Cognitive effects of brief and ultrabrief pulse bitemporal electroconvulsive therapy: a randomised controlled proof-of-concept trial
Open accessAbstract
Background: Reduction of the pulse width has been reported to improve ECT outcomes with unilateral ECT (similar efficacy, fewer cognitive side effects), but has been minimally studied for bitemporal ECT. The only study comparing brief and ultrabrief pulse bitemporal ECT found reduced efficacy for bitemporal ultrabrief compared to bitemporal brief pulse stimulation. This randomised controlled trial (RCT) aimed to test if ultrabrief pulse bitemporal ECT results in fewer cognitive side effects than brief pulse bitemporal ECT, when given at doses adjusted with the aim of achieving comparable efficacy. Methods: Thirty-six participants were randomly assigned to receive ultrabrief (at 3 times seizure threshold) or brief (at 1.5 times seizure threshold) pulse bitemporal ECT given 3 times a week in a double-blind, controlled proof-of-concept trial. Blinded raters assessed mood and cognitive functioning over the ECT course. Results: Efficacy and cognitive outcomes did not differ significantly between the two treatment groups over the ECT course. The ultrabrief pulse group performed better on a test of visual memory assessed acutely after an ECT treatment. Conclusions: This study suggests there may be a small cognitive advantage in giving bitemporal ECT with an ultrabrief pulse when dosage is increased to match the efficacy of brief pulse bitemporal ECT, but the study was underpowered to fully examine this issue. Clinical Trials Registration: www.clinicaltrials.gov, NCT00870805.
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This study's findings of adverse cognitive effects after ECT matched other studies using similar neurocognitive measures, which found effects in complex visual scanning, cognitive flexibility, attention, and verbal learning and memory.
“Our study findings of adverse cognitive effects after ECT were in line with other studies that have used similar neurocognitive measures (e.g., Trail Making Test, Hopkins Verbal Learning Test-Revised) and found adverse effects for cognitive domains such as complex visual scanning and cognitive flexibility, attention, and verbal learning and memory.[48][49][50]”
From Magnetic seizure therapy is efficacious and well tolerated for treatment-resistant bipolar depression: An open-label clinical trial (2020) · cites this paper as [49]
The neuropsychological-outcomes passage (Discussion; page unavailable) lists the Hopkins Verbal Learning Test and other cognitive measures, so the paper is an example of a study using a similar measure. It does not list the Trail Making Test. The Cognitive outcomes section (page unavailable) reports an acute difference in face recognition between ECT conditions, but does not establish adverse effects across the claimed domains of complex visual scanning, cognitive flexibility, attention, and verbal learning and memory. (LLM, conf=0.84)
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Cites
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975) · Journal of Psychiatric Research · doi:10.1016/0022-3956(75)90026-6 · Cited by 88,282 · see citing works
A Simple Sequentially Rejective Multiple Test Procedure
(1979) · Scandinavian Journal of Statistics · doi:10.2307/4615733 · Cited by 21,526 · see citing works
(1998) · The Journal of Clinical Psychiatry · Cited by 19,139 · see citing works
A new depression scale designed to be sensitive to change
Montgomery, S. A., & Åsberg, M. (1979) · British Journal of Psychiatry · doi:10.1192/bjp.134.4.382 · Cited by 13,962 · see citing works
A compendium of neuropsychological tests: administration, norms, and commentary
(1991) · Choice Reviews Online · doi:10.5860/choice.29-2400 · Cited by 6,117 · see citing works
A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary
Levin, H. S. (1993) · Archives of Neurology · doi:10.1001/archneur.1993.00540050007005 · Cited by 4,793 · see citing works
L’examen Clinique en Psychologie
Rubé, P. (1959) · American Journal of Psychotherapy · doi:10.1176/appi.psychotherapy.1959.13.4.989 · Cited by 3,299 · see citing works
Benedict, R. H. B., Schretlen, D., Groninger, L., & Brandt, J. (1998) · The Clinical Neuropsychologist · doi:10.1076/clin.12.1.43.1726 · Cited by 1,597 · see citing works
Woodcock-Johnson Psycho-Educational Battery-Revised
Leighton, C. R. (1990) · PsycEXTRA Dataset · doi:10.1037/e500812010-005 · Cited by 1,315 · see citing works
Smith, A. (1973) · PsycTESTS Dataset · doi:10.1037/t27513-000 · Cited by 1,314 · see citing works
Sackeim, H. A., Prudic, J., Nobler, M. S., Fitzsimons, L., Lisanby, S. H., Payne, N., Berman, R. M., Brakemeier, E.-L., Perera, T., & Devanand, D. P. (2008) · Brain Stimulation · doi:10.1016/j.brs.2008.03.001 · Cited by 542 · see citing works
ECT Remission Rates in Psychotic Versus Nonpsychotic Depressed Patients: A Report from CORE
Petrides, G., Fink, M., Husain, M. M., Knapp, R. G., Rush, A. J., Mueller, M., Rummans, T. A., O’Connor, K. M., Rasmussen, K. G., Bernstein, H. J., et al. (2001) · Journal of Ect · doi:10.1097/00124509-200112000-00003 · Cited by 493 · see citing works
Attention-deficit/hyperactivity disorder: a life-span perspective.
