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Cognitive effects of brief and ultrabrief pulse bitemporal electroconvulsive therapy: a randomised controlled proof-of-concept trial

Published online by Cambridge University Press:  02 May 2019

Donel Martin Open the ORCID record for Donel Martin [Opens in a new window] ,
Natalie Katalinic ,
Dusan Hadzi-Pavlovic ,
Anna Ingram ,
Nicholas Ingram ,
Brett Simpson ,
Jenny McGoldrick ,
Nathan Dowling  and
Colleen Loo
Donel Martin
Affiliation:
School of Psychiatry, University of New South Wales, Sydney, NSW, Australia Black Dog Institute, Sydney, NSW, Australia
Natalie Katalinic
Affiliation:
St George Hospital, Sydney, NSW, Australia
Dusan Hadzi-Pavlovic
Affiliation:
School of Psychiatry, University of New South Wales, Sydney, NSW, Australia Black Dog Institute, Sydney, NSW, Australia
Anna Ingram
Affiliation:
Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
Nicholas Ingram
Affiliation:
The Melbourne Clinic, Melbourne, VIC, Australia
Brett Simpson
Affiliation:
St George Hospital, Sydney, NSW, Australia Welsey Hospital, Sydney, NSW, Australia
Jenny McGoldrick
Affiliation:
Welsey Hospital, Sydney, NSW, Australia
Nathan Dowling
Affiliation:
The Melbourne Clinic, Melbourne, VIC, Australia Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
Colleen Loo*
Affiliation:
School of Psychiatry, University of New South Wales, Sydney, NSW, Australia Black Dog Institute, Sydney, NSW, Australia St George Hospital, Sydney, NSW, Australia Welsey Hospital, Sydney, NSW, Australia
*
Author for correspondence: Colleen Loo, E-mail: colleen.loo@unsw.edu.au
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Abstract

Background

Reduction of the pulse width has been reported to improve ECT outcomes with unilateral ECT (similar efficacy, fewer cognitive side effects), but has been minimally studied for bitemporal ECT. The only study comparing brief and ultrabrief pulse bitemporal ECT found reduced efficacy for bitemporal ultrabrief compared to bitemporal brief pulse stimulation. This randomised controlled trial (RCT) aimed to test if ultrabrief pulse bitemporal ECT results in fewer cognitive side effects than brief pulse bitemporal ECT, when given at doses adjusted with the aim of achieving comparable efficacy.

Methods

Thirty-six participants were randomly assigned to receive ultrabrief (at 3 times seizure threshold) or brief (at 1.5 times seizure threshold) pulse bitemporal ECT given 3 times a week in a double-blind, controlled proof-of-concept trial. Blinded raters assessed mood and cognitive functioning over the ECT course.

Results

Efficacy and cognitive outcomes did not differ significantly between the two treatment groups over the ECT course. The ultrabrief pulse group performed better on a test of visual memory assessed acutely after an ECT treatment.

Conclusions

This study suggests there may be a small cognitive advantage in giving bitemporal ECT with an ultrabrief pulse when dosage is increased to match the efficacy of brief pulse bitemporal ECT, but the study was underpowered to fully examine this issue.

Clinical Trials Registration: www.clinicaltrials.gov, NCT00870805.

Keywords

Cognitivedepressionelectroconvulsive therapyrandomised controlled trialtreatmentultrabrief
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 7 , May 2020 , pp. 1121 - 1128
Copyright
Copyright © Cambridge University Press 2019

