New form of ECT is as effective as older types but without cognitive side effects

Philadelphia, PA, May 27, 2008 - In a study appearing in the new issue of BRAIN STIMULATION, scientists report that a new form of electroconvulsive therapy (ECT) is just as effective as older forms in treating depression but without any of the cognitive side effects found in the older forms. In the NIMH-sponsored study, Dr. Harold Sackeim and colleagues from Columbia University randomly assigned 90 depressed patients to either right sided or bilateral ECT, using either a traditional electrical pulse or a newer “ultrabrief pulse”, and measured clinical response and cognitive side effects.

The study found that 73 % of the depressed subjects who received the ultrabrief pulse responded, compared with a 65% response from subjects who received the ‘gold standard’ bilateral older form. Importantly, the ultrabrief group had less severe cognitive side effects than the other group. “The use of an ultrabrief stimulus markedly reduces adverse cognitive effects and, when coupled with markedly suprathreshold right unilateral ECT, also preserves efficacy,” write Dr. Sackeim and colleagues.

In a related editorial in the same edition of BRAIN STIMULATION, Dr. Bernard Lerer, a psychiatrist from Israel not involved in the study, wrote “The paper by Sackeim and colleagues in the current issue of BRAIN STIMULATION shows that use of an ultrabrief stimulus has remarkably few, if any, effects on cognitive function without loss of efficacy. The results provide convincing evidence derived from a randomized controlled trial. … If supported by additional controlled studies and borne out by clinical experience in the field, these findings will be an important further step forward in the practice of ECT. They also have intriguing implications for our understanding of how the treatment works, a conundrum that has not been resolved in the 73 years since convulsive therapy was first introduced. ”

Dr. Lerer went on to comment, “Overall, these are interesting times for brain stimulation therapies in general and ECT in particular. Ultrabrief stimulation is an exciting development in the optimization of ECT. It could turn out to be a pivotal step in an exciting cascade of events that may radically alter the treatment of depression and other psychiatric disorders.”

BRAIN STIMULATION: Basic Translational and Clinical Research in Neuromodulation is a new journal recently published by Elsevier, with a goal of promoting cross-disciplinary dialogue and new understanding concerning the brain stimulation methods. In another accompanying editorial reasoning from the physics of brain stimulation, Dr. Cameron McIntyre, a biomedical engineer from the Cleveland Clinic, commented that, “a first principals analysis of ECT stimulation parameters, along with the results of Sackeim et al, suggest that we should rethink the dogma of standard clinical ECT settings and work to optimize the therapy by bridging scientific understanding with clinical evaluation.”

“This pioneering and landmark article, with accompanying diverse viewpoints and editorials, is exactly the new approach to brain stimulation that we hope to foster,” writes Dr. Mark S. George, MD, Editor-in-Chief of BRAIN STIMULATION. Knowledge and approaches from the different techniques are starting to cross-fertilize, with important changes in theory and clinical practice. The field requires a multidisciplinary approach for full understanding.

The article is “Effects of Pulse Width and Electrode Placement on the Efficacy and Cognitive Effects of Electroconvulsive Therapy” by Harold A. Sackeim, PhD, Joan Prudic, MD, Mitchell S. Nobler, MD, Linda Fitzsimons, RN, Sarah H. Lisanby, MD, Nancy Payne, CSW, Robert M. Berman, MD, PhD, Eva-Lotta Brakemeier, MA, Tarique Perera, MD, D. P. Devanand, MD, all with Columbia University. The article appears in BRAIN STIMULATION, Volume 1, Issue 2, (May 2008) and is published by Elsevier.

Full text of the article mentioned above is available upon request. Contact Jayne M. Dawkins at (215) 239-3674 or ja.dawkins@elsevier.com to obtain a copy or to schedule an interview.

BRAIN STIMULATION: Basic Translational and Clinical Research in Neuromodulation commenced publication in January 2008. The scope of BRAIN STIMULATION extends across the entire field of brain stimulation, including noninvasive and invasive techniques and technologies that alter brain function through the use of electrical, magnetic, radiowave, or focally targeted pharmacologic stimulation. This includes investigations that study the effects of brain stimulation on basic processes, such as gene expression and other aspects of molecular biology, neurochemical regulation, functional brain activity, sensorimotor function, and cognitive and affective processes at the systems level.

The journal seeks the highest level of research on the biophysics and biopsychophysics of stimulation paradigms as well as the use of these techniques as a probe to outline patterns of neural connectivity. As an equal partner with this basic emphasis, the journal will have strong representation of research on the therapeutic potential and adverse effects of the stimulation technologies. The inclusion of research in therapeutics will represent not only clinical trials, but also conceptual pieces, discussions of ethics as they pertain to this field, services research, etc. More information can be found at www.BrainStimJrnl.com.

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