Christopher C Abbott1, Davin Quinn2, Jeremy Miller2, Enstin Ye2, Sulaiman Iqbal2, Megan Lloyd2, Thomas R Jones2, Joel Upston2, Zhi De Deng3, Erik Erhardt4, Shawn M McClintock5. 1. Department of Psychiatry (CCA, DQ, JM, EY, SI, ML, TRJ, JU), University of New Mexico, Albuquerque, NM. Electronic address: cabbott@salud.unm.edu. 2. Department of Psychiatry (CCA, DQ, JM, EY, SI, ML, TRJ, JU), University of New Mexico, Albuquerque, NM. 3. Noninvasive Neuromodulation Unit (ZDD), Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD; Division of Brain Stimulation and Neurophysiology (SMM), Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC. 4. Department of Mathematics and Statistics (EE), University of New Mexico, Albuquerque, NM. 5. Division of Psychology, Department of Psychiatry (SMM), UT Southwestern Medical Center, Dallas, TX; Division of Brain Stimulation and Neurophysiology (SMM), Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC.
Abstract
INTRODUCTION: Electroconvulsive therapy (ECT) pulse amplitude, which determines the induced electric field magnitude in the brain, is currently set at 800-900 milliamperes (mA) on modern ECT devices without any clinical or scientific rationale. The present study assessed differences in depression and cognitive outcomes for three different pulse amplitudes during an acute ECT series. We hypothesized that the lower amplitudes would maintain the antidepressant efficacy of the standard treatment and reduce the risk of neurocognitive impairment. METHODS: This double-blind investigation randomized subjects to three treatment arms: 600, 700, and 800 mA (active comparator). Clinical, cognitive, and imaging assessments were conducted pre-, mid- and post-ECT. Subjects had a diagnosis of major depressive disorder, age range between 50 and 80 years, and met clinical indication for ECT. RESULTS: The 700 and 800 mA arms had improvement in depression outcomes relative to the 600 mA arm. The amplitude groups showed no differences in the primary cognitive outcome variable, the Hopkins Verbal Learning Test-Revised (HVLT-R) retention raw score. However, secondary cognitive outcomes such as the Delis Kaplan Executive Function System Letter and Category Fluency measures demonstrated cognitive impairment in the 800 mA arm. DISCUSSION: The results demonstrated a dissociation of depression (higher amplitudes better) and cognitive (lower amplitudes better) related outcomes. Future work is warranted to elucidate the relationship between amplitude, electric field, neuroplasticity, and clinical outcomes.
INTRODUCTION: Electroconvulsive therapy (ECT) pulse amplitude, which determines the induced electric field magnitude in the brain, is currently set at 800-900 milliamperes (mA) on modern ECT devices without any clinical or scientific rationale. The present study assessed differences in depression and cognitive outcomes for three different pulse amplitudes during an acute ECT series. We hypothesized that the lower amplitudes would maintain the antidepressant efficacy of the standard treatment and reduce the risk of neurocognitive impairment. METHODS: This double-blind investigation randomized subjects to three treatment arms: 600, 700, and 800 mA (active comparator). Clinical, cognitive, and imaging assessments were conducted pre-, mid- and post-ECT. Subjects had a diagnosis of major depressive disorder, age range between 50 and 80 years, and met clinical indication for ECT. RESULTS: The 700 and 800 mA arms had improvement in depression outcomes relative to the 600 mA arm. The amplitude groups showed no differences in the primary cognitive outcome variable, the Hopkins Verbal Learning Test-Revised (HVLT-R) retention raw score. However, secondary cognitive outcomes such as the Delis Kaplan Executive Function System Letter and Category Fluency measures demonstrated cognitive impairment in the 800 mA arm. DISCUSSION: The results demonstrated a dissociation of depression (higher amplitudes better) and cognitive (lower amplitudes better) related outcomes. Future work is warranted to elucidate the relationship between amplitude, electric field, neuroplasticity, and clinical outcomes.
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