as head of the "mechanism of act... Read more »
T E Schlaepfer, C Frick, A Zobel, W Maier, I Heuser, M Bajbouj, V O'Keane, C Corcoran, R Adolfsson, M Trimble.... (2008) Vagus nerve stimulation for depression: efficacy and safety in a European study. Psychological Medicine, 1. DOI: 10.1017/S0033291707001924
M GEORGE. (2005) A One-Year Comparison of Vagus Nerve Stimulation with Treatment as Usual for Treatment-Resistant Depression. Biological Psychiatry, 58(5), 364-373. DOI: 10.1016/j.biopsych.2005.07.028
A RUSH. (2005) Effects of 12 Months of Vagus Nerve Stimulation in Treatment-Resistant Depression: A Naturalistic Study. Biological Psychiatry, 58(5), 355-363. DOI: 10.1016/j.biopsych.2005.05.024
A RUSH. (2005) Vagus Nerve Stimulation for Treatment-Resistant Depression: A Randomized, Controlled Acute Phase Trial. Biological Psychiatry, 58(5), 347-354. DOI: 10.1016/j.biopsych.2005.05.025
- February 19, 2008
- 02:00 PM
- 675 views
Lack of Proper Evaluation of Curricula about resident-phamaceutical industry interaction
by Dr Shock in Dr Shock MD PhD
9 Curricula were identified in a literature search for curricula addressing resident-pharmaceutical industry relationship. Lack of experience may make young doctors particular vulnerable to pharmaceutical industry influence. These interactions between doctor and pharmaceutical companies have an impact on doctor knowledge and prescribing practice. The pharmaceutical companies have different and efficient marketing techniques to influence doctors. Residents may be even more influenced when not educated about these threats.Inconsistency in content (of the curricula), application... Read more »
Brian T Montague, Auguste Fortin VI, & Julie Rosenbaum. (2008) A systematic review of curricula on relationships between residents and the pharmaceutical industry. Medical Education, 42(3), 301-308. DOI: 10.1111/j.1365-2923.2007.02998.x
- February 14, 2008
- 08:00 AM
- 760 views
rTMS update part 2
by Dr Shock in Dr Shock MD PhD
Even a Dutch research group published a placebo controlled trial with rTMS. Not that they found rTMS to be significantly better than sham TMS after two weeks of treatment. Both groups had a reduction of 2.5 points on the Hamilton Depression Rating Scale (17-item version) and 1 point in the second week, the decrease never passed 20% in either group. Their point being a continuing improvement in the rTMS and the sham rTMS group during the follow-up of 3 months. This resulted in a significant mean difference of more than 4 points in favor of the rTMS group over the sham group. N... Read more »
Frank Koerselman. (2004) a 3-month, follow-up, randomized, placebo-controlled study of repetitive transcranial magnetic stimulation in depression. Journal of Clinical Psychiatry, 65(10), 1323-1328.
Curtis Kauffmann, Muhammad A Cheema, & Barney E Miller. (2004) Slow right perfrontal transcranial magnetic stimulation as a reatment for medication-resistant depression: A double-blind, placebo-controlled study. Depression and Anxiety, 19(1), 59-62. DOI: 10.1002/da.10144
Paul Fitzgerald. (2003) Transcranial Magnetic Stimulation in the Treatment of Depression. Archives of General Psychiatry, 60(Octobre), 1002-1008.
