New research compares lower amplitude electroconvulsive therapy with standard amplitude for the treatment of suicidal ideation and finds that the former relieves suicidal thoughts without affecting cognitive or memory function.
In 2017, there were more than 47,000 cases of suicide in the United States, which is double the number of registered homicides. Suicide is the 10th leading cause of death in the U.S. and the second leading cause of death in people aged between 10 and 34 years.
One of the treatments available for acute suicidal ideation — which includes “thinking about, considering, or planning suicide” — is electroconvulsive therapy (ECT).
However, there is considerable stigma around the use of ECT for suicidal thoughts, despite the fact that experts officially recognize it as a valid form of treatment and studies have shown it to be highly effective in treating depression.
Another reason why people often regard ECT with suspicion is that they have concerns regarding the side effects that it may have on cognition and memory.
However, the findings of a new study suggest that lowering the amplitude of ECT may help bypass these side effects and make ECT an effective treatment for acute suicidal thoughts.
The principal investigator of the new study is Dr. Nagy A. Youssef, a psychiatrist specializing in ECT in the Medical College of Georgia Department of Psychiatry and Health Behavior at Augusta University.
In the past, Dr. Youssef and his colleagues conducted a first-of-its-kind small study of 22 people with treatment-resistant depression or psychosis. They administered low-amp ECT to the study participants and found that it relieved their depression while having a minimal cognitive impact.
Before undergoing ECT, a person receives general anesthesia and a muscle relaxant to send them to sleep.
Then, following the precise placement of electrodes on specific areas of the scalp, short bursts of electrical pulses stimulate their brain while they sleep. This stimulation triggers brief convulsions that last for about a minute.
The new research, which appears in the journal Brain Sciences, was a randomized pilot study of seven people living with major depression and bipolar depression. Three of the participants received low-amp ECT (500 milliamps) while researchers gave the remaining four participants the standard 900 milliamps.
Those who received low-amp ECT reported fewer suicidal thoughts by the third treatment session. In comparison, the standard amp group reported feeling better after four sessions, on average.
Significantly, the low-amp study participants woke up within a few minutes of their treatment, whereas those in the standard group woke up after 15 minutes. The time that it takes for people to wake up from ECT is a reliable predictor of the possible cognitive side effects that the treatment may have.
The researchers found no side effects on cognition or memory in the low-amp group. Also, low-amp participants reported more relief from their suicidal thoughts than people in the standard-amp group.
To compare the groups, Dr. Youssef and team used the suicidal ideation questionnaire both at baseline and following the treatment. The score of those in the low-amp group improved by 5.1 points on average compared with an average improvement of 3 points for those in the standard group.
Dr. Youssef explains that depression centers in the brain tend to be more superficial than the brain’s memory areas, so avoiding higher amplitude is a good strategy to target depression without harming memory.
Furthermore, the researcher explains, placing electrodes on both sides of the brain increases the risk of affecting memory. But, in the current study, the researchers placed electrodes on only one side of the brain — the right side — which may explain the absence of cognitive side effects.
For the vast majority of people, the left side of the brain comprises brain areas that have an association with speech and writing, says Dr. Youssef, so the scientists applied ECT on the opposite side. In the rare cases where people have these linguistic centers in the right-hand side of the brain, scientists can administer therapy to the left side instead.
In the future, the researchers plan to conduct a multicenter trial that compares the two approaches in a larger cohort and clinically follows the participants for longer.
“We need to do larger studies with more patients as this approach seems very promising.”
Dr. Nagy A. Youssef