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References

Benedict, RHB, Schretlen, D, Groninger, L and Brandt, J (1998) Hopkins verbal learning test revised: normative data and analysis of inter-form and test-retest reliability. The Clinical Neuropsychologist 12, 43–55.10.1076/clin.12.1.43.1726CrossRefGoogle Scholar
Birkenhager, TK, Pluijms, EM and Lucius, SA (2003) ECT response in delusional versus non-delusional depressed inpatients. Journal of Affective Disorders 74, 191–195.10.1016/S0165-0327(02)00005-8CrossRefGoogle ScholarPubMed
Chanpattana, W (2007) A questionnaire survey of ECT practice in Australia. Journal of ECT 23, 89–92.CrossRefGoogle ScholarPubMed
Coryell, W and Zimmerman, M (1984) Outcome following ECT for primary unipolar depression: a test of newly proposed response predictors. The American Journal of Psychiatry 7, 862–867.Google Scholar
Fekadu, A, Wooderson, SC, Markopoulou, K and Cleare, AJ (2009) The Maudsley staging method for treatment-resistant depression: prediction of longer-term outcome and persistence of symptoms. The Journal of Clinical Psychiatry 70, 952–957.10.4088/JCP.08m04728CrossRefGoogle ScholarPubMed
Fekadu, A, Donocik, JC and Cleare, AJ (2018) Standardisation framework for the Maudsley staging method for treatment resistance in depression. BMC Psychiatry 18, 100.CrossRefGoogle ScholarPubMed
Folstein, MF, Folstein, SE and McHugh, PR (1975) “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12, 189–198.CrossRefGoogle ScholarPubMed
Galvez, V, Li, A, Oxley, C, Waite, S, De Felice, N, Hadzi-Pavlovic, D, Kumar, D, Page, AC, Hooke, G and Loo, CK (2016) Health related quality of life after ECT for depression: a study exploring the role of different electrode-placements and pulse-widths. Journal of Affective Disorders 206, 268–272.CrossRefGoogle ScholarPubMed
Hickie, I, Mason, C, Parker, G and Brodaty, H (1996) Prediction of ECT response: validation of a refined sign-based (CORE) system for defining melancholia. British Journal of Psychiatry 169, 68–74.CrossRefGoogle ScholarPubMed
Holm, S (1979) A simple sequentially rejective multiple test procedure. Scandinavian Journal of Statistics 6, 65–70.Google Scholar
Loo, C, Sheehan, P, Pigot, M and Lyndon, W (2007) A report on mood and cognitive outcomes with right unilateral ultrabrief pulsewidth (0.3 ms) ECT and retrospective comparison with standard pulsewidth right unilateral ECT. Journal of Affective Disorders 103, 277–281.CrossRefGoogle ScholarPubMed
Loo, CK, Sainsbury, K, Sheehan, P and Lyndon, B (2008) A comparison of RUL ultrabrief pulse (0.3 ms) ECT and standard RUL ECT. International Journal of Neuropsychopharmacology 11, 883–890.10.1017/S1461145708009292CrossRefGoogle ScholarPubMed
Loo, CK, Mahon, M, Katalinic, N, Lyndon, B and Hadzi-Pavlovic, D (2011) Predictors of response to ultrabrief right unilateral electroconvulsive therapy. Journal of Affective Disorders 130, 192–197.CrossRefGoogle ScholarPubMed
Loo, CK, Garfield, JB, Katalinic, N, Schweitzer, I and Hadzi-Pavlovic, D (2013) Speed of response in ultrabrief and brief pulse width right unilateral ECT. International Journal of Neuropsychopharmacology 16, 755–761.CrossRefGoogle ScholarPubMed
Loo, CK, Katalinic, N, Smith, DJ, Ingram, A, Dowling, N, Martin, D, Addison, K, Hadzi-Pavlovic, D, Simpson, B and Schwitzer, I (2014) A randomized controlled trial of brief and ultrabrief pulse right unilateral electroconvulsive therapy. International Journal of Neuropsychopharmacology 18, 1–8.Google ScholarPubMed
Martin, DM, Galvez, V and Loo, CK (2015) Predicting retrograde autobiographical memory changes following electroconvulsive therapy: relationships between individual, treatment, and early clinical factors. International Journal of Neuropsychopharmacology 18, 1–8.CrossRefGoogle ScholarPubMed
Mayur, P, Byth, K and Harris, A (2013) Acute antidepressant effects of right unilateral ultra-brief ECT: a double-blind randomised controlled trial. Journal of Affective Disorders 149, 426–429.10.1016/j.jad.2012.12.005CrossRefGoogle ScholarPubMed
McCall, WV, Farah, BA, Reboussin, D and Colenda, CC (1995) Comparison of the efficacy of titrated, moderate dose and fixed, high dose RUL ECT in the elderly. American Journal of Geriatric Psychiatry 3, 317–324.CrossRefGoogle Scholar
