title: Expanded Safety and Efficacy Data for a New Method of Performing Electroconvulsive Therapy: Focal Electrically Administered Seizure Therapy.
abstract: OBJECTIVE
  Electroconvulsive therapy (ECT) is the most rapid and effective antidepressant treatment but with concerns about cognitive adverse effects. A new form of ECT, focal electrically administered seizure therapy (FEAST), was designed to increase the focality of stimulation and better match stimulus parameters with neurophysiology. We recently reported on the safety and feasibility of FEAST in a cohort (n = 17) of depressed patients. We now report on the safety, feasibility, preliminary efficacy, and cognitive effects of FEAST in a new cohort.
  
  
  METHODS
  Open-label FEAST was administered to 20 depressed adults (6 men; 3 with bipolar disorder; age 49.1 ± 10.6 years). Clinical and cognitive assessments were obtained at baseline and end of course. Time to orientation recovery was assessed at each treatment. Nonresponders switched to conventional ECT.
  
  
  RESULTS
  Participants tolerated the treatment well with no dropouts. Five patients (25%) transitioned from FEAST to conventional ECT due to inadequate response. After FEAST (mean, 9.3 ± 3.5 sessions; range, 4-14), there was a 58.1% ± 36.0% improvement in Hamilton Rating Scale for Depression scores compared with that in the baseline (P < 0.0001); 13 (65%) of 20 patients met response criteria, and 11 (55%) of 20 met remission criteria. Patients achieved reorientation (4 of 5 items) in 4.4 ± 3.0 minutes (median, 4.5 minutes), timed from eyes opening. There was no deterioration in neuropsychological measures.
  
  
  CONCLUSIONS
  These findings provide further support for the safety and efficacy of FEAST. The remission and response rates were in the range found using conventional ECT, and the time to reorientation may be quicker. However, without a randomized comparison group, conclusions are tentative.
authors.affiliation: From the *Brain Stimulation Division, Department of Psychiatry, Medical University of South Carolina, Charleston, SC; Departments of †Psychiatry and ‡Radiology, Columbia University, New York, NY; §Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon; and ∥Ralph H. Johnson VA Medical Center, Charleston, SC.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Sahlem
authors.forename: E Baron
authors.initials: EB
authors.lastname: Short
authors.forename: Suzanne
authors.initials: S
authors.lastname: Kerns
authors.forename: Jon
authors.initials: J
authors.lastname: Snipes
authors.forename: William
authors.initials: W
authors.lastname: DeVries
authors.forename: James B
authors.initials: JB
authors.lastname: Fox
authors.forename: Carol
authors.initials: C
authors.lastname: Burns
authors.forename: Matthew
authors.initials: M
authors.lastname: Schmidt
authors.forename: Ziad H
authors.initials: ZH
authors.lastname: Nahas
authors.forename: Mark S
authors.initials: MS
authors.lastname: George
authors.forename: Harold A
authors.initials: HA
authors.lastname: Sackeim
mesh_terms: D000328:Adult; D000368:Aged; D000758:Anesthesia; D001714:Bipolar Disorder / Q000523:psychology / Q000628:therapy; D003072:Cognition Disorders / Q000209:etiology; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000009:adverse effects / Q000379:methods*; D004566:Electrodes; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012640:Seizures; D016896:Treatment Outcome