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Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy.

Publication ,  Journal Article
Sackeim, HA; Prudic, J; Nobler, MS; Fitzsimons, L; Lisanby, SH; Payne, N; Berman, RM; Brakemeier, E-L; Perera, T; Devanand, DP
Published in: Brain Stimul
April 2008

BACKGROUND: While electroconvulsive therapy (ECT) in major depression is effective, cognitive effects limit its use. Reducing the width of the electrical pulse and using the right unilateral electrode placement may decrease adverse cognitive effects, while preserving efficacy. METHODS: In a double-masked study, we randomly assigned 90 depressed patients to right unilateral ECT at 6 times seizure threshold or bilateral ECT at 2.5 times seizure threshold, using either a traditional brief pulse (1.5 ms) or an ultrabrief pulse (0.3 ms). Depressive symptoms and cognition were assessed before, during, and immediately, two, and six months after therapy. Patients who responded were followed for a one-year period. RESULTS: The final remission rate for ultrabrief bilateral ECT was 35 percent, compared with 73 percent for ultrabrief unilateral ECT, 65 percent for standard pulse width bilateral ECT, and 59 percent for standard pulse width unilateral ECT (all P's<0.05 after covariate adjustment). The ultrabrief right unilateral group had less severe cognitive side effects than the other 3 groups in virtually all primary outcome measures assessed in the acute postictal period, and during and immediately following therapy. Both the ultrabrief stimulus and right unilateral electrode placement produced less short- and long-term retrograde amnesia. Patients rated their memory deficits as less severe following ultrabrief right unilateral ECT compared to each of the other three conditions (P<0.001). CONCLUSIONS: The use of an ultrabrief stimulus markedly reduces adverse cognitive effects, and when coupled with markedly suprathreshold right unilateral ECT, also preserves efficacy. (ClinicalTrials.gov number, NCT00487500.).

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Published In

Brain Stimul

DOI

EISSN

1876-4754

Publication Date

April 2008

Volume

1

Issue

2

Start / End Page

71 / 83

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Research Design
  • Recurrence
  • Prospective Studies
  • Neuropsychological Tests
  • Neurology & Neurosurgery
  • Middle Aged
  • Memory Disorders
  • Humans
  • Female
 

Citation

APA
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Sackeim, H. A., Prudic, J., Nobler, M. S., Fitzsimons, L., Lisanby, S. H., Payne, N., … Devanand, D. P. (2008). Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. Brain Stimul, 1(2), 71–83. https://doi.org/10.1016/j.brs.2008.03.001
Sackeim, Harold A., Joan Prudic, Mitchell S. Nobler, Linda Fitzsimons, Sarah H. Lisanby, Nancy Payne, Robert M. Berman, Eva-Lotta Brakemeier, Tarique Perera, and D. P. Devanand. “Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy.Brain Stimul 1, no. 2 (April 2008): 71–83. https://doi.org/10.1016/j.brs.2008.03.001.
Sackeim HA, Prudic J, Nobler MS, Fitzsimons L, Lisanby SH, Payne N, et al. Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. Brain Stimul. 2008 Apr;1(2):71–83.
Sackeim, Harold A., et al. “Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy.Brain Stimul, vol. 1, no. 2, Apr. 2008, pp. 71–83. Pubmed, doi:10.1016/j.brs.2008.03.001.
Sackeim HA, Prudic J, Nobler MS, Fitzsimons L, Lisanby SH, Payne N, Berman RM, Brakemeier E-L, 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.
Journal cover image

Published In

Brain Stimul

DOI

EISSN

1876-4754

Publication Date

April 2008

Volume

1

Issue

2

Start / End Page

71 / 83

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Research Design
  • Recurrence
  • Prospective Studies
  • Neuropsychological Tests
  • Neurology & Neurosurgery
  • Middle Aged
  • Memory Disorders
  • Humans
  • Female