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Project

Changing Tactics? Optimizing ECT in difficult-to-treat depression

Electroconvulsive therapy (ECT) is an evidence-based treatment for difficult to treat, severe and sometimes life-threatening depressive episodes. It involves passing an electrical charge through the brain, via electrodes that are placed either on one side of the head (right unilateral RUL) or on both sides (bitemporal, BT), to induce a generalized seizure, under brief anesthesia. Usually, a mean number of 8 to12 treatment sessions are administered in an individual treatment course. Although results are conflicting, RUL ECT has been shown to be less effective than BT ECT, and induces fewer cognitive side-effects, whereas BT ECT is considered to have a faster antidepressant effect, but bears/entails a higher risk of cognitive side-effects. In patients showing response, improvement is mostly witnessed early in the treatment course, i.e. in the first 4 to 6 treatments. In non-responders, it is common practice to switch from RUL to BT electrode placement. However, no randomized controlled trial (RCT) data are available to support this ubiquitous clinical practice. We designed an RCT to address which treatment strategy (continue RUL ECT of switch to BT) speeds up recovery and has the least impact on memory function. The answerable clinical question can be structured as follows: - Patient: Patients treated with ECT for depression, showing no 'response' (≥50% decrease in depressive symptom severity compared to baseline) after 4 treatment sessions; - Intervention: Switch to BT ECT; - Comparison: Continue with RUL ECT; - Outcome: Depressive symptom severity and autobiographical memory (co-primary outcomes) after 8 treatment sessions. This project addresses the clinical question ECT-practitioners are faced with in daily clinical practice, and for which there is no consistent empirical evidence available. Being the first-ever RCT on the switch from RUL ECT to BT ECT, this project will have an important impact on the clinical practice, guiding clinical decision making.
Date:1 Oct 2022 →  Today
Keywords:ANTIDEPRESSANT THERAPIES, DEPRESSION, THERAPY
Disciplines:Biological psychiatry
Project type:Collaboration project