Electroconvulsive Therapy Pulse Amplitude and Clinical Outcomes

Abbott, Christopher; Quinn, Davin K.; Miller, Jeremy; Ye, Enstin; Iqbal, Sulaiman; Lloyd, Megan; Jones, Thomas R.; Upston, Joel; Deng, Zhi‐De; Erhardt, Erik B.; McClintock, Shawn M.

doi:10.1016/j.jagp.2020.06.008

Cited by 26 publications

(42 citation statements)

References 32 publications

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“…Therefore, it could be that there is not much gained by increasing the stimulus amplitude (and thus the electric field) further. There have also been small studies indicating that low amplitude seizure therapy using 500 mA might be effective ( Youssef and Sidhom, 2017 , Youssef et al, 2019 ) A recent trial comparing various stimulus amplitudes (600 – 800 mA) did, however, find that 600 mA resulted in worse ECT-outcome relative to 700 and 800 mA ( Abbott et al, 2020 ). More studies are definitely needed in this area.…”

Section: Discussionmentioning

confidence: 99%

Electric field strength induced by electroconvulsive therapy is associated with clinical outcome

Friðgeirsson

Deng

Denys

et al. 2021

NeuroImage: Clinical

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Highlights Finite element modelling is used to estimate the electric field induced by ECT. The electric field induced by ECT is highly variable between patients. The electric field in certain brain regions is associated with less optimal ECT-outcome. White matter distribution in temporal lobes seems important for this relationship.

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Section: Discussionmentioning

confidence: 99%

Electric field strength induced by electroconvulsive therapy is associated with clinical outcome

Friðgeirsson

Deng

Denys

et al. 2021

NeuroImage: Clinical

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“…The temporary disruption may act on neural circuits, which promotes the rigid negative bias of attention, memory, interpretations, and self-representations, allowing these to rewire in nondepressed states (32). However, disruption beyond the neural circuits maintaining depressive symptoms [likely related to dose (137)] may add side effects without further symptom reduction.…”

Section: The Biological Significance Of the Mri Findingsmentioning

confidence: 99%

The Neurobiological Effects of Electroconvulsive Therapy Studied Through Magnetic Resonance: What Have We Learned, and Where Do We Go?

Ousdal

Brancati

Keßler

et al. 2022

Biological Psychiatry

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Electroconvulsive therapy (ECT) is an established treatment choice for severe, treatment-resistant depression, yet its mechanisms of action remain elusive. Magnetic resonance imaging (MRI) of the human brain before and after treatment has been crucial to aid our comprehension of the ECT neurobiological effects. However, to date, a majority of MRI studies have been underpowered and have used heterogeneous patient samples as well as different methodological approaches, altogether causing mixed results and poor clinical translation. Hence, an association between MRI markers and therapeutic response remains to be established. Recently, the availability of large datasets through a global collaboration has provided the statistical power needed to characterize whole-brain structural and functional brain changes after ECT. In addition, MRI technological developments allow new aspects of brain function and structure to be investigated. Finally, more recent studies have also investigated immediate and long-term effects of ECT, which may aid in the separation of the therapeutically relevant effects from epiphenomena. The goal of this review is to outline MRI studies (T1, diffusion-weighted imaging, proton magnetic resonance spectroscopy) of ECT in depression to advance our understanding of the ECT neurobiological effects. Based on the reviewed literature, we suggest a model whereby the neurobiological effects can be understood within a framework of disruption, neuroplasticity, and rewiring of neural circuits. An improved characterization of the neurobiological effects of ECT may increase our understanding of ECT's therapeutic effects, ultimately leading to improved patient care.

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“…Thus, the results should be replicated in large clinical trials of LAP-ST at 0.5 A, with a longer follow-up period to show long-term effects of LAP-ST on cognition, depression, and suicidality [ 39 ]. This would add to the emerging literature [ 32 , 39 , 44 ] as a practical therapeutic alternative for TRD with less CSEs.…”

Section: Discussionmentioning

confidence: 95%

“…A recent larger randomized clinical trial [ 44 ] found less antidepressant effectiveness for 600 mA when comparing three different pulse amplitudes of 600, 700, and 800 mA. Although that may be the case, there are several differences between the two studies that are likely to explain difference in findings.…”

Section: Discussionmentioning

confidence: 99%

“…Although that may be the case, there are several differences between the two studies that are likely to explain difference in findings. For the purpose of future research directions for the field, we briefly outline some of these differences in the design between our study and the most recent low amplitude study [ 44 ]: There is an age difference between the two studies, with no restriction to 50 years and older in our study. Our study used TRO, rather than the Hopkins verbal learning test-revised retention raw score, as a primary outcome measure for cognition.…”

Section: Discussionmentioning

confidence: 99%

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Double-Blinded Randomized Pilot Clinical Trial Comparing Cognitive Side Effects of Standard Ultra-Brief Right Unilateral ECT to 0.5 A Low Amplitude Seizure Therapy (LAP-ST)

et al. 2020

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Background: Concerns over cognitive side effects (CSE) of electroconvulsive therapy (ECT) still limit its broader usage for treatment-resistant depression (TRD). The objectives of this study were to (1) examine the CSE of Low Amplitude Seizure Therapy (LAP-ST) at 0.5 A compared to Ultra-brief Right Unilateral (UB-RUL) ECT using Time to Reorientation (TRO) as the main acute primary outcome, and (2) to compare effects on depressive symptoms between the two treatment groups. Methods: Participants were referred for ECT, consented for the study, and were randomized to a course of LAP-ST or standard UB-RUL ECT. TRO and depression were measured by the Montgomery-Åsberg Depression Rating Scale (MADRS). Results: Eleven patients consented. Of these, eight with a current major depressive episode (MDE) of unipolar or bipolar disorders were randomized. TRO was faster for the LAP-ST (mean = 6.8 min; SE = 4.9) than standard RUL ECT (mean = 15.5 min; SE = 6.5). Depression improved similarly in the two arms of the study from baseline (MADRS: LAP-ST = 41.0; SE = 2.0, RUL = 39.0; SE = 3.8) to endpoint (MADRS score: LAP-ST = 8.0; SE7.2, RUL = 9.5; SE = 3.8). Conclusions: This pilot, randomized and blinded clinical trial, suggests that the LAP-ST (at 0.5 A) has faster reorientation and possibly lower CSE compared to standard RUL-UB ECT. Caution is advised in interpreting these results due to the small sample size of this pilot study. Thus, future studies with similar design are warranted for replicating these findings.

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Electroconvulsive Therapy Pulse Amplitude and Clinical Outcomes

Cited by 26 publications

References 32 publications

Electric field strength induced by electroconvulsive therapy is associated with clinical outcome

Electric field strength induced by electroconvulsive therapy is associated with clinical outcome

The Neurobiological Effects of Electroconvulsive Therapy Studied Through Magnetic Resonance: What Have We Learned, and Where Do We Go?

Double-Blinded Randomized Pilot Clinical Trial Comparing Cognitive Side Effects of Standard Ultra-Brief Right Unilateral ECT to 0.5 A Low Amplitude Seizure Therapy (LAP-ST)

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