Biederman, J. (1998) · PubMed · Cited by 361 · see citing works
Predictors of retrograde amnesia following ECT
Sobin, C. A., Sackeïm, H. A., Prudic, J., Devanand, D. P., Moody, B. J., & McElhiney, M. C. (1995) · American Journal of Psychiatry · doi:10.1176/ajp.152.7.995 · Cited by 287 · see citing works
Tor, P.-C., Bautovich, A., Wang, M.-J., Martin, D., Harvey, S. B., & Loo, C. (2015) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.14r09145 · Cited by 230 · see citing works
Self-citationKreutzer, J. S., DeLuca, J., & Caplan, B. (2010) · Springer eBooks · doi:10.1007/978-0-387-79948-3_6121 · Cited by 168 · see citing works
A comparison of RUL ultrabrief pulse (0.3 ms) ECT and standard RUL ECT
Loo, C. K., Sainsbury, K., Sheehan, P., & Lyndon, B. (2008) · The International Journal of Neuropsychopharmacology · doi:10.1017/s1461145708009292 · Cited by 127 · see citing works
Self-citationFekadu, A., Wooderson, S. C., Markopoulou, K., & Cleare, A. J. (2009) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.08m04728 · Cited by 125 · see citing works
Sienaert, P. A., Vansteelandt, K., Demyttenaere, K., & Peuskens, J. (2009) · Journal of Affective Disorders · doi:10.1016/j.jad.2009.06.011 · Cited by 122 · see citing works
Hickie, I., Mason, C., Parker, G., & Brodaty, H. (1996) · British Journal of Psychiatry · doi:10.1192/bjp.169.1.68 · Cited by 118 · see citing works
Semkovska, M., & McLoughlin, D. M. (2013) · The Journal of ECT · doi:10.1097/yct.0b013e318279c2c9 · Cited by 114 · see citing works
Standardisation framework for the Maudsley staging method for treatment resistance in depression
Fekadu, A., Donocik, J. G., & Cleare, A. J. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1679-x · Cited by 106 · see citing works
Autobiographical Memory and Electroconvulsive Therapy
Sackeïm, H. A. (2014) · Journal of Ect · doi:10.1097/yct.0000000000000117 · Cited by 101 · see citing works
Sienaert, P. A., Vansteelandt, K., Demyttenaere, K., & Peuskens, J. (2008) · Journal of Affective Disorders · doi:10.1016/j.jad.2008.11.001 · Cited by 97 · see citing works
Martin, D. M., Gálvez, V., & Loo, C. K. A. (2015) · The International Journal of Neuropsychopharmacology · doi:10.1093/ijnp/pyv067 · Cited by 95 · see citing works
Self-citationSpaans, H., Verwijk, E., Comijs, H. C., Kok, R., Sienaert, P. A., Bouckaert, F., Fannes, K., Vandepoel, K., Scherder, E., Stek, M. L., et al. (2013) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.13m08538 · Cited by 91 · see citing works
Loo, C. K. A., Sheehan, P. V., Pigot, M., & Lyndon, W. (2007) · Journal of Affective Disorders · doi:10.1016/j.jad.2007.06.012 · Cited by 81 · see citing works
Self-citationA Questionnaire Survey of ECT Practice in Australia
Chanpattana, W. (2007) · Journal of Ect · doi:10.1097/yct.0b013e318031bc50 · Cited by 79 · see citing works
Loo, C. K. A., Katalinic, N., Smith, D., Ingram, A., Dowling, N. L., Martin, D. M., Addison, K., Hadži-Pavlović, D., Simpson, B., & Schweitzer, I. (2014) · The International Journal of Neuropsychopharmacology · doi:10.1093/ijnp/pyu045 · Cited by 77 · see citing works
Self-citationECT response in delusional versus non-delusional depressed inpatients
Birkenhäger, T. K. (2003) · Journal of Affective Disorders · doi:10.1016/s0165-0327(02)00005-8 · Cited by 75 · see citing works
Speed of response in ultrabrief and brief pulse width right unilateral ECT
Loo, C. K. A., Garfield, J. B. B., Katalinic, N., Schweitzer, I., & Hadži-Pavlović, D. (2012) · The International Journal of Neuropsychopharmacology · doi:10.1017/s1461145712000806 · Cited by 52 · see citing works
Self-citationPredictors of response to ultrabrief right unilateral electroconvulsive therapy
Loo, C. K. A., Mahon, M., Katalinic, N., Lyndon, B., & Hadži-Pavlović, D. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.09.016 · Cited by 48 · see citing works
Self-citationThe role of cholinergic systems in visuospatial processing and memory
