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Efficacy of Right Unilateral Ultrabrief Pulse Width ECT: A Preliminary Report

Magid, Michelle MD*; Truong, Liz MD; Trevino, Kenneth PhD; Husain, Mustafa MD‡§

doi: 10.1097/YCT.0000000000000080
Original Studies

Background and Objectives Ultrabrief (right unilateral) electroconvulsive therapy (UB-RU ECT) is a newer form of ECT, which uses a shorter pulse width than the standard ECT (0.3 vs 1.0 millisecond, respectively). As a result, the use of UB ECT may provide a means of further decreasing ECT-related cognitive adverse effects. In 2011, the University of Texas Southwestern Department of ECT in Austin adopted a UB ECT protocol. The purpose of this study was to perform a preliminary evaluation of the effectiveness and efficiency of UB-RU ECT. This study also examined whether sex, age, or diagnosis affected response rates.

Methods This retrospective chart review identified 62 patients treated with the UB ECT protocol. An analysis of ECT response rates and demographic characteristics was conducted based on the data from clinical evaluations and Patient Health Questionnaire 9.

Results Sixty-eight percent of patients in the study responded to ECT; 55% responded to UB pulse width RU ECT with another 13% responding when switched to standard pulse width bilateral ECT. The mean number of treatments in an index ECT series was 12.5. There was no statistically significant difference in response rates between bipolar and unipolar depressed patients. Men required progression to bilateral treatment more than women.

Conclusions This UB ECT protocol demonstrated a similar response rate when compared to standard ECT protocols; however, an increase in the number of treatments was required. Ultrabrief protocols are a viable option for both bipolar and unipolar depression. In men, UB ECT protocols may be less advantageous due to a need to overcome a potentially higher seizure threshold in men; however, additional research is needed to confirm this finding.

From the *Department of Psychiatry, University of Texas Southwestern at Seton Family of Hospitals, Austin; †University of Texas Health Science Center at Houston, Houston; ‡Neurostimulation Research Lab, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas; and §Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina.

Received for publication November 27, 2012; accepted August 15, 2013.

Reprints: Michelle Magid, MD, Department of Psychiatry, University of Texas Southwestern at Seton Family of Hospitals, 3501 Mills Avenue, Austin Texas, 78731 (e-mail: michellemagid@austinpsychcare.com; michellemagidmd@gmail.com).

Dr Michelle Magid has received research grant support/funding from the Brain and Behavior Research Grant. Dr Liz Truong has no potential conflicts of interest to disclose. Dr Kenneth Trevino has received research grant support funding from the NIMH (T-32 Fellowship). Dr Mustafa Husain has received research grant support/funding from the NIH/NIMH, NIDA, NINDS, NIA, NARSD, Stanley Foundation, Cyberonics, Neuronetics (previous), St Jude Medical (ANS), MagStim (equipment only), Brainsway, NeoSync, and Alkmers.

Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.ectjournal.com).

© 2013 by Lippincott Williams & Wilkins