Expanded Safety and Efficacy Data for a New Method of Performing Electroconvulsive Therapy: Focal Electrically Administered Seizure Therapy

Overview

Journal J ECT

Date 2016 Jul 6

PMID 27379790

Citations 7

Authors

Gregory L Sahlem

E Baron Short

Suzanne Kerns

Jon Snipes

William Devries

James B Fox

Carol Burns

Matthew Schmidt

Ziad H Nahas

Mark S George

Harold A Sackeim

Affiliations

Soon will be listed here.

Abstract

Objective: Electroconvulsive therapy (ECT) is the most rapid and effective antidepressant treatment but with concerns about cognitive adverse effects. A new form of ECT, focal electrically administered seizure therapy (FEAST), was designed to increase the focality of stimulation and better match stimulus parameters with neurophysiology. We recently reported on the safety and feasibility of FEAST in a cohort (n = 17) of depressed patients. We now report on the safety, feasibility, preliminary efficacy, and cognitive effects of FEAST in a new cohort.

Methods: Open-label FEAST was administered to 20 depressed adults (6 men; 3 with bipolar disorder; age 49.1 ± 10.6 years). Clinical and cognitive assessments were obtained at baseline and end of course. Time to orientation recovery was assessed at each treatment. Nonresponders switched to conventional ECT.

Results: Participants tolerated the treatment well with no dropouts. Five patients (25%) transitioned from FEAST to conventional ECT due to inadequate response. After FEAST (mean, 9.3 ± 3.5 sessions; range, 4-14), there was a 58.1% ± 36.0% improvement in Hamilton Rating Scale for Depression scores compared with that in the baseline (P < 0.0001); 13 (65%) of 20 patients met response criteria, and 11 (55%) of 20 met remission criteria. Patients achieved reorientation (4 of 5 items) in 4.4 ± 3.0 minutes (median, 4.5 minutes), timed from eyes opening. There was no deterioration in neuropsychological measures.

Conclusions: These findings provide further support for the safety and efficacy of FEAST. The remission and response rates were in the range found using conventional ECT, and the time to reorientation may be quicker. However, without a randomized comparison group, conclusions are tentative.

Citing Articles

Electroconvulsive Therapy: Mechanisms of Action, Clinical Considerations, and Future Directions.

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Shaping plasticity with non-invasive brain stimulation in the treatment of psychiatric disorders: Present and future.

George M, Caulfield K, Wiley M Handb Clin Neurol. 2022; 184:497-507.

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The Future of Training and Practice in Neuromodulation: An Interventional Psychiatry Perspective.

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The Efficacy and Safety of Neuromodulation Treatments in Late-Life Depression.

van Rooij S, Riva-Posse P, McDonald W Curr Treat Options Psychiatry. 2021; 7(3):337-348.

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A two-site, open-label, non-randomized trial comparing Focal Electrically-Administered Seizure Therapy (FEAST) and right unilateral ultrabrief pulse electroconvulsive therapy (RUL-UBP ECT).

Sahlem G, McCall W, Short E, Rosenquist P, Fox J, Youssef N Brain Stimul. 2020; 13(5):1416-1425.

PMID: 32735987 PMC: 7500956. DOI: 10.1016/j.brs.2020.07.015.

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