Paul Holtzheimer, Joan Russo, Keith H Claypoole, Peter Roy-Byrne, & David H Avery. (2004) Shorter duration of depressive episode may predict response to repetitive transcranial magnetic stimulation. Depression and Anxiety, 19(1), 24-30. DOI: 10.1002/da.10147
- February 11, 2008
- 02:00 PM
- 957 views
The Influence on Reporting a Celebrity Suicide on Suicidal Behavior
by Dr Shock in Dr Shock MD PhD
Patients who are younger and depressed and have made a suicide attempt within a month prior to a media report of a celebrity suicide are at increased risk of a subsequent suicide attempt. The increase was almost 12 times higher than subjects with no previous attempt, 8 times higher to those with a suicide attempt within a half year, and further to 2 to 3-fold among those with a suicide attempt of longer than a half year.Factors influencing the risk of media influences Age under 55 yearsPrevious suicidal behaviorPresence of depression... Read more »
A CHENG, K HAWTON, T CHEN, A YEN, J CHANG, M CHONG, C LIU, Y LEE, P TENG, & L CHEN. (2007) The influence of media reporting of a celebrity suicide on suicidal behavior in patients with a history of depressive disorder. Journal of Affective Disorders, 103(1-3), 69-75. DOI: 10.1016/j.jad.2007.01.021
- February 10, 2008
- 12:00 PM
- 1,022 views
Update on rTMS part 1
by Dr Shock in Dr Shock MD PhD
The information in this review suggests that there is no strong evidence for benefit from using transcranial magnetic stimulation to treat depression, although the small sample sizes do not exclude the possibility of benefit.This was the conclusion of the authors of the Cochrane library about Transcranial magnetic stimulation for treating depression.Since then (2002) 8 randomized controlled trials were published about rTMS and depressionSearch strategy in PubMed:"Transcranial Magnetic Stimulation/therapeutic use"[Mesh] AND "Depressive Disorder/therapy"[Mesh]... Read more »
D RUMI, W GATTAZ, S RIGONATTI, M ROSA, F FREGNI, M ROSA, C MANSUR, M MYCZKOWSKI, R MORENO, & M MARCOLIN. (2005) Transcranial magnetic stimulation accelerates the antidepressant effect of amitriptyline in severe depression: A double-blind placebo-controlled study. Biological Psychiatry, 57(2), 162-166. DOI: 10.1016/j.biopsych.2004.10.029
John O'Reardon. (2005) Long-Term Maintenance Therapy for Major Depressive Disorder With rTMS. Journal of Clinical Psychiatry, 66(12), 1524-1528.
J OREARDON, H SOLVASON, P JANICAK, S SAMPSON, K ISENBERG, Z NAHAS, W MCDONALD, D AVERY, P FITZGERALD, & C LOO. (2007) Efficacy and Safety of Transcranial Magnetic Stimulation in the Acute Treatment of Major Depression: A Multisite Randomized Controlled Trial. Biological Psychiatry, 62(11), 1208-1216. DOI: 10.1016/j.biopsych.2007.01.018
- February 9, 2008
- 12:00 PM
- 1,141 views
3 Guidelines for ECT with Adolescents
by Dr Shock in Dr Shock MD PhD
So far I have found three guidelines about ECT with adolescents for depression. Summarized these guidelines suggest the following recommendations:ECT is not recommended for children (5–11 years).ECT should only be considered for young people with very severe depression and either life-threatening symptoms (such as suicidalbehaviour) or intractable and severe symptoms that have not responded to other treatments. ECT should be used extremely rarely in young people and only after careful assessment by a practitioner experienced in its use and only in a specialist e... Read more »
Neera Ghaziuddin, Stanley Kutcher, Penelope Knapp, William Bernet, Valerie Arnold, Joseph Beitchman, R Benson, Oscar Bukstein, Joan Kinlan, Jon McClellan.... (2004) Practice Parameter for Use of Electroconvulsive Therapy With Adolescents. Journal of the American Academy of Child , 43(12), 1521-1539. DOI: 10.1097/01.chi.0000142280.87429.68
. (2007) Practice Parameter for the Assessment and Treatment of Children and Adolescents With Depressive Disorders. Journal of the American Academy of Child , 46(11), 1503-1526. DOI: 10.1097/chi.0b013e318145ae1c
- February 7, 2008
- 01:00 PM
- 1,221 views
Differences between depression and dementia
by Dr Shock in Dr Shock MD PhD
We have an elderly patient admitted to our ward for second opinion. She has a history of depressive episodes. Two post partum depressions and one depressive episode about 6 years ago. She is 72 years old. When I met her the first day she was in a dysphoric mood complaining about her transfer to our department. She already took nortryptiline for 2 months with adequate plasma levels. Her referring psychiatrist said that this had led to some improvement, the patient was less pleased with the antidepressant. According to her this drug was causing memory problems. She ... Read more »
S Wright, & C Persad. (2007) Distinguishing Between Depression and Dementia in Older Persons: Neuropsychological and Neuropathological Correlates. Journal of Geriatric Psychiatry and Neurology, 20(4), 189-198. DOI: 10.1177/0891988707308801
- February 6, 2008
- 03:00 PM
- 1,122 views
What do drug addiction and running have in common?
