Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy
Received 21 February 2008; received in revised form 6 March 2008; accepted 11 March 2008. published online 12 May 2008.
Background
Although electroconvulsive therapy (ECT) in major depression is effective, cognitive effects limit its use. Reducing the width of the electrical pulse and by using the right unilateral electrode placement may decrease adverse cognitive effects, while preserving efficacy.
Methods
In a double-masked study, we randomly assigned 90 depressed patients to right unilateral ECT at 6 times seizure threshold or bilateral ECT at 2.5 times seizure threshold, using either a traditional brief pulse (1.5 milliseconds) or an ultrabrief pulse (0.3 millisecond). Depressive symptoms and cognition were assessed before, during, and immediately, 2, and 6 months after therapy. Patients who responded were monitored for a 1-year period.
Results
The final remission rate for ultrabrief bilateral ECT was 35%, compared with 73% for ultrabrief unilateral ECT, 65% for standard pulse width bilateral ECT, and 59% for standard pulse width unilateral ECT (all P < .05 after covariate adjustment). The ultrabrief right unilateral group had less severe cognitive side effects than the other three groups in virtually all primary outcome measures assessed in the acute postictal period, and during and immediately after therapy. Both the ultrabrief stimulus and right unilateral electrode placement produced less short- and long-term retrograde amnesia. Patients rated their memory deficits as less severe after ultrabrief right unilateral ECT compared with each of the other three conditions (P < .001).
Conclusions
The use of an ultrabrief stimulus markedly reduces adverse cognitive effects, and when coupled with markedly suprathreshold right unilateral ECT, also preserves efficacy. (ClinicalTrials.gov number, NCT00487500.)
Department of Biological Psychiatry, New York State Psychiatric Institute and the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
Address reprint requests to: Dr. Harold A. Sackeim, Department of Biological Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 126, New York, NY 10032.
This study was supported in part by grants R01 MH35636 and R01 MH47739 from the National Institute of Mental Health.
Dr. Sackeim serves as an unpaid consultant to the MECTA Corporation, which donated the electroconvulsive therapy devices used in this study.
ABSTRACT