A randomized controlled trial of brief and ultrabrief pulse right unilateral electroconvulsive therapy

Colleen K Loo, Natalie Katalinic, Deirdre J Smith, Anna Ingram, Nathan Dowling, Donel Martin, Kerryn Addison, Dusan Hadzi-Pavlovic, Brett Simpson, Isaac Schweitzer, Colleen K Loo, Natalie Katalinic, Deirdre J Smith, Anna Ingram, Nathan Dowling, Donel Martin, Kerryn Addison, Dusan Hadzi-Pavlovic, Brett Simpson, Isaac Schweitzer

Abstract

Background: Some studies suggest better overall outcomes when right unilateral electroconvulsive therapy (RUL ECT) is given with an ultrabrief, rather than brief, pulse width.

Methods: The aim of the study was to test if ultrabrief-pulse RUL ECT results in less cognitive side effects than brief- pulse RUL ECT, when given at doses which achieve comparable efficacy. One hundred and two participants were assigned to receive ultrabrief (at 8 times seizure threshold) or brief (at 5 times seizure threshold) pulse RUL ECT in a double-blind, randomized controlled trial. Blinded raters assessed mood and cognitive functioning over the ECT course.

Results: Efficacy outcomes were not found to be significantly different. The ultrabrief group showed less cognitive impairment immediately after a single session of ECT, and over the treatment course (autobiographical memory, orientation).

Conclusions: In summary, when ultrabrief RUL ECT was given at a higher dosage than brief RUL ECT (8 versus 5 times seizure threshold), efficacy was comparable while cognitive impairment was less.

Trial registration: ClinicalTrials.gov NCT00870805.

Keywords: cognitive; depression; electroconvulsive therapy; pulse width; randomized controlled trial.

© The Author 2014. Published by Oxford University Press on behalf of CINP.

Figures

Figure 1.
Figure 1.
CONSORT diagram.
Figure 2.
Figure 2.
(A) Mean Montgomery-Åsberg Depression Rating Scale (MADRS) scores at baseline, week 1, week 2, and after the final ECT, adjusted for covariates; (B) Mean MADRS scores at 1 week, 1 month, and 6 month follow-ups, adjusted for covariates.

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Source: PubMed

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