Right unilateral versus bilateral formula‐based electroconvulsive therapy in the treatment of major depression in elderly patients: a randomised, open label, pilot controlled trial

Abstract

Background Electroconvulsive therapy (ECT) remains the most effective treatment of depression in the elderly population; however, it is still unclear which type of ECT is most beneficial in this population. The aims of this study were: (i) to assess the feasibility of a randomised controlled trial in elderly depressed patients treated with right unilateral (RUL) or fronto‐temporal bilateral (BT) formula‐based ECT; (ii) to compare formula‐based RUL and BT ECT in terms of efficacy, safety and tolerability in this population. Methods The study lasted 3 years and managed to randomise 29 patients over 65 years old to receive either BT (n = 14) or RUL (n = 15) ECT. Brief pulse width (0.5 ms) and age‐based dosing method were applied. The clinical efficacy was assessed using Hamilton Depression Rating Scale, somatic state was monitored throughout the ECT course. In neuropsychological examination general cognitive performance, executive functions, verbal fluency, memory, autobiographical memory were evaluated. Results The recruitment was poor due to small number of patients able to give informed consent. ECT proved to be a highly effective and safe method of treatment among elders. Formula‐based RUL ECT did not differ from BT in antidepressant efficacy and had cognitive advantages ‐ the indices of general cognitive performance, verbal fluency and memory were significantly better than before the treatment in the RUL group. Decline in retrieval consistency of autobiographical memory was more pronounced in the BT group, although it was observed across both groups. Conclusions Formula‐based RUL ECT might not differ from BT in antidepressant efficacy and has an advantage in terms of tolerability.

Autobiographical memory after electroconvulsive therapy: systematic review and meta-analysis

“…Our results are in accordance with previous findings that ECT causes autobiographical memory loss, 8 as well as studies finding a greater autobiographical memory loss/retrograde amnesia after bilateral compared to RUL ECT. [49][50][51][52][53] Regarding the moderating effect of age, our result is in line with an earlier finding that a higher age is associated with less autobiographical memory loss after ECT. 54 In contrast, another study found the opposite association, 41 Bergfeld 2017 44 healthy controls EOT 44 Bergfeld 2017 44 Bjoerke-Bertheussen 2018 36 Blomberg 2020 45 Blomberg 2020 45 Dybedal 2014 46 Kessler 2014 35 Sackeim 2007 34 Sackeim 2007 34 Weeks 2013 48 Weeks 2013 48 Semkovska 2017 43 Semkovska 2017 43 Schulze-Rausch 2005 47 Schulze-Rausch 2005 47 and others did not find any association between age and autobiographical memory loss after ECT.…”

Autobiographical memory after electroconvulsive therapy: systematic review and meta-analysis

“…Our results are in accordance with previous findings that ECT causes autobiographical memory loss, 8 as well as studies finding a greater autobiographical memory loss/retrograde amnesia after bilateral compared to RUL ECT. [49][50][51][52][53] Regarding the moderating effect of age, our result is in line with an earlier finding that a higher age is associated with less autobiographical memory loss after ECT. 54 In contrast, another study found the opposite association, 41 Bergfeld 2017 44 healthy controls EOT 44 Bergfeld 2017 44 Bjoerke-Bertheussen 2018 36 Blomberg 2020 45 Blomberg 2020 45 Dybedal 2014 46 Kessler 2014 35 Sackeim 2007 34 Sackeim 2007 34 Weeks 2013 48 Weeks 2013 48 Semkovska 2017 43 Semkovska 2017 43 Schulze-Rausch 2005 47 Schulze-Rausch 2005 47 and others did not find any association between age and autobiographical memory loss after ECT.…”

Electroconvulsive Therapy and Age: Effectiveness, Safety and Tolerability in the Treatment of Major Depression among Patients under and over 65 Years of Age

