Ultrabrief Pulsewidth Electroconvulsive Therapy (ECT)

NCT ID: NCT00870805

Last Updated: 2013-02-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

150 participants

Study Classification

INTERVENTIONAL

Study Start Date

2009-01-31

Study Completion Date

2013-01-31

Brief Summary

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Electroconvulsive Therapy (ECT) remains essential to contemporary psychiatric practice and is one of the safest and most effective treatments available for depression. Despite modern advances in pharmacotherapy, about 15-20 per cent of all hospitalised patients receive treatment with ECT. Its use, however, is limited by concerns over associated cognitive side effects.

Recent research has suggested that using an ultrabrief pulsewidth with ECT may greatly reduce cognitive side effects, while maintaining efficacy (Sackeim et al 2008). Preliminary results were positive for unilateral ECT, however, suggest that for bilateral ECT, dosing may need to be adjusted to preserve efficacy while reducing side effects. This study will examine the relative cognitive side effects and efficacy of right unilateral and bilateral ECT given with a standard pulsewidth or an ultrabrief pulsewidth. Some participants will also receive an MRI scan before and after ECT.

Detailed Description

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Conditions

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Major Depressive Disorder

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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bilateral-ultrabrief ECT

Patients will be treated with an ultrabrief (0.3ms) pulse with a bilateral placement at 3-4 times seizure threshold.

Group Type EXPERIMENTAL

bilateral ultrabrief ECT

Intervention Type PROCEDURE

Bilateral ECT at 3-4 times seizure threshold with an ultrabrief pulse (0.3ms)

bilateral standard ECT

Patients will be treated with a standard (1.0ms) pulse with a bilateral placement at 1.5 times seizure threshold.

Group Type ACTIVE_COMPARATOR

bilateral standard ECT

Intervention Type PROCEDURE

Bilateral ECT with at 1.5 times seizure threshold with a standard pulse (1.0ms)

right-unilateral ultrabrief ECT

Patients will be treated with an ultrabrief (0.3ms) pulse with a right unilateral placement at 8 times seizure threshold.

Group Type EXPERIMENTAL

right-unilateral ultrabrief ECT

Intervention Type PROCEDURE

Right-unilateral ECT at 6 times seizure threshold with an ultrabrief pulse (0.3ms)

right-unilateral standard ECT

Patients will be treated with a standard (1.0ms) pulse with a right unilateral placement at 5 times seizure threshold.

Group Type ACTIVE_COMPARATOR

right-unilateral standard ECT

Intervention Type PROCEDURE

Right-unilateral ECT with at 5 times seizure threshold with a standard pulse (1.0ms)

Interventions

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bilateral ultrabrief ECT

Bilateral ECT at 3-4 times seizure threshold with an ultrabrief pulse (0.3ms)

Intervention Type PROCEDURE

bilateral standard ECT

Bilateral ECT with at 1.5 times seizure threshold with a standard pulse (1.0ms)

Intervention Type PROCEDURE

right-unilateral ultrabrief ECT

Right-unilateral ECT at 6 times seizure threshold with an ultrabrief pulse (0.3ms)

Intervention Type PROCEDURE

right-unilateral standard ECT

Right-unilateral ECT with at 5 times seizure threshold with a standard pulse (1.0ms)

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Subjects meet criteria for a DSM-IV-TR Major Depressive Episode
* Total MADRS score \>/= 25
* Age \>/= 18 years
* Educated or working in an English medium setting

Exclusion Criteria

* Diagnosis (as defined by DSM-IV-TR) of any psychotic disorder (lifetime with exception of Major Depressive Episode with psychotic features); rapid cycling bipolar disorder, eating disorder (current or within the past year); obsessive compulsive disorder (lifetime); post-traumatic stress disorder (current or within the past year).
* history of drug or alcohol abuse or dependence (as per DSM-IV-TR) in the last 6 months (except nicotine and caffeine).
* ECT in last 3 months
* Subject requires an urgent clinical response due to inanition, psychosis or high suicide risk
* unable to give informed consent
* score \< 24 on Mini Mental State Examination
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Northside Clinic, Australia

