title: Efficacy and cognitive side effects after brief pulse and ultrabrief pulse right unilateral electroconvulsive therapy for major depression: a randomized, double-blind, controlled study.
abstract: OBJECTIVE
  To compare the efficacy and cognitive side effects of high-dose unilateral brief pulse electroconvulsive therapy (ECT) with those of high-dose unilateral ultrabrief pulse ECT in the treatment of major depression.
  
  
  METHODS
  From April 2007 until March 2011, we conducted a prospective, double-blind, randomized multicenter trial in 3 tertiary psychiatric hospitals. All patients with a depressive disorder according to DSM-IV criteria were eligible. Depression severity was assessed with the Montgomery-Asberg Depression Rating Scale; primary efficacy outcomes were response, defined as a score decrease ≥ 60% from baseline, and remission, defined as a score < 10 at 2 consecutive weekly assessments. Total scores on the Autobiographical Memory Interview and Amsterdam Media Questionnaire were the primary outcome measures for retrograde amnesia. Other cognitive domains included category fluency (semantic memory) and letter fluency (lexical memory). Patients received twice-weekly unilateral brief pulse (1.0 millisecond) or ultrabrief pulse (0.3-0.4 millisecond) ECT 8 times seizure threshold until remission, for a maximum of 6 weeks.
  
  
  RESULTS
  Of the 116 patients, 75% (n = 87) completed the study. Among completers, 68.4% (26/58) of those in the brief pulse group achieved remission versus 49.0% (24/49) of those in the ultrabrief pulse group (P = .019), and the brief pulse group needed fewer treatment sessions to achieve remission: mean (SD) of 7.1 (2.6) versus 9.2 (2.3) sessions (P = .008). No significant group differences were found in the evaluation of the cognitive assessments.
  
  
  CONCLUSIONS
  The efficacy and speed of remission seen with high-dose brief pulse right unilateral ECT twice weekly were superior to those seen with high-dose ultrabrief pulse right unilateral ECT, with equal cognitive side effects as defined by retrograde amnesia, semantic memory, and lexical memory.
  
  
  BACKGROUND
  Netherlands National Trial Register number: NTR1304.
authors: Parnassia Psychiatric Institute, The Hague VU University Medical Center, Amsterdam.
authors: Harm-Pieter
authors: HP
authors: Spaans
authors: Esmée
authors: E
authors: Verwijk
authors: Hannie C
authors: HC
authors: Comijs
authors: Rob M
authors: RM
authors: Kok
authors: Pascal
authors: P
authors: Sienaert
authors: Filip
authors: F
authors: Bouckaert
authors: Katrien
authors: K
authors: Fannes
authors: Koen
authors: K
authors: Vandepoel
authors: Erik J A
authors: EJ
authors: Scherder
authors: Max L
authors: ML
authors: Stek
authors: King H
authors: KH
authors: Kho
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D018692:Antimanic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D003072:Cognition Disorders / Q000209:etiology* / Q000517:prevention & control*; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D004311:Double-Blind Method; D004565:Electroconvulsive Therapy / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D016651:Lithium Carbonate / Q000627:therapeutic use; D008297:Male; D061212:Memory, Episodic; D008570:Memory, Short-Term; D008875:Middle Aged; D009426:Netherlands; D011569:Psychiatric Status Rating Scales; D014706:Verbal Learning
chemical_list: D000928:Antidepressive Agents; D018692:Antimanic Agents; D016651:Lithium Carbonate