“…This result is partially consistent with data in the literature. The efficacy of ECT in the older patients was higher than in the younger age groups [ 26 , 30 , 31 , 32 , 33 , 34 , 35 ]. Recent reviews and meta-analyses also seem to support these findings [ 27 , 28 , 36 ].…”

“…The methodology of clinical assessment was as previously described in the work of Dominiak et al [ 30 , 48 ]. To assess the efficacy of ECT and compare it between groups, we used the Hamilton Depression Rating Scale (HDRS-21) as the primary measure.…”

Autobiographical memory after electroconvulsive therapy: systematic review and meta-analysis

“…Our results are in accordance with previous findings that ECT causes autobiographical memory loss, 8 as well as studies finding a greater autobiographical memory loss/retrograde amnesia after bilateral compared to RUL ECT. [49][50][51][52][53] Regarding the moderating effect of age, our result is in line with an earlier finding that a higher age is associated with less autobiographical memory loss after ECT. 54 In contrast, another study found the opposite association, 41 Bergfeld 2017 44 healthy controls EOT 44 Bergfeld 2017 44 Bjoerke-Bertheussen 2018 36 Blomberg 2020 45 Blomberg 2020 45 Dybedal 2014 46 Kessler 2014 35 Sackeim 2007 34 Sackeim 2007 34 Weeks 2013 48 Weeks 2013 48 Semkovska 2017 43 Semkovska 2017 43 Schulze-Rausch 2005 47 Schulze-Rausch 2005 47 and others did not find any association between age and autobiographical memory loss after ECT.…”

Electroconvulsive Therapy and Age: Effectiveness, Safety and Tolerability in the Treatment of Major Depression among Patients under and over 65 Years of Age

“…This result is partially consistent with data in the literature. The efficacy of ECT in the older patients was higher than in the younger age groups [ 26 , 30 , 31 , 32 , 33 , 34 , 35 ]. Recent reviews and meta-analyses also seem to support these findings [ 27 , 28 , 36 ].…”

“…The methodology of clinical assessment was as previously described in the work of Dominiak et al [ 30 , 48 ]. To assess the efficacy of ECT and compare it between groups, we used the Hamilton Depression Rating Scale (HDRS-21) as the primary measure.…”

Autobiographical memory after electroconvulsive therapy: systematic review and meta-analysis

“…Our results are in accordance with previous findings that ECT causes autobiographical memory loss, 8 as well as studies finding a greater autobiographical memory loss/retrograde amnesia after bilateral compared to RUL ECT. [49][50][51][52][53] Regarding the moderating effect of age, our result is in line with an earlier finding that a higher age is associated with less autobiographical memory loss after ECT. 54 In contrast, another study found the opposite association, 41 Bergfeld 2017 44 healthy controls EOT 44 Bergfeld 2017 44 Bjoerke-Bertheussen 2018 36 Blomberg 2020 45 Blomberg 2020 45 Dybedal 2014 46 Kessler 2014 35 Sackeim 2007 34 Sackeim 2007 34 Weeks 2013 48 Weeks 2013 48 Semkovska 2017 43 Semkovska 2017 43 Schulze-Rausch 2005 47 Schulze-Rausch 2005 47 and others did not find any association between age and autobiographical memory loss after ECT.…”

Electroconvulsive Therapy and Age: Effectiveness, Safety and Tolerability in the Treatment of Major Depression among Patients under and over 65 Years of Age

“…This result is partially consistent with data in the literature. The efficacy of ECT in the older patients was higher than in the younger age groups [ 26 , 30 , 31 , 32 , 33 , 34 , 35 ]. Recent reviews and meta-analyses also seem to support these findings [ 27 , 28 , 36 ].…”

“…The methodology of clinical assessment was as previously described in the work of Dominiak et al [ 30 , 48 ]. To assess the efficacy of ECT and compare it between groups, we used the Hamilton Depression Rating Scale (HDRS-21) as the primary measure.…”