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Electroconvulsive Therapy For Depression With Less Cognitive Side Effects?

Last updated July 21, 2015

Approved by: Maulik P. Purohit MD, MPH

Photo by Sander van der Wel

ECT is often employed as a last resort in patients whose medication fails to improve their depression. Electroconvulsive therapy involves the application of brief electrical pulses on the scalp of the patient under anesthesia.

Electroconvulsive therapy (ECT) has been considered to be one of the gold standards of treatment for individuals with severe depression; however, this technique has been known to result in several cognitive side effects. Researchers at the University of New South Wales have identified the effectiveness of a new treatment method, ultra-brief pulse stimulation, for severe depression with less cognitive side effects than the standard ECT.

ECT is often employed as a last resort in patients whose medication fails to improve their depression.   Electroconvulsive therapy involves the application of brief electrical pulses on the scalp of the patient under anesthesia. The pulse generated stimulates the brain cells to fire in unison, generating a seizure. The procedure is theorized to alter the chemical messengers in the brain, known as neurotransmitters, which can reverse the symptoms of certain mental illnesses such as severe depression. However, ECT has been criticized for its common side effects such as memory loss and confusion.

The Australian researchers have found ultra-brief pulse stimulation, which is less intense than ECT, to be as effective as ECT, but with significantly fewer side effects. Ultra-brief pulse right unilateral electroconvulsive therapy (UBP RUL ECT), which is another name for ultra-brief pulse stimulation, sends sudden pulses of electricity to the brain in 1/3 of the delivery time of the standard ECT and about 1/3 to ½ of the electrical dose. According to Dr. Colleen Loo, a professor of psychiatry at the University of New South Wales, the treatment targets a narrower area of the brain, therefore making the stimulation more focal.

This more recent procedure was developed due to concerns of negative cognitive side effects (e.g. cognitive impairment) arising from the standard ECT. The study discussed here was designed to evaluate the effectiveness and safety of both methods by evaluating 6 existing studies, amounting to 689 patients. It was found that:

  • Standard ECT was slightly more effective in the treatment of depression compared to ultra brief pulse stimulation, but caused more cognitive side effects, in all areas observed, such as difficulty in memory recall and learning new information post procedure.
  • Standard ECT required less consecutive treatment than ultra brief pulse stimulation.

Dr. Loo and fellow researchers suggest that treatment decisions “should be made on an individual patient basis and should be based on a careful weighing of the relative priorities of efficacy versus minimization of cognitive impairment.”

A 2003 study in London, England revealed that between 29% and 55% of standard ECT patients believed that they experienced long-term or even permanent memory impairment. The findings of this study signify the growing need for new, less damaging treatment methods for the numerous individuals who suffer from severe depression for cases in which all medications fail to improve symptoms.

Primary Reference: 

Tor, P. C., Bautovich, A., Wang, M. J., Martin, D., Harvey, S. B., & Loo, C. (2015). A systematic review and meta-analysis of brief vs ultrabrief right unilateral electroconvulsive therapy for depression. Brain Stimulation, 2(8), 310.

DoveMed Resources: 

Major Depression. Retrieved from http://www.dovemed.com/diseases-conditions/major-depression/

Additional References:  

Electroconvulsive Therapy Program. Retrieved from http://www.psych.med.umich.edu/ect/how-does-ect-work.asp

Electroconvulsive Therapy (ECT). Retrieved from http://www.mayoclinic.org/tests-procedures/electroconvulsive-therapy/basics/definition/prc-20014161

MacQueen, G., Parkin, C., Marriott, M., Bégin, H., & Hasey, G. (2007). The long-term impact of treatment with electroconvulsive therapy on discrete memory systems in patients with bipolar disorder. Journal of psychiatry & neuroscience, 32(4), 241.

Rose, D., Fleischmann, P., Wykes, T., Leese, M., & Bindman, J. (2003). Patients' perspectives on electroconvulsive therapy: systematic review. Bmj, 326(7403), 1363.

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: July 21, 2015
Last updated: July 21, 2015