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Cognitive effects of brief and ultrabrief pulse bitemporal electroconvulsive therapy: a randomised controlled proof-of-concept trial

Published online by Cambridge University Press:  02 May 2019

Donel Martin Open the ORCID record for Donel Martin [Opens in a new window] ,
Natalie Katalinic ,
Dusan Hadzi-Pavlovic ,
Anna Ingram ,
Nicholas Ingram ,
Brett Simpson ,
Jenny McGoldrick ,
Nathan Dowling  and
Colleen Loo
Donel Martin
Affiliation:
School of Psychiatry, University of New South Wales, Sydney, NSW, Australia Black Dog Institute, Sydney, NSW, Australia
Natalie Katalinic
Affiliation:
St George Hospital, Sydney, NSW, Australia
Dusan Hadzi-Pavlovic
Affiliation:
School of Psychiatry, University of New South Wales, Sydney, NSW, Australia Black Dog Institute, Sydney, NSW, Australia
Anna Ingram
Affiliation:
Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
Nicholas Ingram
Affiliation:
The Melbourne Clinic, Melbourne, VIC, Australia
Brett Simpson
Affiliation:
St George Hospital, Sydney, NSW, Australia Welsey Hospital, Sydney, NSW, Australia
Jenny McGoldrick
Affiliation:
Welsey Hospital, Sydney, NSW, Australia
Nathan Dowling
Affiliation:
The Melbourne Clinic, Melbourne, VIC, Australia Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
Colleen Loo*
Affiliation:
School of Psychiatry, University of New South Wales, Sydney, NSW, Australia Black Dog Institute, Sydney, NSW, Australia St George Hospital, Sydney, NSW, Australia Welsey Hospital, Sydney, NSW, Australia
*
Author for correspondence: Colleen Loo, E-mail: [email protected]
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Abstract

Background

Reduction of the pulse width has been reported to improve ECT outcomes with unilateral ECT (similar efficacy, fewer cognitive side effects), but has been minimally studied for bitemporal ECT. The only study comparing brief and ultrabrief pulse bitemporal ECT found reduced efficacy for bitemporal ultrabrief compared to bitemporal brief pulse stimulation. This randomised controlled trial (RCT) aimed to test if ultrabrief pulse bitemporal ECT results in fewer cognitive side effects than brief pulse bitemporal ECT, when given at doses adjusted with the aim of achieving comparable efficacy.

Methods

Thirty-six participants were randomly assigned to receive ultrabrief (at 3 times seizure threshold) or brief (at 1.5 times seizure threshold) pulse bitemporal ECT given 3 times a week in a double-blind, controlled proof-of-concept trial. Blinded raters assessed mood and cognitive functioning over the ECT course.

Results

Efficacy and cognitive outcomes did not differ significantly between the two treatment groups over the ECT course. The ultrabrief pulse group performed better on a test of visual memory assessed acutely after an ECT treatment.

Conclusions

This study suggests there may be a small cognitive advantage in giving bitemporal ECT with an ultrabrief pulse when dosage is increased to match the efficacy of brief pulse bitemporal ECT, but the study was underpowered to fully examine this issue.

Clinical Trials Registration: www.clinicaltrials.gov, NCT00870805.

Keywords

Cognitivedepressionelectroconvulsive therapyrandomised controlled trialtreatmentultrabrief
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 7 , May 2020 , pp. 1121 - 1128
Copyright
Copyright © Cambridge University Press 2019

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