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Original Research

Efficacy and Cognitive Side Effects After Brief Pulse and Ultrabrief Pulse Right Unilateral Electroconvulsive Therapy for Major Depression: A Randomized, Double-Blind, Controlled Study

Harm-Pieter Spaans, MD; Esmée Verwijk, MSc; Hannie C. Comijs, PhD; Rob M. Kok, MD, PhD; Pascal Sienaert, MD, PhD; Filip Bouckaert, MD; Katrien Fannes, MSc; Koen Vandepoel, MSc; Erik J. A. Scherder, PhD; Max L. Stek, MD, PhD; and King H. Kho, MD, PhD

Published: November 15, 2013

Article Abstract

Objective: To compare the efficacy and cognitive side effects of high-dose unilateral brief pulse electroconvulsive therapy (ECT) with those of high-dose unilateral ultrabrief pulse ECT in the treatment of major depression.

Method: From April 2007 until March 2011, we conducted a prospective, double-blind, randomized multicenter trial in 3 tertiary psychiatric hospitals. All patients with a depressive disorder according to DSM-IV criteria were eligible. Depression severity was assessed with the Montgomery-Asberg Depression Rating Scale; primary efficacy outcomes were response, defined as a score decrease ≥ 60% from baseline, and remission, defined as a score < 10 at 2 consecutive weekly assessments. Total scores on the Autobiographical Memory Interview and Amsterdam Media Questionnaire were the primary outcome measures for retrograde amnesia. Other cognitive domains included category fluency (semantic memory) and letter fluency (lexical memory). Patients received twice-weekly unilateral brief pulse (1.0 millisecond) or ultrabrief pulse (0.3-0.4 millisecond) ECT 8 times seizure threshold until remission, for a maximum of 6 weeks.

Results: Of the 116 patients, 75% (n = 87) completed the study. Among completers, 68.4% (26/58) of those in the brief pulse group achieved remission versus 49.0% (24/49) of those in the ultrabrief pulse group (P = .019), and the brief pulse group needed fewer treatment sessions to achieve remission: mean (SD) of 7.1 (2.6) versus 9.2 (2.3) sessions (P = .008). No significant group differences were found in the evaluation of the cognitive assessments.

Conclusions: The efficacy and speed of remission seen with high-dose brief pulse right unilateral ECT twice weekly were superior to those seen with high-dose ultrabrief pulse right unilateral ECT, with equal cognitive side effects as defined by retrograde amnesia, semantic memory, and lexical memory.

Trial Registration: Netherlands National Trial Register number: NTR1304

J Clin Psychiatry 2013;74(11):e1029-e1036

Submitted: April 16, 2013; accepted July 3, 2013 (doi:10.4088/JCP.13m08538).

Corresponding author: Esmée Verwijk, MSc, Parnassia Psychiatric Institute, the Hague, Clinical Center for the Elderly-ECT Department, Mangostraat 1, 2552 KS, The Hague, The Netherlands (

Volume: 74

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