by Dr Shock in Dr Shock MD PhD
Running is rewarding, antidepressive. Running has beneficial effects in treatment of depression. Running can increase neurogenesis in hippocampus in rodents.But what have addictive drugs and exercise in common?Excessive training can result in fatigue and mood disturbances.This is comparable to withdrawal in substance abusers.Sudden cessation of running can result in withdrawal with negative mood states comparable to drug withdrawal.It is for both not known why controlled behavior such as running can change to compulsive running or from recreational alc... Read more »
S BRENE, A BJORNEBEKK, E ABERG, A MATHE, L OLSON, & M WERME. (2007) Running is rewarding and antidepressive. Physiology , 92(1-2), 136-140. DOI: 10.1016/j.physbeh.2007.05.015
- February 2, 2008
- 04:00 PM
- 1,312 views
rapid Transcranial Magnetic Stimulation (rTMS) in Bulimia Nervosa
by Dr Shock in Dr Shock MD PhD
rTMS for Bulimia Nervosa does not exert additional benefit over placebo. Bulimia Nervosa is a disease strongly influenced by sociocultural influences and psychological factors. In the past this has led to preliminary optimism about efficacy of fluoxetine in this eating disorder. The efficacy was based on the trial effect (Hawthorne Effect). Being in a trial with appointments, rating sessions, diagnostic sessions has effect on well being especially in diseases with a strong origination in sociocultural and psychological factors.Bulimia Nervosa is accompanied by several psychia... Read more »
M Walpoth, C Hoertnagl, B Mangweth-Matzek, G Kemmler, J Hinterh, A Conca, & A Hausmann. (2008) Repetitive Transcranial Magnetic Stimulation in Bulimia Nervosa: Preliminary Results of a Single-Centre, Randomised, Double-Blind, Sham-Controlled Trial in Female Outpatients. Psychotherapy and Psychosomatics, 77(1), 57-60. DOI: 10.1159/000110061
- February 1, 2008
- 12:00 PM
- 887 views
Does a surgeon make more steps a day in the hospital than an internist?
by Dr Shock in Dr Shock MD PhD
Age and Body Mass Index (BMI)were the most important variables that predicted the number of steps taken per hour by doctors. Each year older corresponded with a decrease of 5 steps per hour and each point rise in BMI resulted in an average decrease of 20 steps per hour on the job.There was no difference in the number of steps taken in the hospital by general surgeons and internists. There wasn't even a difference between housemen, registrars and members of the staff. The average number of steps taken per day was 5325, per hour 548. For comparison flight attendants take 842 st... Read more »
J Goosen. (2008) How many steps does a doctor take in the hospital? No difference between internist and genral surgeon, but a relationship with age and BMI. Nederlands Tijdschrift voor Geneeskunde, 152(4), 203-206.
- February 1, 2008
- 06:00 AM
- 781 views
Does a surgeon make more steps a day in the hospital than a internist?
by Dr Shock in Dr Shock MD PhD
Age and Body Mass Index (BMI)were the most important variables that predicted the number of steps taken per hour by doctors. Each year older corresponded with a decrease of 5 steps per hour and each point rise in BMI resulted in an average decrease of 20 steps per hour on the job.There was no difference in the number of steps taken in the hospital by general surgeons and internists. There wasn't even a difference between housemen, registrars and members of the staff. The average number of steps taken per day was 5325, per hour 548. For comparison flight attendants take 842 st... Read more »
J Goosen. (2008) How many steps does a doctor take in the hospital? No difference between internist and genral surgeon, but a relationship with age and BMI. Nederlands Tijdschrift voor Geneeskunde, 152(4), 203-206.
