Efficacy of ultrabrief pulse electroconvulsive therapy for depression: A systematic review

Abstract Background Ultrabrief pulse electroconvulsive therapy (ECT) is increasingly used in daily practice when treating depression despite doubts about its efficacy compared to standard techniques. Method Using electronic search techniques, we collected all studies on the comparison between ultrab...

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Bibliographic Details
Published in:Journal of affective disorders 2013-09, Vol.150 (3), p.720-726
Main Authors: Spaans, Harm-Pieter, H. Kho, King, Verwijk, Esmée, Kok, Rob M, Stek, Max L
Format: Article
Language:English
Subjects:
Adult
Adult and adolescent clinical studies
Affective disorders
Bilateral
Biological and medical sciences
Brief pulse
Depression
Depression - psychology
Depression - therapy
Depressive Disorder - psychology
Depressive Disorder - therapy
Depressive Disorder, Major - psychology
Depressive Disorder, Major - therapy
Efficacy
Electroconvulsive therapy
Electroconvulsive Therapy - adverse effects
Electroconvulsive Therapy - methods
Heterogeneity
Humans
Medical sciences
Mood disorders
Prospective studies
Psychiatry
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Randomized Controlled Trials as Topic
Remission
Systematic review
Treatment Outcome
Treatments
Unilateral
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Summary:Abstract Background Ultrabrief pulse electroconvulsive therapy (ECT) is increasingly used in daily practice when treating depression despite doubts about its efficacy compared to standard techniques. Method Using electronic search techniques, we collected all studies on the comparison between ultrabrief pulse (UBP) versus brief pulse (BP) ECT in depressed patients which reported validated rating scales as outcome measures. The Jadad scale was used to evaluate the quality of the studies. Results Two randomized and one non-randomized prospective study using unilateral (UL) ECT, and two randomized and one retrospective study using bilateral (BL) ECT were identified comparing UBP with BP ECT. One UL randomized high quality study and one non-randomized study suggest an equal response and remission for both conditions. The number of treatment sessions to achieve remission using UBP is equal in one study and is higher in the second. Both BL studies, one of high quality, point to a lower efficacy for UBP ECT with a lower speed of remission. Limitations We restricted our review to the efficacy of UBP vs. BP ECT in depressed patients and did not address other clinically important issues such as the cognitive adverse effects. A statistical meta-analysis was not possible, because of the heterogeneity of outcome measures and the small amount of studies. Conclusion The literature shows no clear advantage for the efficacy of ultrabrief pulse over brief pulse ECT using unilateral as well as bilateral electrode placement. The increasing use of unilateral brief pulse ECT as first line method for depression is not supported by the current evidence.
ISSN:0165-0327
1573-2517
DOI:10.1016/j.jad.2013.05.072