The Relative Efficacy and Side-Effect Profile of Ultrabrief Pulse and Brief Pulse ECT: A Systematic Review of Recent Literature.

Abstract

Objective: Electroconvulsive therapy (ECT) is an interventional psychiatric technique used primarily to address treatment resistant psychiatric disorders. There are many different stimulus electrode placements and pulse widths utilized in the administration of this therapy, but it is presently unclear which is optimal. The aim of this study is to assess the relative efficacy and side-effect profile of ultrabrief pulse width ECT (UBP ECT) and brief-pulse width ECT (BP ECT) in the treatment of major depressive disorders.

Method: A systematic review of the literature was performed. Studies were identified from PubMed, MEDLINE and PsycINFO between January 2013 to October 2023. The final search terms included ECT, depression, brief pulse, and ultrabrief pulse.

Results: The search initially included 64 studies. Forty-three of these studies were not duplicates, after applying exclusion criteria 11 studies were included. UBP ECT was found to have fewer cognitive side effects than BP ECT. Additionally, patients undergoing BP ECT were found to discontinue treatment more frequently due to inability to tolerate side effects. Despite this, BP ECT may have higher rates of symptom remission than UBP ECT. Further studies should be done to clarify the outcomes of each technique.

Conclusions: The current evidence slightly favors UBP ECT due to its beneficial side effect profile compared to BP ECT while it has a similar efficacy. However, there is insubstantial evidence in the current body of literature. Additional studies are required to determine which of these techniques is safer and more efficacious in the treatment of major depressive disorders.

Study design: Systematic review.