In the NIMH-sponsored study, Dr. Harold Sackeim and colleagues from Columbia University randomly assigned 90 depressed patients to either right sided or bilateral ECT, using either a traditional electrical pulse or a newer “ultrabrief pulse”, and measured clinical response and cognitive side effects.
The study found that 73 % of the depressed subjects who received the ultrabrief pulse responded, compared with a 65% response from subjects who received the ‘gold standard’ bilateral older form. Importantly, the ultrabrief group had less severe cognitive side effects than the other group. “The use of an ultrabrief stimulus markedly reduces adverse cognitive effects and, when coupled with markedly suprathreshold right unilateral ECT, also preserves efficacy,” write Dr. Sackeim and colleagues.
In a related editorial in the same edition of 'Brain Stimulation', Dr. Bernard Lerer, a psychiatrist from Israel not involved in the study, wrote “The paper by Sackeim and colleagues in the current issue of 'Brain Stimulation' shows that use of an ultrabrief stimulus has remarkably few, if any, effects on cognitive function without loss of efficacy. The results provide convincing evidence derived from a randomized controlled trial. … If supported by additional controlled studies and borne out by clinical experience in the field, these findings will be an important further step forward in the practice of ECT. They also have intriguing implications for our understanding of how the treatment works, a conundrum that has not been resolved in the 73 years since convulsive therapy was first introduced. ”
Dr. Lerer went on to comment, “Overall, these are interesting times for brain stimulation therapies in general and ECT in particular. Ultrabrief stimulation is an exciting development in the optimization of ECT. It could turn out to be a pivotal step in an exciting cascade of events that may radically alter the treatment of depression and other psychiatric disorders.”
In another accompanying editorial reasoning from the physics of brain stimulation, Dr. Cameron McIntyre, a biomedical engineer from the Cleveland Clinic, commented that, “a first principals analysis of ECT stimulation parameters, along with the results of Sackeim et al, suggest that we should rethink the dogma of standard clinical ECT settings and work to optimize the therapy by bridging scientific understanding with clinical evaluation.”
“This pioneering and landmark article, with accompanying diverse viewpoints and editorials, is exactly the new approach to brain stimulation that we hope to foster,” writes Dr. Mark S. George, MD, Editor-in-Chief of 'Brain Stimulation'. Knowledge and approaches from the different techniques are starting to cross-fertilize, with important changes in theory and clinical practice. The field requires a multidisciplinary approach for full understanding.
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