New type of ECT as effective as the old with fewer side-effects

U.S. National Institute of Mental Health study reported in the journal Brain Stimulation has found that a new form of electroconvulsive therapy (ECT) is just as effective as older forms in treating depression but with far fewer of the cognitive side effects found in the older forms. Dr Harold Sackeim and colleagues from Columbia University randomly assigned 90 depressed patients to either right sided or bilateral ECT, using either a traditional electrical pulse or a newer "ultrabrief pulse", and measured clinical response and cognitive side effects.

The study found that 73 percent of the patients that received the ultrabrief pulse responded, compared to a 65 percent response from subjects who received the 'gold standard' bilateral older form. Importantly, the ultrabrief group had less severe cognitive side effects than the other group. "The use of an ultrabrief stimulus markedly reduces adverse cognitive effects and, when coupled with markedly suprathreshold right unilateral ECT, also preserves efficacy," write Dr Sackeim and colleagues.

In a related editorial, Dr Bernard Lerer, an Israeli psychiatrist not involved in the study, wrote "The paper by Sackeim and colleagues in the current issue of 'Brain Stimulation' shows that use of an ultrabrief stimulus has remarkably few, if any, effects on cognitive function without loss of efficacy. The results provide convincing evidence derived from a randomized controlled trial. ... If supported by additional controlled studies and borne out by clinical experience in the field, these findings will be an important further step forward in the practice of ECT. They also have intriguing implications for our understanding of how the treatment works, a conundrum that has not been resolved in the 73 years since convulsive therapy was first introduced."

Dr Lerer went on to comment, "Overall, these are interesting times for brain stimulation therapies in general and ECT in particular. Ultrabrief stimulation is an exciting development in the optimization of ECT. It could turn out to be a pivotal step in an exciting cascade of events that may radically alter the treatment of depression and other psychiatric disorders."