Meador, KJ, Moore, EE, Nichols, ME, Abney, OL, Taylor, HS, Zamrini, EY and Loring, DW (1993) The role of cholinergic systems in visuospatial processing and memory. Journal of Clinical and Expermental Neuropsychology 15, 832–842.CrossRefGoogle ScholarPubMed
McElhiney, M, Moody, B and Sackeim, H (2001) The Autobiographical Memory Interview - Short Form, Version 3. New York: New York State Psychiatric Institute.Google Scholar
Montgomery, SA and Asberg, M (1979) A new depression scale designed to be sensitive to change. The British Journal of Psychiatry: The Journal of Mental Science 134, 382–389.CrossRefGoogle ScholarPubMed
NSW Health (2011) Electroconvulsive therapy: ECT minimum standard of practice in NSW. Available at https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2011_003.pdf (Accessed 21 March 2019).Google Scholar
Petrides, G, Fink, M, Husain, MM, Knapp, RG, Rush, AJ, Mueller, M, Rummans, TA, O'Connor, KM, Rasmussen, KG, Bernstein, HJ, Biggs, M, Bailine, SH and Kellner, CH (2001) ECT remission rates in psychotic versus nonpsychotic depressed patients: a report from CORE. Journal of ECT 17, 244–253.10.1097/00124509-200112000-00003CrossRefGoogle Scholar
Rey, A (1964) L'Examen Clinique en Psychologie. Paris: Presses Universitaires de France.Google Scholar
Sackeim, HA (2014) Autobiographical memory and electroconvulsive therapy: do not throw out the baby. Journal of ECT 30, 177–186.CrossRefGoogle ScholarPubMed
Sackeim, HA, Prudic, J, Nobler, MS, Fitzsimons, L, Lisanby, SH, Payne, N, Berman, RM, Brakemeier, EL, Perera, T and Devanand, DP (2008) Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. Brain Stimulation 1, 71–83.CrossRefGoogle ScholarPubMed
Semkovska, M and McLoughlin, DM (2013) Measuring retrograde autobiographical amnesia following electroconvulsive therapy: historical perspective and current issues. Journal of ECT 29, 127–133.CrossRefGoogle ScholarPubMed
Sienaert, P, Vansteelandt, K, Demyttenaere, K and Peuskens, J (2009) Randomized comparison of ultra-brief bifrontal and unilateral electroconvulsive therapy for major depression:clincial efficacy. Journal of Affective Disorders 116, 106–112.CrossRefGoogle Scholar
Sienaert, P, Vansteelandt, K, Demyttenaere, K and Peuskens, J (2010) Randomized comparison of ultra-brief bifrontal and unilateral electroconvulsive therapy for major depression:cognitive side-effects. Journal of Affective Disorders 122, 60–67.CrossRefGoogle ScholarPubMed
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, Herqueta, T, Baker, R and Dunbar, GC (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. The Journal of Clinical Psychiatry 59, 4–57.Google ScholarPubMed
Smith, A (1991) Symbol Digit Modalities Test. Los Angeles: Western Psychological Services.Google Scholar
Sobin, C, Sackeim, HA, Prudic, J, Devanand, DP, Moody, BJ and McElhiney, MC (1995) Predictors of retrograde amnesia following ECT. American Journal of Psychiatry 152, 995–1001.Google ScholarPubMed
Spanns, HP, Verwijk, E, Comijs, HC, Kok, RM, Sienaert, P, Bouckaert, F, Fannes, K, Vandepoel, K, Scherder, EJ, Stek, ML and Kho, KH (2013) Efficacy and cognitive side effects after brief pulse and ultrabrief pulse width unilateral electroconvulsive therapy for major depression: a randomized, double-blind, controlled study. Journal of Clinical Psychiatry 74, e1029–e1036.CrossRefGoogle Scholar
Strauss, E, Sherman, E and Spreen, O (2006) A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary. Oxford: Oxford Univerisity Press.Google Scholar
Tor, PC, Bautovich, A, Wang, MJ, Martin, D, Harvey, SB and Loo, C (2015) A systematic review and meta-analysis of brief versus ultrabrief right unilateral electroconvulsive therapy for depression. Journal of Clinical Psychiatry 76, e1092–8.CrossRefGoogle ScholarPubMed
van Waarde, JA, Verwey, B, van den Broek, WW and van der Mast, RC (2009) Electroconvulsive therapy in the Netherlands: a questionnaire survey on contemporary practice. Journal of ECT 25, 190–194.CrossRefGoogle ScholarPubMed
Wechsler, D (1997) Wechsler Memory Scale - Third Edition Administration and Scoring Manual. San Antonio, TX: The Psychological Corporation.Google Scholar
Wechsler, D (2001) Wechsler Test of Adult Reading: WTAR. San Antonio, TX: Psychological Corporation.Google Scholar
Woodcock, R and Johnson, M (1989) Woodcock-Johnson Psycho-Educational Battery - Revised. Chicago: Riverside.Google Scholar
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