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Rate of continuing acute course treatment using right unilateral ultrabrief pulse electroconvulsive therapy at a large academic medical center

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Abstract

Right unilateral ultrabrief pulse (RUL-UBP) ECT has emerged as a promising technique for minimizing cognitive side effects of ECT while retaining clinical efficacy, but it is unknown how often patients will require alternative treatment parameters and at what point in the treatment course this occurs. To better define this problem, this study analyzes continuation in RUL-UBP ECT in a retrospective cohort of patients beginning acute course treatment. A single-center retrospective chart review was conducted of adult patients receiving a first lifetime course of ECT from 2010 to 2017 starting with RUL-UBP treatment parameters. 1793 patients met study criteria. Patients received a mean of 10.0 ± 3.2 ECT treatments, of which a mean of 8.4 ± 3.4 were RUL-UBP treatments; proportion using RUL-UBP through 12 treatments was 57.8%. In total, 65.6% of patients were treated with RUL-UPB ECT exclusively. Mean dose increased from 7.6 × seizure threshold at the second RUL-UBP treatment to 14.3 × seizure threshold at the twelfth RUL-UBP treatment. Rates of continuation in RUL-UBP ECT did not differ based on age or on primary diagnosis of major depression vs. bipolar disorder. Among patients beginning acute-course treatment using RUL-UPB ECT, two thirds were treated with these parameters exclusively. Among patients who received twelve RUL-UBP treatments, mean final dose was 14.3 × seizure threshold. Further studies regarding optimal dosing of RUL-UBP ECT are indicated.

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Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Funding

This work was supported by the National Institute of Mental Health (R25MH094612, JL; R56MH115187 and R01MH120991, THM; 5R01MH112737-03, MEH), the National Institute on Aging (5R01AG061100-02; BPF), and the Brain and Behavior Research Foundation (NARSAD 26489; THM). The sponsors had no role in study design, writing of the report, or data collection, analysis, or interpretation.

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Authors and Affiliations

  1. Department of Psychiatry, Massachusetts General Hospital, 32 Fruit Street, Yawkey 6A, Boston, MA, 02114, USA

    James Luccarelli, Thomas H. McCoy Jr, Alec P. Shannon & Michael E. Henry

  2. Department of Psychiatry, McLean Hospital, Belmont, MA, USA

    James Luccarelli & Stephen J. Seiner

  3. Division of Geriatric Psychiatry, McLean Hospital, Belmont, USA

    Brent P. Forester

  4. Harvard Medical School, Boston, MA, USA

    James Luccarelli, Thomas H. McCoy Jr, Brent P. Forester, Stephen J. Seiner & Michael E. Henry

Authors
  1. James Luccarelli
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  2. Thomas H. McCoy Jr
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  3. Alec P. Shannon
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  4. Brent P. Forester
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  5. Stephen J. Seiner
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  6. Michael E. Henry
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Correspondence to James Luccarelli.

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Conflict of interest

THM receives research funding from the Stanley Center at the Broad Institute, the Brain and Behavior Research Foundation, National Institute of Mental Health, National Human Genome Research Institute Home, and Telefonica Alfa. Dr. Forester receives research support from the National Institute on Aging, Biogen, Lilly, the Rogers Family Foundation, and the Spier Family Foundation. He reports consulting for Biogen. The remaining authors have no disclosures to report.

Ethical approval

This study was approved by the Partners Healthcare Institutional Review Board.

Electronic supplementary material

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406_2020_1202_MOESM1_ESM.docx

Figure S1: Histogram of RUL-UBP charges applied during acute course treatment. Of the 15,118 RUL-UBP treatments, 12,018 (79.5%) used one of four doses: 19.2 mC (generally for treatment #1), 115.2 mC, 230.4 mC, and 345.6 mC (DOCX 36 kb)

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Luccarelli, J., McCoy, T.H., Shannon, A.P. et al. Rate of continuing acute course treatment using right unilateral ultrabrief pulse electroconvulsive therapy at a large academic medical center. Eur Arch Psychiatry Clin Neurosci 271, 191–197 (2021). https://doi.org/10.1007/s00406-020-01202-2

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  • DOI: https://doi.org/10.1007/s00406-020-01202-2

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