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Cited by 40Electroconvulsive Therapy StudiesTranscranial Magnetic Stimulation StudiesNeurological disorders and treatments

Relapse and long-term cognitive performance after brief pulse or ultrabrief pulse right unilateral electroconvulsive therapy: a multicenter naturalistic follow up

Verwijk, Esmée, Spaans, Harm-Pieter, Comijs, Hannie C., Kho, King H., Sienaert, Pascal, Bouckaert, Filip, Obbels, Jasmien, Scherder, Erik J.A. +2 more·2015·Journal of Affective Disorders
DOI 10.1016/j.jad.2015.05.022
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Abstract

Background Superior cognitive functioning for electroconvulsive therapy (ECT) with right unilateral (RUL) ultrabrief pulse (UBP) stimulation compared to RUL brief pulse (BP) stimulation is not clearly established and long-term data is needed.Methods We conducted a prospective naturalistic follow-up of 87 inpatients from three tertiary psychiatric hospitals. Before these patients entered the follow up phase, they had participated in a RCT comparing twice weekly RUL BP (1.0 ms) with RUL UBP (0.3-0.4 ms) ECT eight times seizure threshold until remission (MADRS < 10), for a maximum of six weeks. Three and six months after the index ECT patients were monitored for relapse and cognitive performance (retrograde amnesia, semantic memory and lexical memory). We compared relapse rate and cognitive performance between RUL BP and RUL UBP stimulation.Results Of the 50 patients who remitted after index ECT 44 (24 BP; 20 UBP) were monitored for follow up. Relapse occurred in 25% of the BP group and in 25% of the UBP group (χ(2) = 0.00, p = 1.0) at three-month follow-up; whereas 43.5% of the BP group and 35% of the UBP group relapsed (χ(2) = 0.322, p = 0.57) at six months follow-up. Cognitive assessments (17 BP; 16 UBP) showed no significant differences between BP and UBP groups, except for an advantage for the BP group in the autobiographical incident questions at three months follow-up only (p = 0.04; d = 0.77).Limitations This study may be limited since relapse in a naturalistic follow-up can be influenced by medication and other unknown factors, like social support, medical comorbidity, and psychotherapy. The small numbers of our subgroups hamper statistical significance.Conclusions Patients that achieved remission after RUL BP or RUL UBP ECT showed similar relapse rates after three and six months. There was no cognitive advantage of UBP over BP ECT in follow up.Clinical trials registration Netherlands trial register www.trialregister.nl registration number NTR1304.

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Crossref · 10.1016/j.jad.2015.05.022

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  • 20 articles define relapse with psychometric measures (Hamilton Depression Rating Scale, Beck Depression Inventory, Montgomery-Asberg Depression Rating Scale, Goldberg Anxiety and Depression Scale, Clinical Global Impression).

    “20 do so with psychometric measures (Hamilton Depression Rating Scale, Beck Depression Inventory, Montgomery-Asberg Depression Rating Scale, Goldberg Anxiety and Depression Scale, Clinical Global Impression) (4, 7, 9, 13–18, 33, 34, 42–49)”

    From Administrative criteria in the relapse of depressive disorder: a critical appraisal (2026) · cites this paper as [16]

  • 40 articles define relapse based on administrative criteria.

    “and 40 define it based on what we will establish as administrative criteria (1, 4, 7, 9, 11–13, 15–29, 33, 34, 38, 39, 42–50, 52–55).”

    From Administrative criteria in the relapse of depressive disorder: a critical appraisal (2026) · cites this paper as [16]

  • The second most used scale is the Montgomery-Asberg Depression Rating Scale (MADRS), with 7 studies establishing the definition of relapse based on it, with varying criteria: 15+, 18+, 21 or 50% increase, and >=22 for 2 consecutive weeks.

    “The second most used scale is the Montgomery-Asberg Depression Rating Scale (MADRS), with 7 studies establishing the definition of relapse based on it, although again the criteria vary; for Verwijk et al. (16) and van Diermen et al. (46) a score of 15 or more would be sufficient, for Durgam et al. (15), 18 or more”

    From Administrative criteria in the relapse of depressive disorder: a critical appraisal (2026) · cites this paper as [16]

  • Necessity of ECT is mentioned 13 times as an administrative criterion.

    “and necessity of ECT 13 times (1, 8, 16, 17, 19, 21, 26, 27, 38, 40, 46, 48, 50, 52).”

    From Administrative criteria in the relapse of depressive disorder: a critical appraisal (2026) · cites this paper as [16]

  • Suicide/suicide attempt is mentioned 19 times as an administrative criterion.

    “Suicide/suicide attempt is mentioned 19 times (1, 15, 16, 18, 19, 26, 27, 33, 37, 38, 41, 43–46, 48–50, 52)”

    From Administrative criteria in the relapse of depressive disorder: a critical appraisal (2026) · cites this paper as [16]

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Authors
Verwijk, E., Spaans, H.-P., Comijs, H. C., Kho, K. H., Sienaert, P., Bouckaert, F., Obbels, J., Scherder, E. J. A., Stek, M. L., & Kok, R. M.
Affiliations
  • Parnassia Groep (NL)
  • Amsterdam Public Health (NL)
  • KU Leuven (BE)
  • Vrije Universiteit Amsterdam (NL)
  • GGZ inGeest (NL)
Corresponding author
Spaans, Harm-Pieter
ORCID
Venue
Journal of Affective Disorders
Publisher
Elsevier BV
Published
2015-09
Volume
184
Pages
137-144
ISSN
0165-0327 (ISSN-L)
DOI
10.1016/j.jad.2015.05.022
OpenAlex
W1483155110
Cited by
40
References
37
Citations by year
2026: 2 · 2025: 3 · 2024: 2 · 2023: 1 · 2021: 3 · 2020: 3 · 2019: 17 · 2018: 4 · 2017: 1 · 2016: 2 · 2015: 2
FWCI
2.44
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of Affective Disorders (publishedVersion)
  • PubMed (publishedVersion)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
  • VU Research Portal (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • Lirias (KU Leuven) (submittedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
  • Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
  • Health Sciences › Medicine › Neurology › Neurological disorders and treatments
Keywords
electroconvulsive therapy, right unilateral ECT, relapse, retrograde amnesia, semantic memory, lexical memory, autobiographical memory, depression remission, seizure threshold
MeSH terms
Adult, Aged, Aged, 80 and over, Cognition, Electroconvulsive Therapy, Female, Follow-Up Studies, Humans, Male, Middle Aged, Netherlands, Prospective Studies, Recurrence, Randomized Controlled Trials as Topic, Treatment Outcome

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