Scientists have found that a different form of electroconvulsive therapy (also known as electroshock or ECT) using an "ultrabrief pulse" can improve mood without causing the associated cognitive deficits of normal ECT. ECT involves giving the brain a large jolt of electricity that drastically changes brain functioning. Currently, ECT is one of the most effective treatments for severe mood disorders. ECT is usually administered in 6 to 12 sessions. An ECT procedure usually takes around 10 to 15 minutes and is performed under anesthesia. A large electric current is passed through the subject's skull and this causes a seizure in the brain. It is hypothesized that this large jolt of electricity can alter brain functionality in a way that improves a patient's mood.By using the so called "brief pulse" of electricity researchers have been able to maintain the antidepressant response of ECT while reducing the cognitive deficits. See this paper "Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy" for more information. ECT normally can cause a patient to have amnesia including retrograde (forgetting events happening before treatment) and anterograde (forgetting events happening after treatment) memory impairments.
"The final remission rate for ultrabrief bilateral ECT was 35%, compared with 73% for ultrabrief unilateral ECT, 65% for standard pulse width bilateral ECT, and 59% for standard pulse width unilateral ECT (all P < .05 after covariate adjustment). The ultrabrief right unilateral group had less severe cognitive side effects than the other three groups in virtually all primary outcome measures assessed in the acute postictal period, and during and immediately after therapy. Both the ultrabrief stimulus and right unilateral electrode placement produced less short- and long-term retrograde amnesia. Patients rated their memory deficits as less severe after ultrabrief right unilateral ECT compared with each of the other three conditions (P < .001)."
This study appears to confirm another recent study that has gotten similar results using this method according to this blog.
At the end of the treatment course, 78.1% of patients responded (≥ 50% decrease HDRS-scores). There was a significant increase in global cognitive function (MMSE), verbal memory (RAVLT), attention (CPT), executive function (WCST) and autobiographical memory (AMI).More ways that scientists have been able to reduce the cognitive side effects of ECT can be found at the Dr Shock MD PhD blog.
2 comments:
Wow! I wonder how long it will take for this information to spread. I suppose they can't just make those zaps ultrashort without a computer interface so it will require some purchases (-> also bureacracy :()
We have used ultrabrief pulses for ECT wihout a computer since 1985, with a computer, which calculates the dosage parameters based on electrode placement, patient's age, gender and previous ECT, since 1993. Alternating sides with UL ECT rther than using RUL virtually eliminates cognitive side effects.
Vaclav Hyrman,MD
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