ANTIDEPRESSANT AND COGNITIVE EFFECTS OF TWICE-WEEKLY VERSUS 3-TIMES-WEEKLY ECT

Objective: The purpose of this study was to determine which of the two commonly used schedules of ECT administration, twice or three times w eekly, is clinically optimal in terms of antidepressant efficacy and c ognitive effects. Method: In this double-blind study, 52 consenting, m edication-free patients with major depressive disorder, endogenous sub type (Research Diagnostic Criteria), were randomly assigned to bilater al, brief-pulse, constant-current ECT administered over 4 weeks at a r ate of three times weekly or twice weekly with the addition of one sim ulated ECT (anesthesia and muscle relaxant only) per week. Outcome mea sures were the Hamilton Depression Rating Scale, Acute Cognitive Effec ts Battery, and Chronic Cognitive Effects Battery. Results: Hamilton d epression scale scores were significantly improved by both schedules, with no difference in outcome either 1 week or 1 month after the end o f the ECT series. However, the rate of response to ECT three times a w eek was significantly faster and was related to the rate of real ECT a dministration. Cognitive effects were more prominent with ECT three ti mes a week. Conclusions: ECT twice a week is an effective schedule for clinical practice and is potentially advantageous in view of a therap eutic outcome identical to that of ECT three times a week and less sev ere cognitive effects. ECT three times a week may be specifically indi cated when early onset of clinical effect is of primary importance.