Ultra-brief unilateral electroconvulsive therapy: effects on severe depression, memory and the ictal electroencephalogram- a randomised double-blind trial

Abstract

Study Title: Ultra-brief unilateral electroconvulsive therapy: effects on severe depression, memory and the ictal electroencephalogram- a randomised double-blind trial. Introduction Electroconvulsive therapy (ECT) is an established treatment against severe depression whose use is mainly limited by its effects on cognition. This thesis tested one promising approach to minimise cognitive adverse effects. Right unilateral ultra-brief (0.3ms) ECT was compared with right unilateral brief pulse (1ms) ECT on: equivalence of antidepressant effect, b) degree of retrograde amnesia to personal memory and subjective memory and c) ictal-EEG quality. Materials and Methods Forty adult patients with Major Depressive Disorder (DSM IV) were randomised to the brief pulse (1ms) or ultra-brief (0.3ms) three times a week right unilateral ECT treatment groups at 6 times threshold dose. Depression severity, autobiographical retrograde memory and ictal-EEG quality, the latter measured by spectral analysis. Results Symptom and speed of remission was identical. Autobiographical memory improved during the course of ultra-brief ECT although between-group differences did not persist at 3 months after ECT. Post seizure spectral density suppression in ultra-brief ECT was similar to that of brief pulse ECT. Spectral power density of the mid seizure was weaker with ultra-brief ECT. Conclusion High dose right unilateral ECT with ultra-brief pulses lead to significant amelioration of severe depression, spared autobiographical memory and lead to robust post-ictal suppression.