Optimal Electrical Stimulus During Electroconvulsive Therapy for Depression: a National Register-based Randomized Trial

What this Trial Is About

Researchers are evaluating the optimal electrical current stimulus during electroconvulsive therapy (ECT) to balance antidepressant effects and memory disturbance in patients with unipolar or bipolar depression. This national, register-based randomized trial compares two pulse widths, 0.5 ms and 1.0 ms, to determine which produces a higher remission rate within one week after treatment. Secondary objectives include assessing self-rated health, memory changes, antidepressive response, number of ECT sessions, hospital readmission, and suicide rates within six months. Participants receive ECT treatment initiated with either a 0.5 ms or a 1.0 ms pulse width stimulus, delivered usually three times per week during the treatment series. Anesthetic doses, electrode placement, and stimulus parameters are adjusted based on seizure quality and clinical response. The study uses a web-based system for randomizing patients by hospital and age group. Evaluations occur weekly during treatment and at six-month follow-up. Participants undergo assessments of depressive symptoms using the Montgomery-Åsberg Depression Rating Scale (MADRS-S), Clinical Global Impression Scale, and subjective memory ratings before treatment, within one week after treatment, and at six months. Self-rated health is measured with the EQ5D visual analogue scale. Hospital admissions, medication use, social factors, and comorbidities are collected from national registers. Safety data including adverse events and mortality are monitored during and after treatment. The total participation duration includes initial treatment and a six-month follow-up period.

Optimal Electrical Stimulus During Electroconvulsive Therapy