Meador, K. J., Moore, E. E., Nichols, M., Abney, O. L., Taylor, H. S., ZAMRINI, E. Y., & Loring, D. W. (1993) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/01688639308402599 · Cited by 45 · see citing works
Outcome following ECT for primary unipolar depression: a test of newly proposed response predictors
Coryell, W. H., & Zimmerman, M. B. (1984) · American Journal of Psychiatry · doi:10.1176/ajp.141.7.862 · Cited by 44 · see citing works
McCall, W. V., Farah, B. A., Reboussin, D. M., & Colenda, C. C. (1995) · American Journal of Geriatric Psychiatry · doi:10.1097/00019442-199503040-00006 · Cited by 33 · see citing works
Wang, H. R., Woo, Y. S., Ahn, H. S., Ahn, I. M., Kim, H. J., & Bahk, W. (2015) · The International Journal of Neuropsychopharmacology · doi:10.1093/ijnp/pyv023 · Cited by 31 · see citing works
Electroconvulsive Therapy in the Netherlands
van Waarde, J. A., Verwey, B., van den Broek, W. W., & van der Mast, R. C. (2009) · Journal of Ect · doi:10.1097/yct.0b013e31819190b5 · Cited by 27 · see citing works
Mayur, P. M., Byth, K., & Harris, A. W. F. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.12.005 · Cited by 23 · see citing works
Gálvez, V., Li, A., Oxley, C. J., Waite, S., Felice, N. D., Hadži-Pavlović, D., Kumar, D., Page, A. C., Hooke, G. R., & Loo, C. K. A. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.08.002 · Cited by 23 · see citing works
Self-citationElectroconvulsive Therapy: ECT Minimum Standard of Practice in NSW - NSW Health
Branch, A. (2011) · Cited by 3 · see citing works
Flagged first, then by citations
1 of the 41 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- Wechsler D (1997) Wechsler Memory Scale -Third Edition administration and scoring manual.The Psychological Corporation: San Antonio, TX.
Cited by
Sorted by citations
Effects of Electroconvulsive Therapy on Depression and Its Potential Mechanism
Li, M., Yao, X., Sun, L., Zhao, L., Xu, W., Zhao, H., Zhao, F., Zou, X., Cheng, Z., Li, B., et al. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.00080 · Cited by 82 · see citing works
Tor, P. C., Tan, X. W., Martin, D. M., & Loo, C. K. A. (2021) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2021.04.023 · Cited by 64 · see citing works
Self-citationRecent advances in electroconvulsive therapy in clinical practice and research
Mukhtar, F., Regenold, W. T., & Lisanby, S. H. (2023) · Faculty Reviews · doi:10.12703/r/12-13 · Cited by 29 · see citing works
Tang, V. M., Blumberger, D. M., Dimitrova, J., Throop, A., McClintock, S. M., Voineskos, D., Downar, J., Knyahnytska, Y., Mulsant, B. H., Fitzgerald, P. B., et al. (2020) · Journal of Psychiatry and Neuroscience · doi:10.1503/jpn.190098 · Cited by 22 · see citing works
Fu, Z., Abbott, C., Miller, J., Deng, Z.-D., McClintock, S. M., Sendi, M. S. E., Sui, J., & Calhoun, V. (2023) · Translational Psychiatry · doi:10.1038/s41398-023-02312-w · Cited by 10 · see citing works
Liu, Y., Yang, J., & Liu, Y. (2024) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2024.05.022 · Cited by 11 · see citing works
Prescribing electroconvulsive therapy for depression: Not as simple as it used to be
Gill, S., Hussain, S., Purushothaman, S., Sarma, S., Weiss, A. M., Chamoli, S., Fasnacht, M., Gandhi, A., Fitzgerald, P. B., Simpson, B., et al. (2023) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674231183368 · Cited by 9 · see citing works
Self-citationUltrabrief pulse electroconvulsive therapy for depression: a systematic review and meta-analysis
Jelovac, A., & McLoughlin, D. M. (2025) · Molecular Psychiatry · doi:10.1038/s41380-025-03327-z · Cited by 8 · see citing works
Electroconvulsive therapy and cognitive performance from the Global ECT MRI Research Collaboration
Kiebs, M., Farrar, D. C., Yrondi, A., Cardoner, N., Tuovinen, N., Redlich, R., Dannlowski, U., Soriano‐Mas, C., Dols, A., Takamiya, A., et al. (2024) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2024.09.013 · Cited by 7 · see citing works
Electroconvulsive Therapy for Treatment-Resistant Depression: Dispelling the Stigma.
