Short And Long Term Effect Of Right Unilateral (RUL) Electroconvulsive Therapy (ECT) In Depressed Patients On Retrograde Memory And Executive Function: A Prospective Study

Abstract

s / Brain Stimulation 8 (2015) 310e325 317 b EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands GGZinGeest, Amsterdam, The Netherlands VU University, department of Clinical Neuropsychology, Amsterdam, The Netherlands University Psychiatric Center e Catholic University of Leuven, campus Kortenberg, Kortenberg, Belgium *E-mail: spaans@parnassia.nl. Introduction: To compare the efficacy, relapse rate and short-/ longterm cognitive functioning of unilateral brief pulse (BP) electroconvulsive therapy (ECT) with unilateral (RUL) ultrabrief pulse (UBP) ECT in the treatment of major depression. Method: We conducted a prospective, double blind, randomized multicenter trial. 116 patients suffering from major depression according to DSM IV criteria were eligible. Patients received twice weekly RUL BP (1.0 millisecond) or RUL UBP (0.3-0.4 millisecond) ECT eight times seizure threshold until remission (MADRS<10), for a maximum of six weeks after which they entered a naturalistic follow-up. Three and six months after the double blind treatment phase patients were monitored for relapse and cognitive performance (retrograde amnesia, semantic memory and executive functioning). Results: Of the 116 patients 75% (n1⁄487) completed the study. The BP group achieved remission in 68.4% (n1⁄426) vs. 49.0% (n1⁄424; p1⁄40.019) in the UBP group and needed less treatment sessions to achieve remission: 7.1 (sd 2.6) vs. 9.2 (sd 2.3); p1⁄40.008. There were no significant group differences for the evaluation of the cognitive assessments. Of the 50 patients who remitted after index ECT 44 were monitored for follow up. Relapse occurred in 25% of the BP group and in 25% of the UBP group (c21⁄40.00, p1⁄41.0) at threemonths follow-up; whereas 43.5% of the BP group and 35% of the UBP group relapsed (c21⁄40.322, p1⁄40.57) at six months follow-up. The long term evaluation of the cognitive assessments showed no significant differences between BP and UBP groups. Conclusion: The efficacy and speed of remission of BP ECT twice weekly was superior compared to UBP ECT with equal cognitive side effects. Patients that achieved remission after RUL BP or RUL UBP ECT show similar relapse rates after three and six months. There was no cognitive advantage of UBP over BP ECT three and six months post ECT.