OBJECTIVE:ECT is the most effective treatment for severe depression. Previous efficacy studies, using thrice-weekly brief-pulse ECT, reported that high-dose (6× seizure threshold) right unilateral ECT is similar to bitemporal ECT but may have fewer cognitive side effects. The authors aimed to assess the effectiveness and cognitive side effects of twice-weekly moderate-dose (1.5× seizure threshold) bitemporal ECT with high-dose unilateral ECT in real-world practice. METHOD: This was a pragmatic, patient- and rater-blinded, noninferiority trial of patients with major depression (N=138; 63% female; age=56.7 years [SD=14.8]) in a national ECT service with a 6-month follow-up. Participants were independently randomly assigned to bitemporal or high-dose unilateral ECT. The primary outcome was change in the 24-item Hamilton Depression Rating Scale (HAM-D) score after the ECT course; the prespecified noninferiority margin was 4.0 points. Secondary outcomes included response and remission rates, relapse status after 6 months, and cognition. RESULTS: Of the eligible patients, 69 were assigned to bitemporal ECT and 69 to unilateral ECT. High-dose unilateral ECT was noninferior to bitemporal ECT regarding the 24-item HAM-D scores after the ECT course (mean difference=1.08 points in favor of unilateral ECT [95% CI=-1.67 to 3.84]). There were no significant differences for response and remission or 6-month relapse status. Recovery of orientation was quicker following unilateral ECT (median=19.1 minutes versus 26.4 minutes). Bitemporal ECT was associated with a lower percent recall of autobiographical information (odds ratio=0.66) that persisted for 6 months. CONCLUSIONS: Twice-weekly high-dose unilateral ECT is not inferior to bitemporal ECT for depression and may be preferable because of its better cognitive side-effect profile.
RCT Entities:
OBJECTIVE: ECT is the most effective treatment for severe depression. Previous efficacy studies, using thrice-weekly brief-pulse ECT, reported that high-dose (6× seizure threshold) right unilateral ECT is similar to bitemporal ECT but may have fewer cognitive side effects. The authors aimed to assess the effectiveness and cognitive side effects of twice-weekly moderate-dose (1.5× seizure threshold) bitemporal ECT with high-dose unilateral ECT in real-world practice. METHOD: This was a pragmatic, patient- and rater-blinded, noninferiority trial of patients with major depression (N=138; 63% female; age=56.7 years [SD=14.8]) in a national ECT service with a 6-month follow-up. Participants were independently randomly assigned to bitemporal or high-dose unilateral ECT. The primary outcome was change in the 24-item Hamilton Depression Rating Scale (HAM-D) score after the ECT course; the prespecified noninferiority margin was 4.0 points. Secondary outcomes included response and remission rates, relapse status after 6 months, and cognition. RESULTS: Of the eligible patients, 69 were assigned to bitemporal ECT and 69 to unilateral ECT. High-dose unilateral ECT was noninferior to bitemporal ECT regarding the 24-item HAM-D scores after the ECT course (mean difference=1.08 points in favor of unilateral ECT [95% CI=-1.67 to 3.84]). There were no significant differences for response and remission or 6-month relapse status. Recovery of orientation was quicker following unilateral ECT (median=19.1 minutes versus 26.4 minutes). Bitemporal ECT was associated with a lower percent recall of autobiographical information (odds ratio=0.66) that persisted for 6 months. CONCLUSIONS: Twice-weekly high-dose unilateral ECT is not inferior to bitemporal ECT for depression and may be preferable because of its better cognitive side-effect profile.
Authors: Sarah H Lisanby; Shawn M McClintock; George Alexopoulos; Samuel H Bailine; Elisabeth Bernhardt; Mimi C Briggs; C Munro Cullum; Zhi-De Deng; Mary Dooley; Emma T Geduldig; Robert M Greenberg; Mustafa M Husain; Styliani Kaliora; Rebecca G Knapp; Vassilios Latoussakis; Lauren S Liebman; William V McCall; Martina Mueller; Georgios Petrides; Joan Prudic; Peter B Rosenquist; Matthew V Rudorfer; Shirlene Sampson; Abeba A Teklehaimanot; Kristen G Tobias; Richard D Weiner; Robert C Young; Charles H Kellner Journal: Am J Geriatr Psychiatry Date: 2019-10-12 Impact factor: 4.105
Authors: Harold A Sackeim; Joan Prudic; D P Devanand; Mitchell S Nobler; Roger F Haskett; Benoit H Mulsant; Peter B Rosenquist; William V McCall Journal: Brain Stimul Date: 2020-06-22 Impact factor: 8.955
Authors: Gregory L Sahlem; William V McCall; E Baron Short; Peter B Rosenquist; James B Fox; Nagy A Youssef; Andrew J Manett; Suzanne E Kerns; Morgan M Dancy; Laryssa McCloud; Mark S George; Harold A Sackeim Journal: Brain Stimul Date: 2020-07-29 Impact factor: 8.955
Authors: Marta Cano; Erik Lee; Narcís Cardoner; Ignacio Martínez-Zalacaín; Jesús Pujol; Nikos Makris; Michael Henry; Esther Via; Rosa Hernández-Ribas; Oren Contreras-Rodríguez; José M Menchón; Mikel Urretavizcaya; Carles Soriano-Mas; Joan A Camprodon Journal: J Neuropsychiatry Clin Neurosci Date: 2018-11-21 Impact factor: 2.198
Authors: James Luccarelli; Thomas H McCoy; Alec P Shannon; Brent P Forester; Stephen J Seiner; Michael E Henry Journal: Eur Arch Psychiatry Clin Neurosci Date: 2020-11-16 Impact factor: 5.270
Authors: Sarah H Lisanby; Shawn M McClintock; William V McCall; Rebecca G Knapp; C Munro Cullum; Martina Mueller; Zhi-De Deng; Abeba A Teklehaimanot; Matthew V Rudorfer; Elisabeth Bernhardt; George Alexopoulos; Samuel H Bailine; Mimi C Briggs; Emma T Geduldig; Robert M Greenberg; Mustafa M Husain; Styliani Kaliora; Vassilios Latoussakis; Lauren S Liebman; Georgios Petrides; Joan Prudic; Peter B Rosenquist; Shirlene Sampson; Kristen G Tobias; Richard D Weiner; Robert C Young; Charles H Kellner Journal: Am J Geriatr Psychiatry Date: 2021-05-17 Impact factor: 4.105