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Retrospective comparison of effectiveness of right unilateral ultra-brief pulse with brief pulse ECT in older adults (over 65) with depression

Published online by Cambridge University Press:  07 September 2015

Jothi Ramalingam ,
Alby Elias ,
Kuruvilla George ,
Sathish Thangapandian  and
Ravi Bhat
Jothi Ramalingam*
Affiliation:
Consultation Liaison Psychiatry, Gosford Hospital, Central Coast Local Health District, PO Box 361, Gosford 2250 NSW, Australia
Alby Elias
Affiliation:
The University of Melbourne, VIC, Australia
Kuruvilla George
Affiliation:
Director of Medical Services Peter James Centre and Wantirna Health, Clinical Director of Aged Persons Mental Health, Eastern Health, Director of ECT for Eastern Health, Conjoint Clinical Professor, Deakin University, Adjunct Clinical Associate Professor, Monash University, Peter James Centre, Mahoneys Road, Forest Hill, VIC 3131, Australia
Sathish Thangapandian
Affiliation:
CMO, Central Coast Local Health District, PO Box 361, Gosford 2250, NSWAustralia
Ravi Bhat
Affiliation:
Department of Rural Health, Melbourne Medical School, The University of Melbourne, Australia
*
Correspondence should be addressed to: Dr Jothi Ramalingam, Consultant Psychiatrist, Consultation Liaison Psychiatry, Gosford Hospital, Central Coast Local Health District, PO Box 361, Gosford 2250 NSW, Australia. Phone: +61 2 4320 3171; Fax: +61 2 4320 2230. Email: Jothi.Ramalingam@health.nsw.gov.au.
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Abstract

Background:

To compare response, remission and switch (to other pulse width and/or electrode placement) rates and number of treatments between groups receiving right unilateral ultra-brief (RUL-UB), Bitemporal brief (BT), Bifrontal Brief (BF) and Right unilateral brief (RUL-B).

Method:

Data was collected from case notes in three centers. There were 133 in total, grouped as RUL-UB (50), BT (43), BF (23), RUL-B (17). Two of the three centers had a preferred electrode placement and pulse width.

Results:

Apart from age, the groups did not differ significantly on sex distribution, proportion of bipolar depression and psychotic symptoms. 56% of patients in RUL-UB switched compared to 12.5% in RUL-B, 4.9% in BT and none in BF (p value < 0.0001). When we considered patients who switched as treatment failures, remission rates were significantly different (p value < 0.0001) 40% in RUL-UB, 81.3% in RUL-B, 73.9% in BF and 78.0% in BT. Mean number of treatments in each group was significantly different (p value < 0.0001); 12.02 in RUL-UB, 10.2 in RUL-B, 7 in BF and 7.5 in BT. Post-hoc analysis indicated that RUL-UB differed significantly from BT and BF. Final response and remission rates including patients who switched were 98% and 82% in RUL-UB, 100% and 93.8% in RUL-B, 100% and 73.9% in BF and 97.7% and 83.7% in BT.

Conclusion:

Majority commencing RUL-UB switched and received 4–5 more treatments compared to bilateral placements. RUL-UB ECT appears less effective and might not be appropriate as first line for all older adults as some patients at higher anaesthetic risk would benefit from having reduced number of treatments.

Keywords

electroconvulsive therapyultra-brief electroconvulsive therapyelderlylate life depressionelectrode placementright unilateralbitemporalbifrontal
Type
Research Article
Information
International Psychogeriatrics , Volume 28 , Issue 3 , March 2016 , pp. 469 - 475
Copyright
Copyright © International Psychogeriatric Association 2015 

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References

Bauer, J. et al. (2009). Comparison of propofol and thiopental as anesthetic agents for electroconvulsive therapy: a randomized, blinded comparison of seizure duration, stimulus charge, clinical effect, and cognitive side effects. Journal of ECT, 25, 85–90.Google Scholar
Dunne, R. A. and McLoughlin, D. M. (2012). Systematic review and meta-analysis of bifrontal electroconvulsive therapy versus bilateral and unilateral electroconvulsive therapy in depression. The World Journal of Biological Psychiatry, 13, 248–258.CrossRefGoogle ScholarPubMed
Fink, M. and Taylor, M. A. (2007). Electroconvulsive therapy: evidence and challenges. Journal of American Medical Association, 298, 330–332.Google Scholar
Galletly, C., Clarke, P., Paterson, T., Rigby, A. and Gill, S. (2014). Practical considerations in the use of ultrabrief ECT in clinical practice. Journal of ECT, 30, 10–14.Google Scholar
Gardner, B. K. and O’Connor, D. W. (2008). A review of the cognitive effects of electroconvulsive therapy in older adults. Journal of ECT, 24, 68–80.Google Scholar
Ingram, A., Schweitzer, I., Ng, C. H., Saling, M. M. and Savage, G. (2007). A comparison of propofol and thiopentone use in electroconvulsive therapy: cognitive and efficacy effects. Journal of ECT, 23, 158–162.Google Scholar
Kumar, A., Sharma, D. K. and Mani, R. (2012). A comparison of propofol and thiopentone for electroconvulsive therapy. Journal of Anaesthesiology Clinical Pharmacology, 28, 353–357.CrossRefGoogle ScholarPubMed
Lihua, P., Su, M., Ke, W. and Ziemann-Gimmel, P. (2014). Different regimens of intravenous sedatives or hypnotics for electroconvulsive therapy (ECT) in adult patients with depression. Cochrane Database of Systematic Reviews, 4, CD009763.Google Scholar
Loo, C. K., Katalinic, N., Martin, D. and Schweitzer, I. (2012). A review of ultrabrief pulse width electroconvulsive therapy. Therapeutic Advances in Chronic Disease, 3, 69–85.Google Scholar
Loo, C. K., 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, C. K., 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.Google Scholar
McCormick, L. M., Brumm, M. C., Benede, A. K. and Lewis, J. L. (2009). Relative ineffectiveness of ultrabrief right unilateral versus bilateral electroconvulsive therapy in depression. Journal of ECT, 25, 238–242.Google Scholar
Petrides, G. et al. (2009). Seizure threshold in a large sample: implications for stimulus dosing strategies in bilateral electroconvulsive therapy: a report from CORE. Journal of ECT, 25, 232–237.Google Scholar
Plakiotis, C., George, K. and O’Connor, D. W. (2012). Has electroconvulsive therapy use remained stable over time? A decade of electroconvulsive therapy service provision in Victoria, Australia. Australian & New Zealand Journal of Psychiatry, 46, 522–531.Google Scholar
Purtuloglu, T. et al. (2013). Effect of propofol versus sodium thiopental on electroconvulsive therapy in major depressive disorder: a randomized double-blind controlled clinical trial. Journal of ECT, 29, 37–40.CrossRefGoogle ScholarPubMed
Ranck, J. B. Jr. (1975). Which elements are excited in electrical stimulation of mammalian central nervous system: a review. Brain Research, 98, 417–440.Google Scholar
Sackeim, H. A. et al. (2008). Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. Brain Stimulation, 1, 71–83.Google Scholar
Unutzer, J. and Park, M. (2012). Older adults with severe, treatment-resistant depression. Journal of American Medical Association, 308, 909–918.Google Scholar