Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-25T11:11:20.520Z Has data issue: false hasContentIssue false
  • English
  • Français

Cost and benefit in the choice of ECT schedule

Twice versus three times weekly ECT

Published online by Cambridge University Press:  03 January 2018

Baruch Shapira ,
Nurith Tubi ,
Heinz Drexler ,
David Lidsky ,
Avraham Calev  and
Bernard Lerer
Baruch Shapira
Affiliation:
Depression Treatment Unit, Herzog Hospital, and Department of Psychiatry, Hebrew University–Hadassah Medical School, Jerusalem
Nurith Tubi
Affiliation:
Depression Treatment Unit, Herzog Hospital Jerusalem
Heinz Drexler
Affiliation:
Depression Treatment Unit, Herzog Hospital Jerusalem
David Lidsky
Affiliation:
Depression Treatment Unit, Herzog Hospital Jerusalem
Avraham Calev
Affiliation:
Depression Treatment Unit, Herzog Hospital Jerusalem
Bernard Lerer*
Affiliation:
Biological Psychiatry Laboratory, Hadassah–Hebrew University Medical Center, and Department of Psychiatry, Hebrew University–Hadassah Medical School, Jerusalem
*
Professor Bernard Lerer, Biological Psychiatry Laboratory, Department of Psychiatry, Hadassah – Hebrew University Medical Center, Kiryat Hadassah, PO Box 12000, Jerusalem 91120, Israel. Fax: 972-2-434434; e-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

We compared the anti-depressant and cognitive effects of up to eight sessions of bilateral, brief pulse electroconvulsive therapy (ECT) administered twice (ECT x 2) or three times weekly (ECT x 3), to confirm that ECT x 3 acts more rapidly although the two schedules are equivalent in antidepressant outcome, and to establish whether ECT x 3 is indeed associated with more severe memory impairment.

Method

Patients with major depression, endogenous subtype were randomly assigned to ECT x 3 or ECT x 2 plus one simulated ECT per week, both up to a maximum of eight real ECT. Depression was evaluated by the Hamilton Depression Scale the day after each treatment and cognitive function by a test battery administered before and after the ECT series and at one month follow-up.

Results

Assessed categorically or parametrically, there was no significant difference in antidepressant outcome between the two schedules. Rate of response was significantly more rapid with ECT x 3 but was associated with more severe memory impairment.

Conclusions

Twice weekly administration is an optimum schedule for bilateral ECT unless clinical indications require the more rapid antidepressant effect of three times weekly treatment.

Type
Papers
Information
The British Journal of Psychiatry , Volume 172 , Issue 1 , January 1998 , pp. 44 - 48
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alan, S. (1979) Intelligence Testing with the WISC–R. New York: Wiley.Google Scholar
American Psychiatric Association (1990) The Practise of Electroconvulsive Therapy: Recommendations for Treatment, Training and Privileging. Washington, DC: APA.Google Scholar
Calev, A., Nigal, D., Shapira, B., et al (1991) Early and long-term effects of electroconvulsive therapy and depression on memory and other cognitive functions. Journal of Nervous and Mental Disease, 179, 526–533.Google Scholar
Calev, A., Pass, H. L., Shapira, B., et al (1993) ECT and memory. In The Clinical Science of Electroconvulsive Therapy (ed. Coffey, C. E.), pp. 125–142. Washington, DC: American Psychiatric Press.Google Scholar
Folstein, M. F., Folstein, S. R. & McHugh, P. R. (1975) “Mini-Mental State”: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.Google Scholar
Gangadhar, B. M., Janakiramaiah, N., Subbakrishna, D. K., et al (1993) Twice versus thrice weekly ECT in melancholia: a double-blind prospective comparison. Journal of Affective Disorders, 27, 273–278.Google Scholar
Guy, W. (1976) ECDEU Assessment Manual for Psychopharmacology, pp. 217–222. Rockville, MD: NIMH.Google Scholar
Kallner, C. H., Russell, R., Monroe, J. R., et al (1992) Weekly ECT in geriatric depression. Convulsive Therapy, 8, 245–252.Google Scholar
Koppitz, E. M. (1963) The Bender Gestalt Test for Young Children, Vol 1. New York: Psychological Corporation.Google Scholar
Lerer, B., Shapira, B., Calev, A., et al (1995) Antidepressant and cognitive effects of twice versus three times weekly ECT. American Journal of Psychiatry, 152, 564–570.Google Scholar
McAllister, D. A., Perri, M. G., Jordan, R. C., et al (1987) Effects of ECT given two versus three times weekly. Psychiatry Research, 21, 63–69.Google Scholar
Psychological Corporation (1981) Wechsler Adult Intelligence Scale–Revised. New York: Harcourt Brace Jovanovich.Google Scholar
Segman, R. H., Shapira, B., Gorfine, M., et al (1995) Onset and time course of antidepressant action: Psychopharmacological implications of a controlled trial of electroconvulsive therapy. Psychopharmacology, 119, 440–448.Google Scholar
Shapira, B., Lidsky, D., Gordine, M., et al (1996) Electroconvulsive therapy and resistant depression: Clinical implications of seizure threshold. Journal of Clinical Psychiatry, 57, 32–38.Google Scholar
Spitzer, R. L., Endicott, J. & Robins, E. (1989) Research Diagnostic Criteria for a Selected Group of Functional Disorders. New York: New York Psychiatric Institute.Google Scholar
Squire, L. R. (1982) Neuropsychological effects of ECT. In Electroconvulsive Therapy: Biological Foundations and Clinical Applications (eds Abrams, R. & Essman, W. B.), pp. 169–186. New York: Spectrum Publications.Google Scholar
Squire, L. R., Slater, P. C. & Miller, P. L. (1975) Retrograde amnesia and bilateral electroconvulsive therapy. Archives of General Psychiatry, 38, 89–95.Google Scholar
Squire, L. R., & Slater, P. C. (1978) Bilateral and unilateral ECT: effects on verbal and nonverbal memory. American Journal of Psychiatry, 11, 1316–1320.Google Scholar
Squire, L. R., Slater, P. C. & Miller, P. L. (1981) Retrograde amnesia and bilateral electroconvulsive therapy. Long term follow-up. Archives of General Psychiatry, 38, 89–95.Google Scholar
Stromgren, L. S. (1975) Therapeutic results in brief-interval unilateral ECT. Acta Psychiatrica Scandinavica, 52, 246–255.Google Scholar
Stromgren, L. S., Christensen, A. L. & Fromholt, P. (1976) The effects of unilateral brief interval ECT on memory. Acta Psychiatrica Scandinavica, 336–346.Google Scholar
Weiner, R. D., Rogers, H. J., Davidson, J. R. T., et al (1986) Effects of stimulus parameters on cognitive side effects. Annals of the New York Academy of Sciences, 462, 315–325.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.