Switching ECT Technique: New Editorial in Acta Psychiatrica Scandinavica

Out on PubMed from ECT experts Pascal Sienaert and Declan McLoughlin, is this editorial:

Changing tactics: Does switching improve electroconvulsive therapy outcomes?

Sienaert P, McLoughlin DM.Acta Psychiatr Scand. 2023 Apr;147(4):319-321. doi: 10.1111/acps.13540.PMID: 36945826

The editorial is here.

And here:

This is a thoughtful and important editorial. Like many such pieces, it asks more questions than it answers. We certainly are eager to have the results of the RUL-to-BL switching trial that is described in reference #13, to answer some of them.
But let's back up a bit and ask 30,000 ft questions. Do we really believe that RUL ECT is as "strong," "effective," "powerful," "non-inferior," "as good as" BL ECT? One interpretation of some of the evidence base suggests so, but this is discordant with decades of clinical experience and the widespread practice of switching to BL electrode placement for non-, or slow, response. And what about clinical severity/urgency? My 2001 editorial (referenced in this editorial) was widely misinterpreted as advocating one type of treatment (including identical anesthesia doses!) for all. In fact, I advocated one kind of treatment (with emphasis on efficacy, not tolerability issues) for most, not all, patients; I have always argued that decisions about ECT technique should be based on severity/urgency of illness, with sicker patients preferentially starting with BL electrode placement. And by "sicker" I mean probably about 30-40% of patients seen in a typical ECT clinic.
Even if "most" patients should get RUL ECT, certainly "some", the most urgently ill, still should still get BL ECT, no?


Comments

  1. ECT BloggerMarch 30, 2023 at 9:13 AM

    The below comment is from Dr. Max Fink:

    RUL vs BT assessments were reported in 1957, 1973, 1990s (by CORE) etc, etc. BT is more effective than RUL, averaging 85-90% compared to 65%. Instead of such repeated studies using electricity stimuli, flurothyl inhalant stimulation offers equal EEG, seizure duration, lower cognitive effects to BT. Flurothyl inhalant seizures warrant trials rather than repeated BT vs RUL over 70 years. Flurothyl inductions warrant retrial.

    Max Fink, M.D.

    ReplyDelete

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