Out on PubMed this week from investigators in Sweden and Norway is this study from the
Swedish National Quality Register for ECT:
The Effect of Pulse Width on Subjective Memory Impairment and Remission Rate 6 Months After Electroconvulsive Therapy.
The study involved 312 patients with uni- or bipolar depression who received RUL ECT in 2017-18.
Subjective memory was rated with the memory item from the Comprehensive Psychopathological
Rating Scale (CPRS-M) before, and 6 months after, ECT. Patients were dived into 3 groups based on the pulse width ECT they received: <0.5 ms, 0.5 ms, and >0.5ms.
Remission was rated using the Montgomery-Asberg Depression rating Scale-Self Assessment.
The results were:
"The distribution of patients with remission or a minimum of 2-step worsening on the CPRS-M
6 months after completion of ECT showed no significant differences between the 3 pulse width
groups. Older age was associated with a significantly higher rate of remission 6 months after ECT."
This is a clever use of the Swedish National Quality Register for ECT, but even with 312 patients it is underpowered to find a difference, as the authors note. And there was a trend for lower remission rates
with lower pulse widths that did not reach significance. The replication of the finding of higher remission rates with older age (for the umpteenth time) remains interesting.
The overriding question is how much ECT efficacy can/should be sacrificed to avoid the (mostly) transient cognitive effects? This dovetails with the question of how sick does a patient need to be to get ECT. Clearly, the sicker a patient is, the more appropriately they should be offered a more "powerful" form of ECT, placing efficacy above temporary tolerability effects.
Swedish National Quality Register for ECT:
The Effect of Pulse Width on Subjective Memory Impairment and Remission Rate 6 Months After Electroconvulsive Therapy.
J ECT. 2020 May 22. doi: 10.1097/YCT.0000000000000697. Online ahead of print.PMID: 32453190
The pdf is here.The study involved 312 patients with uni- or bipolar depression who received RUL ECT in 2017-18.
Subjective memory was rated with the memory item from the Comprehensive Psychopathological
Rating Scale (CPRS-M) before, and 6 months after, ECT. Patients were dived into 3 groups based on the pulse width ECT they received: <0.5 ms, 0.5 ms, and >0.5ms.
Remission was rated using the Montgomery-Asberg Depression rating Scale-Self Assessment.
The results were:
"The distribution of patients with remission or a minimum of 2-step worsening on the CPRS-M
6 months after completion of ECT showed no significant differences between the 3 pulse width
groups. Older age was associated with a significantly higher rate of remission 6 months after ECT."
This is a clever use of the Swedish National Quality Register for ECT, but even with 312 patients it is underpowered to find a difference, as the authors note. And there was a trend for lower remission rates
with lower pulse widths that did not reach significance. The replication of the finding of higher remission rates with older age (for the umpteenth time) remains interesting.
The overriding question is how much ECT efficacy can/should be sacrificed to avoid the (mostly) transient cognitive effects? This dovetails with the question of how sick does a patient need to be to get ECT. Clearly, the sicker a patient is, the more appropriately they should be offered a more "powerful" form of ECT, placing efficacy above temporary tolerability effects.
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