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The Efficacy of Ultrabrief-Pulse (0.25 millisecond) Versus Brief-Pulse (0.50 millisecond) Bilateral Electroconvulsive Therapy in Major Depression

Niemantsverdriet, Lotte MSc; Birkenhäger, Tom K. MD, PhD; van den Broek, Walter W. MD, PhD

doi: 10.1097/YCT.0b013e3181da8412
Original Studies

Objectives: Electroconvulsive therapy (ECT) is an effective treatment for patients with major depression but carries the risk of memory impairment. Bilateral ECT with ultrabrief pulses, instead of brief pulses, seems to result in a significant decrease in memory impairment. This study explores whether patients treated with ultrabrief-pulse bilateral ECT achieve a similar treatment effect compared with patients treated with regular brief-pulse bilateral ECT.

Methods: This retrospective study included 65 patients with major depression treated with bilateral ECT, in the period 2002 to 2008. The patients were divided into 2 groups, depending on whether they received a pulse-width treatment of 0.5 (46 patients) or 0.25 millisecond (19 patients). Depressive symptoms were assessed with the 17-item Hamilton Rating Scale for Depression (HAM-D) score. Treatment outcomes were mean decrease in HAM-D score and treatment response rates and remission rates.

Results: The mean decrease in HAM-D score in the 0.25- and 0.50-millisecond groups was 20.1 (SD, 8.9) and 19.3 (SD, 9.2), respectively (difference not significant); response rates were 73.6% and 75.6%, and final remission rates were 42.1% and 45.6%, respectively. Thus, the decreases in HAM-D score and the response and remission rates were very similar in both groups.

Conclusions: In this study population, the use of ultrabrief-pulse (0.25 millisecond) bilateral ECT resulted in equivalent treatment outcome and efficacy compared with bilateral ECT with a brief pulse (0.50 millisecond).

From the Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands.

Received for publication August 18, 2009; accepted February 16, 2010.

Reprints: Tom K. Birkenhäger, MD, PhD, Department of Psychiatry, Erasmus Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands (e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.