ECT efficacy and treatment course: A systematic review and meta-analysis of twice vs thrice weekly schedules

Charlson, Fiona J; Siskind, Dan; Doi, Suhail A.R.; McCallum, Emily J.; Broome, A.; Lie, David

doi:10.1016/j.jad.2011.03.039

Cited by 73 publications

(32 citation statements)

References 22 publications

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“…Our analysis of variance was based on a comparison with controls without a psychiatric history and the results were consistent with those of Verwijk et al (2014). In both studies the patients were given ECT twice weekly, and this aspect of the therapeutic technique may have an impact on cognitive side-effects (Charlson et al, 2012). In our study, group comparisons showed no significant differences between groups on screening measures of retrograde amnesia.…”

supporting

confidence: 74%

Cognitive Side-effects of Electroconvulsive Therapy in Elderly Depressed Patients

Dybedal

Tanum

Sundet

et al. 2014

The Clinical Neuropsychologist

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Knowledge about cognitive side-effects induced by electroconvulsive therapy (ECT) in depressed elderly patients is sparse. In this study we investigated changes in the cognitive functioning of non-demented elderly depressed patients receiving ECT (n = 62) compared with healthy elderly people (n = 17). Neuropsychological tests were administered at the start of treatment and again within 1 week after treatment. We computed reliable change indices (RCIs) using simple regression methods. RCIs are statistical methods for analyzing change in individuals that have not yet been used in studies of the acute cognitive side-effects of ECT. At the group level, only letter fluency performance was found to be significantly reduced in the ECT group compared with the controls, whereas both groups demonstrated stable or improved performance on all other measures. At the individual level, however, 11% of patients showed retrograde amnesia for public facts post-ECT and 40% of the patients showed a significant decline in neuropsychological functioning. Decline on a measure of delayed verbal anterograde memory was most common. Our findings indicate that there are mild neurocognitive impairments in the acute phase for a substantial minority of elderly patients receiving ECT. Analysis of reliable change facilitated the illumination of cognitive side-effects in our sample.

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supporting

confidence: 74%

Cognitive Side-effects of Electroconvulsive Therapy in Elderly Depressed Patients

Dybedal

Tanum

Sundet

et al. 2014

The Clinical Neuropsychologist

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“…None of these studies were designed to determine unilateral noninferiority for antidepressant effect, and most had very limited follow-up. All used thrice-weekly treatment, common practice in the United States where most of these trials originated, even though this does not result in better outcomes than twice-weekly ECT (14) but is associated with increased cognitive side effects (15). This limits their generalizability for populations in which twice-weekly frequency is common practice, as occurs in many European countries (e.g., Belgium, Ireland, the Netherlands, United Kingdom) (16,17).…”

mentioning

confidence: 99%

Bitemporal Versus High-Dose Unilateral Twice-Weekly Electroconvulsive Therapy for Depression (EFFECT-Dep): A Pragmatic, Randomized, Non-Inferiority Trial

Semkovska¹,

Landau²,

Dunne³

et al. 2016

AJP

156

118

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Objective: ECT is the most effective treatment for severe depression. Previous efficacy studies, using thrice-weekly brief-pulse ECT, reported that high-dose (63 seizure threshold) right unilateral ECT is similar to bitemporal ECT but may have fewer cognitive side effects. The authors aimed to assess the effectiveness and cognitive side effects of twice-weekly moderate-dose (1.53 seizure threshold) bitemporal ECT with high-dose unilateral ECT in real-world practice.Method: This was a pragmatic, patient-and rater-blinded, noninferiority trial of patients with major depression (N=138; 63% female; age=56.7 years [SD=14.8]) in a national ECT service with a 6-month follow-up. Participants were independently randomly assigned to bitemporal or highdose unilateral ECT. The primary outcome was change in the 24-item Hamilton Depression Rating Scale (HAM-D) score after the ECT course; the prespecified noninferiority margin was 4.0 points. Secondary outcomes included response and remission rates, relapse status after 6 months, and cognition.Results: Of the eligible patients, 69 were assigned to bitemporal ECT and 69 to unilateral ECT. High-dose unilateral ECT was noninferior to bitemporal ECT regarding the 24-item HAM-D scores after the ECT course (mean difference=1.08 points in favor of unilateral ECT [95% CI=21.67 to 3.84]). There were no significant differences for response and remission or 6-month relapse status. Recovery of orientation was quicker following unilateral ECT (median=19.1 minutes versus 26.4 minutes). Bitemporal ECT was associated with a lower percent recall of autobiographical information (odds ratio=0.66) that persisted for 6 months.Conclusions: Twice-weekly high-dose unilateral ECT is not inferior to bitemporal ECT for depression and may be preferable because of its better cognitive side-effect profile.

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“…The ECT usually lasts from 6 to 12 sessions, and it´s applied with a frequency of 2 or 3 times weekly to alternate days [31]. Our patient received 7 sessions, on a biweekly basis, without observing any significant change.…”

Section: Discussionmentioning

confidence: 90%

Electroconvulsive Therapy: Solution or a Cause of Tardiv Dyskinesia?

María¹

2017

J Depress Anxiety

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ECT efficacy and treatment course: A systematic review and meta-analysis of twice vs thrice weekly schedules

Cited by 73 publications

References 22 publications

Cognitive Side-effects of Electroconvulsive Therapy in Elderly Depressed Patients

Cognitive Side-effects of Electroconvulsive Therapy in Elderly Depressed Patients

Bitemporal Versus High-Dose Unilateral Twice-Weekly Electroconvulsive Therapy for Depression (EFFECT-Dep): A Pragmatic, Randomized, Non-Inferiority Trial

Electroconvulsive Therapy: Solution or a Cause of Tardiv Dyskinesia?

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