title: A Systematic Review and Meta-Analysis of Brief Versus Ultrabrief Right Unilateral Electroconvulsive Therapy for Depression.
abstract: OBJECTIVE
  Electroconvulsive therapy (ECT) is an effective depression treatment, but it has potential cognitive side effects. Ultrabrief pulse (UBP) right unilateral (RUL) ECT is an increasingly used treatment option that can potentially combine efficacy with lesser cognitive side effects. However, current trials are underpowered or have conflicting results. A systematic review and meta-analysis was conducted to evaluate the relative efficacy and cognitive effects of brief pulse (BP) and UBP RUL ECT.
  
  
  METHODS
  MEDLINE, EMBASE, PsycINFO, CENTRAL, DARE, and the International Clinical Trials Registry Platform were searched with the search terms ECT, electroconvulsive therapy, electroconvulsive shock, electroconvulsive shock therapy, electrical stimulation, electroconvulsive combined with brief, ultra*, pulse, and trial in English, all fields including title, abstract, subject heading, and full text up to June 20, 2013, for studies comparing BP and UBP RUL ECT in depressed patients that reported formalized mood ratings for depression.
  
  
  METHODS
  Six studies met the inclusion criteria, comprising a total of 689 patients.
  
  
  METHODS
  Efficacy, cognitive, response, and remission outcomes were extracted from each publication or obtained directly from authors.
  
  
  RESULTS
  BP RUL ECT was significantly more efficacious in treating depression than UBP RUL ECT (standardized mean difference = 0.25; 95% CI, 0.08–0.41; P = .004) but showed significantly more cognitive side effects in all cognitive domains examined (global cognition, anterograde learning and recall, retrograde memory) (P < .01). The mean number of treatment sessions given was 8.7 for BP ECT and 9.6 for UBP ECT (P < .001). UBP had a lower remission rate (OR = 0.71; 95% CI, 0.51–0.99; P = .045), with a number needed to treat of 12.1.
  
  
  CONCLUSIONS
  BP compared with UBP RUL ECT was slightly more efficacious in treating depression and required fewer treatment sessions, but led to greater cognitive side effects. The decision of whether to use BP or UBP RUL ECT should be made on an individual patient basis and should be based on a careful weighing of the relative priorities of efficacy versus minimization of cognitive impairment.
authors.forename: Phern-Chern
authors.initials: PC
authors.lastname: Tor
authors.forename: Alison
authors.initials: A
authors.lastname: Bautovich
authors.forename: Min-Jung
authors.initials: MJ
authors.lastname: Wang
authors.forename: Donel
authors.initials: D
authors.lastname: Martin
authors.forename: Samuel B
authors.initials: SB
authors.lastname: Harvey
authors.forename: Colleen
authors.initials: C
authors.lastname: Loo
mesh_terms: D003072:Cognition Disorders; D003863:Depression / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D016896:Treatment Outcome