COMPARISON OF THE SPEED OF REMISSION BETWEEN BILATERAL AND RIGHT UNILATERAL ECT IN A COHORT OF GERIATRIC PSYCHIATRY PATIENTS

Abstract

Introduction • Electroconvulsive therapy (ECT) has been clinically proven to be an effective form of treatment for severe depression. It is also a safe treatment option when a quick response is needed. ECT is especially useful in the geriatric population where the complications of severe depression like not eating or drinking, self-neglect, deteriorating medical co morbidities lead to increased morbidity and mortality. •Several studies have compared efficacy of the different electrode placements as well as any resulting cognitive side effects from ECT. • A randomized trial comparing bifrontal, bitemporal and right unilateral electrode placement in ECT (commonly referred to as CORE) showed clinical and statistically significant antidepressant outcomes with all three electrode placements. Bitemporal electrode placement in this study however resulted in a more rapid decline in symptoms over the early course of treatment leading to the recommendation that bitemporal leads be considered the preferred placement for urgent clinical situations. Of note the mean age characteristics of these patients was 53.1 and all carrying a diagnosis of Unipolar/bipolar depression with/without psychosis, receiving acute ECT treatment. • In Phase I of the PRIDE study, a sample of geriatric patients with severe depression were given RUL ECT 3?times a week. One of the secondary outcomes they looked at was the speed of remission which was determined by the number of RUL ECT treatments required to achieve remission. In this study, the mean number of RUL ECT treatments to achieve remission was 7.3. • In this retrospective chart review we hypothesized that using bitemporal electrode placement would lead to remission of symptoms with fewer ECT treatments than right unilateral placement among a strictly geriatric population. • Potentially fewer treatments could lead to lower treatment costs, reduce the risk of cognitive impairment and illness burden by achieving quicker response. Methods •Retrospective chart review of 20 inpatient psychiatry patients all over age 65. Diagnoses included Major depressive disorder with psychosis (6), without psychosis (11), Bipolar disorder, depressed (2) and schizoaffective disorder (1). •All 20 patients received and responded positively to acute ECT treatment at Mount Sinai Hospital administered 3 times a week. •10 patients received bitemporal treatment and 10 received right unilateral treatment. •Treatment outcome was measured by the Quick Inventory of Depressive Symptomatology (QIDS) before each ECT treatment. The QIDS-SR is a self-report inventory that measures depressive symptom severity in the following domains: sleep, psychomotor activity, appetite/weight, sad mood, concentration, energy, interest, guilt and suicidal ideations/intent. • We looked at QIDS scores at baseline and over the course determined how many ECT treatments each group received before their QIDS scores were reduced by 50%. Results Of the 20 patient ECT records reviewed, 11 were male and 9 females. 6 patients were between ages 66-70 and the remaining 14 patients were all above age 70. . At the start of ECT the average QIDS score for patients receiving bitemporal ECT was 19.8 and for RUL was 17. This indicates a moderate to severe depression from the QIDS inventory. . The average number of ECT treatments to achieve 50% QIDS score reduction in bitemporal ECT was 4.5 and that for RUL ECT was 4.1. Conclusions The average number of bitemporal ECT treatments to achieve a QIDS score reduction of 50% was 4.5 whilst that for right unilateral ECT was 4.1. • Patients that received bilateral ECT had higher average QIDS scores of 19.8 suggesting that sicker patients are treated with BL ECT. This could potentially have been because of a perceived need for a quicker response compared to RUL ECT which was not consistent with our findings. •We observed that there was little difference in the number of treatments needed to achieve fifty percent reduction in symptoms. From our findings it appears that in the geriatric population both bitemporal and right unilateral electrode placements have rapid onset of action with only a marginal difference. •Our study was limited by it being a retrospective medical chart review with only 20 patients. This research was funded by: Not Applicable