Pascal Sienaert

Randomized comparison of ultra-brief bifrontal and unilateral electroconvulsive therapy for major depression: cognitive side-effects.

OBJECTIVE The cognitive side-effects of bifrontal (BF) and right unilateral (UL) ultra-brief pulse (0.3 ms) electroconvulsive therapy (ECT) were compared, in the treatment of patients with a depressive episode. METHOD Neuropsychological functioning in patients with a medication refractory depressive episode, that were treated with a course of BF ultra-brief ECT at 1.5 times seizure threshold (ST) or UL ultra-brief ECT at 6 times ST, by random assignment, was assessed before treatment, and 1 and 6 weeks after the treatment course, by a blinded rater. RESULTS Of the 64 patients that were included, 32 (50%) received BF ECT, and 32 (50%) received UL ECT, by random assignment. Neuropsychological testing 1 and 6 weeks after treatment was performed by 30 (93.75%) and 19 (59.37%) patients, respectively, in the BF-group and 29 (90.62%) and 20 (62.50%), respectively, in the UL-group. There was no deterioration in any of the neuropsychological measures. Patients rated their memory as clearly improved after treatment. There were no significant differences between the patients given BF ECT and those given UL ECT. CONCLUSIONS Ultrabrief pulse ECT, used either in combination with a UL electrode position and a stimulus of 6 times ST, or a BF electrode position with a stimulus of 1.5 times ST, are effective antidepressant techniques, that do not have a deleterious effect on cognitive function.

Ultra-brief pulse ECT in bipolar and unipolar depressive disorder: differences in speed of response

OBJECTIVES There is little evidence for differences in response and speed of response to electroconvulsive therapy (ECT) between patients with bipolar and patients with unipolar depressive disorder. In the only prospective study to date, Daly et al. (Bipolar Disord 2001; 3: 95-104) found patients with bipolar depression to show more rapid clinical improvement and require fewer treatments than unipolar patients. In this study, response and speed of response of patients with unipolar and bipolar depression treated with ultra-brief pulse ECT were compared. METHODS All patients (n = 64) participated in a randomized trial comparing ultra-brief pulse bifrontal ECT at 1.5 times seizure threshold and unilateral ECT at 6 times seizure threshold. Thirteen patients (20.3%) had DSM-IV-defined bipolar depression. The Hamilton Rating Scale for Depression and Clinical Global Impression scale were administered at baseline and repeated weekly during and after the course of treatment by a blinded rater. At the same time point, the Beck Depression Inventory and the Patient Global Impression scale were administered. Speed of response was analyzed using survival analyses. RESULTS Patients with bipolar and unipolar depression did not differ in rates of response or remission following the ECT course, nor in response to unilateral or bifrontal ECT. Patients with bipolar depression, however, showed a more rapid response than patients with unipolar depression. CONCLUSIONS Patients with bipolar depression tend to show more rapid clinical improvement with ECT than patients with unipolar depression.

Randomized comparison of ultra-brief bifrontal and unilateral electroconvulsive therapy for major depression: clinical efficacy.

BACKGROUND It has been suggested that electroconvulsive therapy (ECT) with an ultra-brief pulse width in combination with a bilateral electrode placement has diminished antidepressive efficacy, as compared to unilateral ultra-brief pulse ECT. OBJECTIVE The antidepressive efficacy of bifrontal and right unilateral ultra-brief pulse (0.3 ms) ECT were compared. METHOD Eighty-one patients with a medication refractory depressive episode were treated with a course of bifrontal ultra-brief pulse ECT at 1.5 times seizure threshold or unilateral ultra-brief pulse ECT at 6 times seizure threshold by random assignment. The 17 item-Hamilton Rating Scale for Depression (HRSD), Beck Depression Inventory, Clinical Global Impression and Patient Global Impression were administered at baseline and repeated weekly during and 1 and 6 weeks after the course, by a blinded rater. RESULTS 64/81 patients (79%) completed the study, half of which were treated with bifrontal ECT. At the end of the course, 78.1% of the BF group and 78.1% of the UL group responded, whereas, 34.38% (N=11) of the BF group and 43.75% (N=14) of the UL group achieved strict remission criteria (HRSD-score < or = 7). There were no significant differences between the patients given bifrontal ECT and those given unilateral ECT, although patients receiving unilateral ECT achieved response/remission-criteria after a smaller number of treatments. LIMITATIONS Relatively small number of subjects. CONCLUSIONS Using an ultra-brief pulse width, both BF and UL-ECT are efficacious, although patients receiving UL-ECT achieve response/remission-criteria after a smaller number of treatments. TRIAL REGISTRY http://www.controlled-trials.com/ REGISTRATION NUMBER ISRCTN56570426.

Efficacy and Safety of Continuation and Maintenance Electroconvulsive Therapy in Depressed Elderly Patients: A Systematic Review

BACKGROUND Electroconvulsive therapy (ECT) is the most efficacious treatment in severely depressed elderly patients. Relapse and recurrence of geriatric depression after recovery is an important clinical issue, which requires vigorous and safe treatment in the long term. Continuation or maintenance ECT (M-ECT) may play an important role in this respect. METHODS In this systematic search, we evaluate the efficacy and safety of M-ECT in preventing depressive relapse in patients age 55 or older. Computer databases were searched for relevant literature published from 1966 until August 2010 with additional references. RESULTS Twenty-two studies met the search criteria including three randomized clinical trials. M-ECT was studied in nine studies exclusively in the elderly patients. CONCLUSIONS Research on this clinically important topic is sparse. On the basis of available literature, M-ECT is probably as effective as continuation medication in severely depressed elderly patients after a successful course of ECT and is generally well tolerated. To date, methodologically sound studies, which take into account important issues in geriatric depression like cognition, comorbidity, and clinical parameters, are lacking.

Salivary cortisol as predictor for depression characteristics and remission in electroconvulsive therapy in older persons

Abstract Objectives: Electroconvulsive therapy (ECT) is the most effective treatment for depression; however, consensus on predictors for ECT outcome is lacking. We aim to examine the relation between pre-ECT salivary cortisol values and clinical characteristics and ECT outcome in depressed, older persons. Methods: A total of 102 inpatients meeting DSM-IV criteria for depression and referred for ECT were selected. Salivary cortisol was assessed at five time points during the day, providing insight into the cortisol awakening curve to the ground (AUCg) and to the increase (AUCi) and evening cortisol level. Depression severity was assessed using the Montgomery–Asberg Depression Rating Scale (MADRS). Remission was defined as MADRS <10; response was defined as MADRS-reduction of at least 50%. Regression analysis was used to assess associations between cortisol and (1) clinical variables, including depression severity, psychomotor symptoms and presence of psychosis, and (2) ECT outcome. Results: No significant relations were found between AUCg, AUCi, evening cortisol and depression severity, psychomotor symptoms, and presence of psychosis. In addition, no significant relation was found between cortisol and response or remission. Conclusions: Our results do not support a relation between cortisol values and depression characteristics, or ECT outcome in severely depressed, older patients treated with ECT.

Vascular risk factors in older patients with depression: outcome of electroconvulsive therapy versus medication

Research suggests that in depression, vascular burden predicts a lower efficacy for medication (MED) and a more favourable outcome for electroconvulsive therapy (ECT). Therefore, we investigated the influence of the following vascular risk factors (VRF): hypercholesterolemia, hypertension, smoking, diabetes mellitus, cardiovascular disease, and cerebral vascular accident/transient ischemic attack, on remission from major depression after ECT versus MED.