TY - JOUR
T1 - Electroconvulsive Therapy Pulse Amplitude and Clinical Outcomes
AU - Abbott, Christopher C.
AU - Quinn, Davin
AU - Miller, Jeremy
AU - Ye, Enstin
AU - Iqbal, Sulaiman
AU - Lloyd, Megan
AU - Jones, Thomas R.
AU - Upston, Joel
AU - Deng, Zhi De
AU - Erhardt, Erik
AU - McClintock, Shawn M.
N1 - Funding Information:
BRAIN Initiative (U01 MH111826, PI Abbott), National Institute of Mental Health Intramural Research Program (ZIAMH002955, PI Deng), Brain & Behavioral Research Foundation NARSAD Young Investigator Award (26161, PI Deng), and National Institute of Mental Health (R01 MH119285, PI McClintock) supported this invesgiation.
Publisher Copyright:
© 2020 The Authors
PY - 2021/2
Y1 - 2021/2
N2 - Introduction: Electroconvulsive therapy (ECT) pulse amplitude, which determines the induced electric field magnitude in the brain, is currently set at 800–900 milliamperes (mA) on modern ECT devices without any clinical or scientific rationale. The present study assessed differences in depression and cognitive outcomes for three different pulse amplitudes during an acute ECT series. We hypothesized that the lower amplitudes would maintain the antidepressant efficacy of the standard treatment and reduce the risk of neurocognitive impairment. Methods: This double-blind investigation randomized subjects to three treatment arms: 600, 700, and 800 mA (active comparator). Clinical, cognitive, and imaging assessments were conducted pre-, mid- and post-ECT. Subjects had a diagnosis of major depressive disorder, age range between 50 and 80 years, and met clinical indication for ECT. Results: The 700 and 800 mA arms had improvement in depression outcomes relative to the 600 mA arm. The amplitude groups showed no differences in the primary cognitive outcome variable, the Hopkins Verbal Learning Test-Revised (HVLT-R) retention raw score. However, secondary cognitive outcomes such as the Delis Kaplan Executive Function System Letter and Category Fluency measures demonstrated cognitive impairment in the 800 mA arm. Discussion: The results demonstrated a dissociation of depression (higher amplitudes better) and cognitive (lower amplitudes better) related outcomes. Future work is warranted to elucidate the relationship between amplitude, electric field, neuroplasticity, and clinical outcomes.
AB - Introduction: Electroconvulsive therapy (ECT) pulse amplitude, which determines the induced electric field magnitude in the brain, is currently set at 800–900 milliamperes (mA) on modern ECT devices without any clinical or scientific rationale. The present study assessed differences in depression and cognitive outcomes for three different pulse amplitudes during an acute ECT series. We hypothesized that the lower amplitudes would maintain the antidepressant efficacy of the standard treatment and reduce the risk of neurocognitive impairment. Methods: This double-blind investigation randomized subjects to three treatment arms: 600, 700, and 800 mA (active comparator). Clinical, cognitive, and imaging assessments were conducted pre-, mid- and post-ECT. Subjects had a diagnosis of major depressive disorder, age range between 50 and 80 years, and met clinical indication for ECT. Results: The 700 and 800 mA arms had improvement in depression outcomes relative to the 600 mA arm. The amplitude groups showed no differences in the primary cognitive outcome variable, the Hopkins Verbal Learning Test-Revised (HVLT-R) retention raw score. However, secondary cognitive outcomes such as the Delis Kaplan Executive Function System Letter and Category Fluency measures demonstrated cognitive impairment in the 800 mA arm. Discussion: The results demonstrated a dissociation of depression (higher amplitudes better) and cognitive (lower amplitudes better) related outcomes. Future work is warranted to elucidate the relationship between amplitude, electric field, neuroplasticity, and clinical outcomes.
KW - Electroconvulsive therapy
KW - cognition
KW - depression
KW - pulse amplitude
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U2 - 10.1016/j.jagp.2020.06.008
DO - 10.1016/j.jagp.2020.06.008
M3 - Article
C2 - 32651051
AN - SCOPUS:85087679833
SN - 1064-7481
VL - 29
SP - 166
EP - 178
JO - American Journal of Geriatric Psychiatry
JF - American Journal of Geriatric Psychiatry
IS - 2
ER -