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Effects of stimulus intensity and electrode placement on the efficacy and
cognitive effects of electroconvulsive therapy
Abstract:
BACKGROUND. The efficacy of electroconvulsive therapy in major
depression is established, but the importance of the electrical dosage and electrode
placement in relation to efficacy and side effects is uncertain.
METHODS. In a double-
blind study, we randomly assigned 96 depressed patients to receive right unilateral or
bilateral electroconvulsive therapy at either a low electrical dose (just above the
seizure threshold) or a high dose (2.5 times the threshold). Symptoms of depression
and cognitive functioning were assessed before, during, immediately after, and two
months after therapy. Patients who responded to treatment were followed for one
year to assess the rate of relapse.
RESULTS. The response rate for low-dose unilateral
electroconvulsive therapy was 17 percent, as compared with 43 percent for high-dose
unilateral therapy (P = 0.054), 65 percent for low-dose bilateral therapy (P = 0.001), and
63 percent for high-dose bilateral therapy (P = 0.001). Regardless of electrode
placement, high dosage resulted in more rapid improvement (P therapy (59 percent)
relapsed, and there were no differences between treatment groups.
CONCLUSIONS.
Increasing the electrical dosage increases the efficacy of right unilateral
electroconvulsive therapy, although not to the level of bilateral therapy. High
electrical dosage is associated with a more rapid response, and unilateral treatment is
associated with less severe cognitive side effects after treatment.
Authors: Devanand DP, Sackeim HA, Prudic J
Psychiatr Clin North Am
1991 Dec
Electroconvulsive therapy in the treatment-resistant patient.
Abstract:
In medication-resistant patients with major depressive disorder, the
response rate with bilateral electroconvulsive therapy (ECT) drops to 50% from the
expected range of 80% to 90%. Relapse rates following ECT are high in medication-
resistant depressed patients and are clustered in the first 4 months following clinical
response. Medication resistance during the index episode predicts a high rate of
relapse, whereas those patients who have not received an adequate medication trial
prior to ECT are less likely to relapse. If a patient who fails an antidepressant trial
then responds to a course of ECT, alternative pharmacological strategies or
maintenance ECT should be considered to decrease the likelihood of relapse. Patients
who do not respond to a traditional course of bilateral ECT may respond
subsequently to longer courses of bilateral ECT at markedly suprathreshold stimulus
intensity, or may respond to a different class of antidepressant medication from that
which they failed previously.
Authors: Kornhuber J, Weller M
Convuls Ther 1995 Jun;11(2):104-109
Patient selection and remission rates with the current practice of
electroconvulsive therapy in Germany.
| Disorder Treated | Effectiveness of ECT |
| Unipolar | 31.9% |
| Bipolar | 38.3% |
The current practice of German psychiatric hospitals restricts
electroconvulsive therapy (ECT) to patients with profound disability and
failure to respond to pharmacotherapy. We studied clinical features and
seizure parameters in 63 patients who received ECT in a 3-year period at a
German university hospital. Patients with unipolar and bipolar disorder
(depressed) (n = 47) showed a complete or partial recovery as assessed 2
weeks after completion of the ECT course in 31.9 and 38.3%, respectively.
Multiple linear regression analysis performed on several clinical and ECT
seizure parameters failed to identify strong outcome predictors in our
selected sample of patients. Most patients who eventually responded did so
early in the course of ECT, while there was little improvement when 10 ECT
treatments were given. Our report highlights the efficacy of ECT in the
management of severe psychiatric disorders even in a highly selected sample
of patients previously found to be resistant to alternative modes of
psychiatric treatment.
Authors: Sackeim HA, Prudic J, Devanand DP, Decina P, Kerr B, Malitz S
J Clin Psychopharmacol 1990 Apr;10(2):96-104
The impact of medication resistance and continuation pharmacotherapy on
relapse following response to electroconvulsive therapy in major depression.
After clinical response to electro-convulsive therapy (ECT), 58 patients with
major depressive disorder were followed for 1 year or until relapse. The
rate of relapse was substantially higher in patients who had failed adequate
antidepressant medication trials prior to ECT than in patients not
determined to be medication resistant. Adequacy of post-ECT pharmacotherapy
was only marginally related to likelihood of relapse. The subgroup of
patients who appeared to benefit from adequate post-ECT pharmacotherapy were
those who did not receive an adequate medication trial prior to ECT. The
findings call into question the common practice of administering as
continuation pharmacotherapy following ECT the same class of medications
that patients had failed with during the acute episode prior to ECT. The
findings also indicate that resistance to antidepressant medication is a
strong predictor of relapse following response to ECT.
Authors: Devanand DP, Sackeim HA, Prudic J
Psychiatr Clin North Am 1991 Dec;14(4):905-923
Electroconvulsive therapy in the treatment-resistant patient.
In medication-resistant patients with major depressive disorder, the
response rate with bilateral electroconvulsive therapy (ECT) drops to 50%
from the expected range of 80% to 90%.
Relapse rates following ECT are high
in medication-resistant depressed patients and are clustered in the first 4
months following clinical response. Medication resistance during the index
episode predicts a high rate of relapse, whereas those patients who have not
received an adequate medication trial prior to ECT are less likely to
relapse. If a patient who fails an antidepressant trial then responds to a
course of ECT, alternative pharmacological strategies or maintenance ECT
should be considered to decrease the likelihood of relapse. Patients who do
not respond to a traditional course of bilateral ECT may respond
subsequently to longer courses of bilateral ECT at markedly suprathreshold
stimulus intensity, or may respond to a different class of antidepressant
medication from that which they failed previously.
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