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| Name | Class |
|---|---|
| Northside Clinic, Australia | OTHER |
| The Melbourne Clinic, Australia | UNKNOWN |
| St George Hospital, Australia | OTHER |
| Wandene Private Hospital, Australia |
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Electroconvulsive Therapy (ECT) remains essential to contemporary psychiatric practice and is one of the safest and most effective treatments available for depression. Despite modern advances in pharmacotherapy, about 15-20 per cent of all hospitalised patients receive treatment with ECT. Its use, however, is limited by concerns over associated cognitive side effects.
Recent research has suggested that using an ultrabrief pulsewidth with ECT may greatly reduce cognitive side effects, while maintaining efficacy (Sackeim et al 2008). Preliminary results were positive for unilateral ECT, however, suggest that for bilateral ECT, dosing may need to be adjusted to preserve efficacy while reducing side effects. This study will examine the relative cognitive side effects and efficacy of right unilateral and bilateral ECT given with a standard pulsewidth or an ultrabrief pulsewidth. Some participants will also receive an MRI scan before and after ECT.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| bilateral-ultrabrief ECT | Experimental | Patients will be treated with an ultrabrief (0.3ms) pulse with a bilateral placement at 3-4 times seizure threshold. |
|
| bilateral standard ECT | Active Comparator | Patients will be treated with a standard (1.0ms) pulse with a bilateral placement at 1.5 times seizure threshold. |
|
| right-unilateral ultrabrief ECT | Experimental | Patients will be treated with an ultrabrief (0.3ms) pulse with a right unilateral placement at 8 times seizure threshold. |
|
| right-unilateral standard ECT | Active Comparator | Patients will be treated with a standard (1.0ms) pulse with a right unilateral placement at 5 times seizure threshold. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| bilateral ultrabrief ECT | Procedure | Bilateral ECT at 3-4 times seizure threshold with an ultrabrief pulse (0.3ms) |
|
| Measure | Description | Time Frame |
|---|---|---|
| Change in scores on Memory Tests | Before ECT, after 6 ECT treatments, after final ECT treatment, one month and six month follow-up |
| Measure | Description | Time Frame |
|---|---|---|
| Change in scores on Depression Rating Scale | Before ECT, after each week of treatment, at the end of the ECT course |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Assoc/Prof Colleen K Loo, MBBS, FRANZCP, MD | University of New South Wales | Principal Investigator |
| Prof Isaac Schweitzer, MBBS, FRANZCP, MD | The Melbourne Clinic | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| St George Hospital | Kogarah | New South Wales | 2217 | Australia | ||
| Wandene Private Hospital |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 16866758 | Background | Loo CK, Schweitzer I, Pratt C. Recent advances in optimizing electroconvulsive therapy. Aust N Z J Psychiatry. 2006 Aug;40(8):632-8. doi: 10.1080/j.1440-1614.2006.01862.x. | |
| 17706790 | Background | Loo C, Sheehan P, Pigot M, Lyndon W. 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. J Affect Disord. 2007 Nov;103(1-3):277-81. doi: 10.1016/j.jad.2007.06.012. Epub 2007 Aug 16. |
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| ID | Term |
|---|---|
| D003865 | Depressive Disorder, Major |
| ID | Term |
|---|---|
| D003866 | Depressive Disorder |
| D019964 | Mood Disorders |
| D001523 | Mental Disorders |
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| UNKNOWN |
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| bilateral standard ECT | Procedure | Bilateral ECT with at 1.5 times seizure threshold with a standard pulse (1.0ms) |
|
| right-unilateral ultrabrief ECT | Procedure | Right-unilateral ECT at 6 times seizure threshold with an ultrabrief pulse (0.3ms) |
|
| right-unilateral standard ECT | Procedure | Right-unilateral ECT with at 5 times seizure threshold with a standard pulse (1.0ms) |
|
| Kogarah |
| New South Wales |
| 2217 |
| Australia |
| The Melbourne Clinic | Melbourne | Victoria | Australia |
| 18752719 | Background | Loo CK, Sainsbury K, Sheehan P, Lyndon B. A comparison of RUL ultrabrief pulse (0.3 ms) ECT and standard RUL ECT. Int J Neuropsychopharmacol. 2008 Nov;11(7):883-90. doi: 10.1017/S1461145708009292. Epub 2008 Aug 28. |
| 19756236 | Background | Sackeim HA, Prudic J, Nobler MS, Fitzsimons L, Lisanby SH, Payne N, Berman RM, Brakemeier EL, Perera T, Devanand DP. Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. Brain Stimul. 2008 Apr;1(2):71-83. doi: 10.1016/j.brs.2008.03.001. |
| Background | Sienaert, P., Vansteelandt, K., Demyttenaere, K., & Peuskens, J. (2006). Comparison of bifrontal and unilateral ultra-brief pulse electroconvulsive therapy for depression. European Neuropsychopharmacology, 16 (suppl 4), S28. |
| 31056081 | Derived | Martin D, Katalinic N, Hadzi-Pavlovic D, Ingram A, Ingram N, Simpson B, McGoldrick J, Dowling N, Loo C. Cognitive effects of brief and ultrabrief pulse bitemporal electroconvulsive therapy: a randomised controlled proof-of-concept trial. Psychol Med. 2020 May;50(7):1121-1128. doi: 10.1017/S0033291719000989. Epub 2019 May 2. |
| 25522389 | Derived | Loo CK, Katalinic N, Smith DJ, Ingram A, Dowling N, Martin D, Addison K, Hadzi-Pavlovic D, Simpson B, Schweitzer I. A randomized controlled trial of brief and ultrabrief pulse right unilateral electroconvulsive therapy. Int J Neuropsychopharmacol. 2014 Dec 5;18(1):pyu045. doi: 10.1093/ijnp/pyu045. |