- January 31, 2008
- 05:00 AM
- 1,051 views
Deep Brain Stimulation for Alzheimers Disease.
by Dr Shock in Dr Shock MD PhD
Electrical stimulation of areas deep within the brain could improve memory, early research suggests. A team of doctors in Canada were attempting to treat a morbidly obese man through deep brain stimulation (DBS) for his obesitas. Their long-standing interest in functional neurosurgery and DBS made them consider the possibility of a neurosurgical treatment. They wanted to stimulate the hypothalamus for appetite control. Hypothalamic lesion surgery had been used previously to treat obesity. Hypothalamic stimulation was proposed based on experimental studies of appetite control in rod... Read more »
Clement Hamani, Mary McAndrews, Melanie Cohn, Michael Oh, Dominik Zumsteg, Colin Shapiro, Richard Wennberg, & Andres Lozano. (2008) Memory enhancement induced by hypothalamic/fornix deep brain stimulation. Annals of Neurology, 63(1), 119-123. DOI: 10.1002/ana.21295
- January 30, 2008
- 07:00 AM
- 998 views
Risk Factors for Recurrence in Depression
by Dr Shock in Dr Shock MD PhD
On Vicarious Therapy there was an important question raised: Early Medical Intervention for Major Depression. I kept thinking about it, the answer is: I don't know. Here is the problem:Now, six plus years into this MDE I'm still searching for something that will help me, but I believe I at least FINALLY, in the psychiatrist I see, have the knowledgeable and completely supportive help I needed all along.I often wonder, had I received help at 18 or 19, instead of 36, would I be better today? Would I be struggling so hard to find something to help me?That... Read more »
S BURCUSA, & W IACONO. (2007) Risk for recurrence in depression. Clinical Psychology Review, 27(8), 959-985. DOI: 10.1016/j.cpr.2007.02.005
- January 27, 2008
- 03:00 AM
- 1,345 views
DSM V citeria for Depression for Dummies
by Dr Shock in Dr Shock MD PhD
In an Editorial in the American Journal of Psychiatry the author recommends the use of five psychological symptoms of depression as sufficient for the diagnosis of Major Depression. Diagnosing Major Depression on the basis of a restricted symptom set. Moreover, the justification for this restriction according to the author, is based on studies that showed that psychiatry and primary care trainees could not remember the nine symptoms.That's why they are traineesHe replicated the findings of Zimmerman et al, using the 12 month version of the Composite In... Read more »
G Andrews, T Slade, M Sunderland, & T Anderson. (2007) Issues for DSM-V: Simplifying DSM-IV to Enhance Utility: The Case of Major Depressive Disorder. American Journal of Psychiatry, 164(12), 1784-1785. DOI: 10.1176/appi.ajp.2007.07060928
- January 26, 2008
- 11:00 AM
- 1,124 views
What Sets us Apart from Monkeys and Apes?
by Dr Shock in Dr Shock MD PhD
Which human behaviors are unique compared to other primates such as monkeys and apes?Advanced planning. We humans are able to plan ahead. Planting crops for harvests later on. Humans have a ability to trade immediate gratification for long term rewards.Culture innovation and teaching through language. Apes show some signs of rudimentary culture, such as different traditions in the use of tools to crack nuts. But the complex cultures produced by humans societies are unique to our species.Humans are good imitators, they accumulate culture and knowledge over generations.... Read more »
M Balter. (2008) HUMAN EVOLUTION: Why We're Different: Probing the Gap Between Apes and Humans. Science, 319(5862), 404-405. DOI: 10.1126/science.319.5862.404
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