Am J Psychiatry 1995; 152:564-570
Copyright © 1995 by American Psychiatric Association
Antidepressant and cognitive effects of twice- versus three-times- weekly ECT
B Lerer, B Shapira, A Calev, N Tubi, H Drexler, S Kindler, D Lidsky and JE Schwartz
Department of Psychiatry, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
OBJECTIVE: The purpose of this study was to determine which of the two
commonly used schedules of ECT administration, twice or three times weekly,
is clinically optimal in terms of antidepressant efficacy and cognitive
effects. METHOD: In this double-blind study, 52 consenting, medication-free
patients with major depressive disorder, endogenous subtype (Research
Diagnostic Criteria), were randomly assigned to bilateral, brief-pulse,
constant-current ECT administered over 4 weeks at a rate of three times
weekly or twice weekly with the addition of one simulated ECT (anesthesia
and muscle relaxant only) per week. Outcome measures were the Hamilton
Depression Rating Scale, Acute Cognitive Effects Battery, and Chronic
Cognitive Effects Battery. RESULTS: Hamilton depression scale scores were
significantly improved by both schedules, with no difference in outcome
either 1 week or 1 month after the end of the ECT series. However, the rate
of response to ECT three times a week was significantly faster and was
related to the rate of real ECT administration. Cognitive effects were more
prominent with ECT three times a week. CONCLUSIONS: ECT twice a week is an
effective schedule for clinical practice and is potentially advantageous in
view of a therapeutic outcome identical to that of ECT three times a week
and less severe cognitive effects. ECT three times a week may be
specifically indicated when early onset of clinical effect is of primary
importance.
