Magnitude of Reduction &amp; Speed of Remission of Suicidality for Low AmPlitude Seizure Therapy (LAP-ST) Compared to Standard Right Unilateral ECT

Youssef, Nagy A.; Ravilla, Dheeraj; McCall, William Vaughn; Patel, Cherishma; McCloud, Laryssa; Yassa, Mark; Rosenquist, Peter B.

doi:10.1016/j.brs.2018.12.422

Cited by 2 publications

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“…A recent nonrandomized proof of concept clinical trial suggested that ultra-brief RUL ECT with a lower current amplitude (as low as 500 to 600 mA) may improve cognitive outcomes by reducing reorientation time, a measure correlated with cognitive outcomes from ECT. Intriguingly, there was no difference in treatment response in depressive symptoms when compared to higher current ultra-brief pulse RUL 48,49 . However, there may be an individual tradeoff between the efficacy of treating depression and preserving cognition by using a lower current amplitude.…”

Section: Ect—an Ultra-brief Historymentioning

confidence: 92%

“…Intriguingly, there was no difference in treatment response in depressive symptoms when compared to higher current ultra-brief pulse RUL. 48,49 However, there may be an individual tradeoff between the efficacy of treating depression and preserving cognition by using a lower current amplitude. Abbott and colleagues 50 investigated ultra-brief RUL ECT delivered at three current amplitudes.…”

Section: Ect-an Ultra-brief Historymentioning

confidence: 99%

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Electroconvulsive Therapy: Mechanisms of Action, Clinical Considerations, and Future Directions

Kritzer

Peterchev

Camprodon

2023

Harv Rev Psychiatry

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Learning objectives:• Outline and discuss the fundamental physiologic, cellular, and molecular mechanisms of ECT to devise strategies to optimize therapeutic outcomes• Summarize the overview of ECT, its efficacy in treating depression, the known effects on cognition, evidence of mechanisms, and future directions.AbstractElectroconvulsive therapy (ECT) is the most effective treatment for a variety of psychiatric illnesses, including treatment-resistant depression, bipolar depression, mania, catatonia, and clozapine-resistant schizophrenia. ECT is a medical and psychiatric procedure whereby electrical current is delivered to the brain under general anesthesia to induce a generalized seizure. ECT has evolved a great deal since the 1930s. Though it has been optimized for safety and to reduce adverse effects on cognition, issues persist. There is a need to understand fundamental physiologic, cellular, and molecular mechanisms of ECT to devise strategies to optimize therapeutic outcomes. Clinical trials that set out to adjust parameters, electrode placement, adjunctive medications, and patient selection are critical steps towards the goal of improving outcomes with ECT. This narrative review provides an overview of ECT, its efficacy in treating depression, its known effects on cognition, evidence of its mechanisms, and future directions.

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Section: Ect—an Ultra-brief Historymentioning

confidence: 92%

Section: Ect-an Ultra-brief Historymentioning

confidence: 99%

Electroconvulsive Therapy: Mechanisms of Action, Clinical Considerations, and Future Directions

Kritzer

Peterchev

Camprodon

2023

Harv Rev Psychiatry

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“…The aims of this report are to: 1) compare LAP-ST (at 500mA) versus standard Right Unilateral (RUL) ECT (at 900mA) in terms of magnitude of remission of suicidality and 2) compare the speed of remission of suicidality between LAP-ST versus RUL ECT. We hypothesized that there will be a similar improvement in magnitude and in the speed of remission of suicidality on the suicidality item of the Montgomery-Åsberg Depression Rating Scale (MADRS) for LAP-ST compared to RUL ECT [20,21].…”

Section: Introductionmentioning

confidence: 99%

Magnitude of Reduction and Speed of Remission of Suicidality for Low Amplitude Seizure Therapy (LAP-ST) Compared to Standard Right Unilateral Electroconvulsive Therapy: A Pilot Double-Blinded Randomized Clinical Trial

et al. 2019

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Background: Although treatment guidelines support use of electroconvulsive therapy (ECT) for acute suicidality, it is associated with cognitive side effects. The effect of Low Amplitude Seizure Therapy (LAP-ST) on suicidality is unknown. Our prior precision LAP-ST (pLAP-ST) performing titrating in the current domain has provided initial proof of concept data in humans of its advantage in terms of reduction of cognitive side effects. The aims of this report are to: 1) compare LAP-ST (at 500mA) versus standard Right Unilateral (RUL) ECT (at 900 mA) in terms of magnitude of remission of suicidality in a randomized allocation and 2) compare the speed of remission of suicidality between LAP-ST versus RUL ECT. Methods: Patients were randomized to either LAP-ST or RUL ECT. The scores pertaining to the suicidal ideation (SI) item on the Montgomery-Åsberg Depression Rating Scale (MADRS) were analyzed using descriptive analysis and no confirmatory statistical analysis was performed due to a priori sample size limitations for this pilot study. SI item remission was defined as 2 or below on this item. Results: Eleven patients with major depressive episode (MDE) of mainly unipolar or bipolar disorders signed consent. Of these, 7 were eligible and were randomized and included in the analysis; all were actively suicidal at baseline (suicide item above 2), except 1 patient who had suicide item at 2 in the RUL ECT group. Suicidality remitted on average by session 3 and remission occurred for all patients by session 4. The SI mean score improvement from baseline to endpoint for LAP-ST was 5.1 and for RUL ECT was 3.0. Conclusions: LAP-ST has larger effect size and speed of remission of suicidality compared to standard RUL ECT. Future studies are warranted for replicating these findings. (ClinicalTrials.gov ID: NCT02583490).

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Magnitude of Reduction & Speed of Remission of Suicidality for Low AmPlitude Seizure Therapy (LAP-ST) Compared to Standard Right Unilateral ECT

Cited by 2 publications

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Electroconvulsive Therapy: Mechanisms of Action, Clinical Considerations, and Future Directions

Electroconvulsive Therapy: Mechanisms of Action, Clinical Considerations, and Future Directions

Magnitude of Reduction and Speed of Remission of Suicidality for Low Amplitude Seizure Therapy (LAP-ST) Compared to Standard Right Unilateral Electroconvulsive Therapy: A Pilot Double-Blinded Randomized Clinical Trial

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