OTHER

Sponsor Role collaborator

The Melbourne Clinic, Australia

UNKNOWN

Sponsor Role collaborator

St George Hospital, Australia

OTHER

Sponsor Role collaborator

Wandene Private Hospital, Australia

UNKNOWN

Sponsor Role collaborator

The University of New South Wales

OTHER

Sponsor Role lead

Responsible Party

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University of New South Wales

Principal Investigators

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Assoc/Prof Colleen K Loo, MBBS, FRANZCP, MD

Role: PRINCIPAL_INVESTIGATOR

University of New South Wales

Prof Isaac Schweitzer, MBBS, FRANZCP, MD

Role: PRINCIPAL_INVESTIGATOR

The Melbourne Clinic

Locations

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St George Hospital

Kogarah, New South Wales, Australia

Site Status

Wandene Private Hospital

Kogarah, New South Wales, Australia

Site Status

The Melbourne Clinic

Melbourne, Victoria, Australia

Site Status

Countries

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Australia

References

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Loo CK, Schweitzer I, Pratt C. Recent advances in optimizing electroconvulsive therapy. Aust N Z J Psychiatry. 2006 Aug;40(8):632-8. doi: 10.1080/j.1440-1614.2006.01862.x.

Reference Type BACKGROUND
PMID: 16866758 (View on PubMed)

Loo C, Sheehan P, Pigot M, Lyndon W. A report on mood and cognitive outcomes with right unilateral ultrabrief pulsewidth (0.3 ms) ECT and retrospective comparison with standard pulsewidth right unilateral ECT. J Affect Disord. 2007 Nov;103(1-3):277-81. doi: 10.1016/j.jad.2007.06.012. Epub 2007 Aug 16.

Reference Type BACKGROUND
PMID: 17706790 (View on PubMed)

Loo CK, Sainsbury K, Sheehan P, Lyndon B. A comparison of RUL ultrabrief pulse (0.3 ms) ECT and standard RUL ECT. Int J Neuropsychopharmacol. 2008 Nov;11(7):883-90. doi: 10.1017/S1461145708009292. Epub 2008 Aug 28.

Reference Type BACKGROUND
PMID: 18752719 (View on PubMed)

Sackeim HA, Prudic J, Nobler MS, Fitzsimons L, Lisanby SH, Payne N, Berman RM, Brakemeier EL, Perera T, Devanand DP. Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. Brain Stimul. 2008 Apr;1(2):71-83. doi: 10.1016/j.brs.2008.03.001.

Reference Type BACKGROUND
PMID: 19756236 (View on PubMed)

Sienaert, P., Vansteelandt, K., Demyttenaere, K., & Peuskens, J. (2006). Comparison of bifrontal and unilateral ultra-brief pulse electroconvulsive therapy for depression. European Neuropsychopharmacology, 16 (suppl 4), S28.

Reference Type BACKGROUND

Martin D, Katalinic N, Hadzi-Pavlovic D, Ingram A, Ingram N, Simpson B, McGoldrick J, Dowling N, Loo C. Cognitive effects of brief and ultrabrief pulse bitemporal electroconvulsive therapy: a randomised controlled proof-of-concept trial. Psychol Med. 2020 May;50(7):1121-1128. doi: 10.1017/S0033291719000989. Epub 2019 May 2.

Reference Type DERIVED
PMID: 31056081 (View on PubMed)

Loo CK, Katalinic N, Smith DJ, Ingram A, Dowling N, Martin D, Addison K, Hadzi-Pavlovic D, Simpson B, Schweitzer I. A randomized controlled trial of brief and ultrabrief pulse right unilateral electroconvulsive therapy. Int J Neuropsychopharmacol. 2014 Dec 5;18(1):pyu045. doi: 10.1093/ijnp/pyu045.

Reference Type DERIVED
PMID: 25522389 (View on PubMed)

Other Identifiers

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UNSW HREC 08322

Identifier Type: -

Identifier Source: org_study_id

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