Salani, D. A., Goldin, D., Valdes, B., & DeSantis, J. (2023) · Journal of Psychosocial Nursing and Mental Health Services · doi:10.3928/02793695-20230222-02 · Cited by 8 · see citing works
de Arriba‐Arnau, A., Soria, V., Salvat‐Pujol, N., Menchón, J. M., & Urretavizcaya, M. (2019) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-019-01089-8 · Cited by 7 · see citing works
Guo, Q., Yong, W., Guo, L., Chen, C., Han, S., & Shang, S. (2024) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2024.104169 · Cited by 5 · see citing works
The Relative Efficacy and Side-Effect Profile of Ultrabrief Pulse and Brief Pulse ECT
Gonuguntla, R. K., Dunham, S., Benmaman, I., Gonuguntla, N., & Ha, K. (2025) · Journal of Ect · doi:10.1097/yct.0000000000001164 · Cited by 4 · see citing works
Barreiros, A. R., Massaneda‐Tuneu, C., Waite, S., Sarma, S., Branjerdporn, G., Zeng, C., Dong, V., Loo, C. K. A., & Martin, D. M. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.09.097 · Cited by 4 · see citing works
Self-citationBernardoff, L., Blay, M., Thellier, D., d’Amato, T., Galvão, F., & Poulet, E. (2025) · Journal of Ect · doi:10.1097/yct.0000000000001119 · Cited by 2 · see citing works
Massaneda‐Tuneu, C., Martínez‐Fernandez, L., de Arriba‐Arnau, A., Soria, V., & Urretavizcaya, M. (2021) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.13308 · Cited by 1 · see citing works
Neuromodulation (Brain Stimulation) Technologies for Treatment of Substance Use Disorders
Souki, A., Soleimani, G., Hanlon, C. A., & Ekhtiari, H. (2024) · SAGE Publications Ltd eBooks · doi:10.4135/9781529673913.n37 · Cited by 1 · see citing works
Insight and the Capacity to Refuse Treatment with Electroconvulsive TherapyPreprint
Scott, R. J. (2025) · SSRN Electronic Journal · doi:10.2139/ssrn.5385957 · Cited by 1 · see citing works
Neuromodulation Therapies I: Electroconvulsive Therapy
Lazaro, C., McMurray, L., Ducic, M. R., & Lau, T. (2024) · Springer eBooks · doi:10.1007/978-3-031-47802-4_6
Cognitive effects of convulsive therapies
Martin, D. M., & Loo, C. K. A. (2024) · Elsevier eBooks · doi:10.1016/b978-0-443-18496-3.00011-2
Self-citationSi, Q., Dong, Y., Li, Y., Xu, G., Tang, Y., Cao, P., Chen, C., Ren, F., Li, R., & Sui, Y. (2025) · Schizophrenia Research Cognition · doi:10.1016/j.scog.2025.100369
Younes, M. M. M. B., Arbuzova, A. R., & Ulanova, A. A. (2025) · Neurology Bulletin · doi:10.17816/nb679990
Noda, Y. (2026) · Expert Review of Medical Devices · doi:10.1080/17434440.2026.2717170
- Authors
- Martin, D., Katalinic, N., Hadzi-Pavlovic, D., Ingram, A., Ingram, N., Simpson, B., McGoldrick, J., Dowling, N., & Loo, C.
- Affiliations
- Black Dog Institute (AU)
- St George Hospital (AU)
- The University of Melbourne (AU)
- Melbourne Clinic (AU)
- Corresponding author
- Loo, Colleen
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2019-05-02
- Volume
- 50
- Issue
- 7
- Pages
- 1121-1128
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2943457845
- Cited by
- 24
- References
- 41
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 7 · 2023: 5 · 2021: 2 · 2020: 2 · 2019: 1
- FWCI
- 1.00
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- cc-by-nc-nd
- www.cambridge.org/core/terms (unspecified)
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
- Funders
- Medical Research Council
- National Health and Medical Research Council (568678)
- 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, bitemporal ECT, cognitive side effects, visual memory, seizure threshold, mood, treatment efficacy
- MeSH terms
- Proof of Concept Study, Adult, Cognition, Major Depressive Disorder, Depressive Disorder, Major, Double-Blind Method, Electroconvulsive Therapy, Female, Humans, Male, Middle Aged, Prospective Studies, Treatment Outcome
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