Electroconvulsive therapy (ECT) is a highly effective treatment for depression, but its use is limited by the risk of associated cognitive side-effects. This study aimed to investigate the relative effectiveness and cognitive side-effects of ECT given in four different forms, varying in electrode placement and pulsewidth, to determine the optimal form of ECT.
Depressed in-patients referred for ECT in a private clinic in Sydney were recruited after giving informed consent. Subjects received the form of ECT prescribed by their treating psychiatrist [bitemporal at 1.5 times seizure threshold (1.5 ST), bifrontal at 1.5 ST, right unilateral at 5 ST or right unilateral with ultrabrief pulsewidth at 6 ST]. Mood (MADRS) and neuropsychological functioning (digit span, Rey Auditory Verbal Learning Test, Rey figure, word generation, STROOP, Autobiographical Memory Interview) were assessed at baseline, after six ECT and at the end of the ECT course.
The study is in progress and preliminary results (mood, neuropsychological function, seizure indexes) will be presented.
All four forms of ECT appear effective, but preliminary results suggest some forms may be advantageous in terms of a lower rate of cognitive side-effects. There is evidence for the clinical use of bifrontal ECT. Ultrabrief unilateral ECT may hold great promise for the future.