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

doi:10.1093/ijnp/pyu045

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

Int J Neuropsychopharmacol. 2014 Dec 5;18(1):pyu045. doi: 10.1093/ijnp/pyu045.

Affiliations

¹ School of Psychiatry, University of New South Wales, Sydney, Australia (Drs Loo and Martin, Ms Katalinic, and Mr Hadzi-Pavlovic); St George Hospital and Wesley Hospital, Sydney, Australia (Dr Loo and Dr Simpson); Black Dog Institute, Sydney, Australia (Drs Loo and Martin, Ms Katalinic, and Mr Hadzi-Pavlovic); and Dr Simpson Department of Psychiatry, University of Melbourne, and The Melbourne Clinic, Melbourne, Australia (Ms Smith and Addison, Mr Dowling, and Dr Schweitzer); Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia (Dr Ingram). colleen.loo@unsw.edu.au.
² School of Psychiatry, University of New South Wales, Sydney, Australia (Drs Loo and Martin, Ms Katalinic, and Mr Hadzi-Pavlovic); St George Hospital and Wesley Hospital, Sydney, Australia (Dr Loo and Dr Simpson); Black Dog Institute, Sydney, Australia (Drs Loo and Martin, Ms Katalinic, and Mr Hadzi-Pavlovic); and Dr Simpson Department of Psychiatry, University of Melbourne, and The Melbourne Clinic, Melbourne, Australia (Ms Smith and Addison, Mr Dowling, and Dr Schweitzer); Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia (Dr Ingram).

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.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Affect
Cognition Disorders / etiology
Depressive Disorder / therapy*
Double-Blind Method
Electroconvulsive Therapy / adverse effects
Electroconvulsive Therapy / methods*
Female
Humans
Male
Middle Aged
Neuropsychological Tests
Psychiatric Status Rating Scales
Seizures / etiology
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT00870805