Efficacy of ultrabrief pulse electroconvulsive therapy for depression: A systematic review

Spaans, Harm-Pieter; Kho, King H.; Verwijk, Esmée; Kok, Rob M.; Stek, Max L.

doi:10.1016/j.jad.2013.05.072

Cited by 53 publications

(27 citation statements)

References 38 publications

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“…In terms of harms/benefits ratio, high-dose unilateral ECT was noninferior to bitemporal ECT but showed a better cognitive profile, especially for preserving retrograde personal memories and fewer subjective cognitive side effects. While there is much interest in other modifications to maintain effectiveness but reduce side effects (e.g., ultrabrief pulse-width ECT), these require further refinement and characterization for optimization (36,37). Our findings justify considering high-dose unilateral ECT as the preferred ECT option for treating depression and may help improve acceptability and availability of this effective treatment.…”

Section: Discussionmentioning

confidence: 80%

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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Section: Discussionmentioning

confidence: 80%

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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“…(Spaans et al, 2013a;Verwijk et al, 2012) In a recent randomized comparison between RUL BP and RUL UBP ECT we did not find differences in cognitive effects with respect to retrograde amnesia, semantic memory and lexical memory one Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/jad week after finishing the ECT course. However, an advantage for RUL BP ECT was demonstrated in short-term efficacy, especially in the speed of remission.…”

Section: Introductionmentioning

confidence: 72%

Relapse and long-term cognitive performance after brief pulse or ultrabrief pulse right unilateral electroconvulsive therapy: A multicenter naturalistic follow up

Verwijk

Spaans

Comijs

et al. 2015

Journal of Affective Disorders

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“…ECT represents an effective treatment of pharmacoresistant cases of depression [29][30][31], bipolar disorder [32], and schizophrenia [33,34]. Mechanisms underlying the therapeutic effects of ECT remain largely elusive, with 2 major hypotheses dominating: the anticonvulsant, whereby the effects are attributed to the increase of seizure threshold and decrease of seizure duration observed during the course of ECT [35], and the neurotrophic, which brings in the induction of several neurotrophic factors (e.g., brain-derived neurotrophic factor, vascular endothelial growth factor), transcription factors (e.g., cfos), and neurogenesis as explanations [36,37].…”

Section: Discussionmentioning

confidence: 99%

Autism-Like Behavior in BTBR Mice Is Improved by Electroconvulsive Therapy

et al. 2015

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Autism is a developmental disorder characterized by impairments in social and communication abilities, as well as by restricted and repetitive behaviors. Incidence of autism is higher than earlier estimates, and treatments have limited efficacy and are costly. Limited clinical and experimental evidence suggest that patients with autism may benefit from electroconvulsive therapy (ECT). We examined the therapeutic potential of ECT in BTBR T+ tf/j mice, which represent a validated model of autism. A series of 13 electroconvulsive shocks (ECS) delivered twice a day over 7 days reversed core autism-like behavioral abnormalities-impaired sociability, social novelty, and repetitive behavior-when the animals were tested 24 h after the last ECS. The effect lasted up to 2 weeks after ECT. Neither single ECS nor a series of 6 ECS modified animals' behavior. Chronic infusion into the lateral brain ventricle of a preferential oxytocin receptor blocker (2S)-2-Amino--(methylsulfonyl)butanamide hydrochloride abolished ECTinduced improvement of sociability and mitigated improvement of social novelty but did not affect ECT-induced reversal of repetitive behavior. These proof-of-principle experiments suggest that ECT may, indeed, be useful in the treatment of autism, and that its therapeutic effects may be mediated, in part, by central oxytocin signaling.

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Efficacy of ultrabrief pulse electroconvulsive therapy for depression: A systematic review

Cited by 53 publications

References 38 publications

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

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

Relapse and long-term cognitive performance after brief pulse or ultrabrief pulse right unilateral electroconvulsive therapy: A multicenter naturalistic follow up

Autism-Like Behavior in BTBR Mice Is Improved by Electroconvulsive Therapy

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