Safety and benefit of five times per week electroconvulsive therapy

Abstract

Objective: The study aimed to test whether there was more rapid response with daily Electroconvulsive Therapy (ECT) (5 times per week right unilateral) and shorter lengths of stay (LOS) without an increase in adverse effects compared to ECT administered in a routine fashion of 2-3 times/week. Methods: This is a retrospective chart review study of inpatient ECT cases performed over a two year period in a general psychiatric unit. Different practitioners used 5 times/week right unilateral (RUL) ECT, 2-3 times/week right unilateral ECT, or bilateral (BL) ECT. All inpatient records of patients, who received inpatient ECT in a general hospital with 80 psychiatric adult beds, were reviewed in the two year study period. Due to a variation in the quality of documentation, the analysis used proxy variables for improvement and side effects of ECT: LOS following the first ECT to discharge, total treatments in the series, and switches in treatment parameters that indicating poor response or adverse effects. Results: 78 patients received inpatient ECT. 35 cases were started with RUL ECT in the standard 3 times/week frequency. 32 cases were started with 5 times/week frequency. 11 cases continued BL ECT placement 3 times per week for a repeat ECT series. Diagnosis was not factor in lead placement or frequency of treatment. 90% of patients had major depression, and 10% were treated for bipolar disorder or schizophrenia. The number of treatments in a successful series was roughly equivalent irrespective of starting lead placement. 5 times/week RUL lead placement did not lead to significant morbidity based on switch rates. The findings show a trend supporting the use of 5 times/ week RUL ECT as a means to shorten the course of ECT without increasing cognitive morbidity.