The Effects of Focal Electrically Administered Seizure Therapy Compared With Ultrabrief Pulse Right Unilateral Electroconvulsive Therapy on Suicidal Ideation: A 2-Site Clinical Trial

Abstract

Background: Preliminary data suggest that focal electrically administered seizure therapy (FEAST) has antidepressant effects and less adverse cognitive effects than traditional forms of electroconvulsive therapy (ECT). This study compared the impact of FEAST and ultrabrief pulse, right unilateral (UB-RUL) ECT on suicidal ideation.

Methods: At 2 sites, patients in a major depressive episode were treated openly with FEAST or UB-RUL ECT, depending on their preference. The primary outcome measure was scores on the Beck Scale for Suicide Ideation (SSI). Scores on the suicide item of the Hamilton Rating Scale for Depression (HRSD-SI) provided a secondary outcome measure.

Results: Thirty-nine patients were included in the intent-to-treat sample (FEAST, n = 20; UB-RUL ECT, n = 19). Scores on both the SSI and HRSD-SI were equivalently reduced with both interventions. Both responders and nonresponders to the interventions showed substantial reductions in SSI and HRSD-SI scores, although the magnitude of improvement was greater among treatment responders.

Conclusions: Although limited by the open-label, nonrandomized design, FEAST showed comparable effects on suicidal ideation when compared with routine use of UB-RUL ECT. These results are encouraging and support the need for further research and a noninferiority trial.

Trial registration: ClinicalTrials.gov NCT02535572.

Conflict of interest statement

Supported in part by an unrestricted educational grant from the MECTA Corporation. The MECTA Corporation also provided custom-modified MECTA spECTrum 5000Q devices for the delivery of FEAST. The MECTA was not involved in study design, data analysis, or data interpretation. N.A.Y. received research support from Department of Veteran Affairs, Augusta Biomedical Research Corporation, MECTA Corporation, and Merck (but not salary support). N.A.Y. also received Speaker CME honoraria from the Georgia Department of Behavioral Health and Developmental Disabilities and Psychiatric Annals for unrelated CME topics. W.V.M. receives research support from MECTA, Vistagen, and Merck. W.V.M. receives royalties from Wolters Kluwer and is a scientific adviser for Jazz, Sage, and Janssen Pharmaceuticals. H.A.S. is the inventor on a patent for FEAST (US8712532 B2), titration in the current domain in electroconvulsive therapy (US9789310), and the adjustment of current in electroconvulsive therapy devices (US10583288), each held by the MECTA Corporation. H.A.S. is also the originator of magnetic seizure therapy and serves as a consultant to the MECTA Corporation, Neuronetics, Inc, and LivaNova LPC. The other authors have no conflicts of interest or financial disclosures to report.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

Figures

Figure 1.

Change in Scores on the Beck Scale for Suicide Ideation and the Hamilton Rating Scale for Depression Suicide Item for Patients Treated with Focal Electrically-Administered Seizure Therapy (FEAST) and Ultrabrief Pulse Right Unilateral (UB-RUL) ECT

Figure 2.

Scores on the Beck Scale for Suicidal Ideation (SSI) and the Hamilton Rating Scale for Depression-Suicide Item (HRSD-SI) Before and Following the ECT Course in Treatment Responders and Non-responders.