New research, published in the journal Brain Sciences, founds lower amplitude electroconvulsive therapy effective for treating suicidal ideation. The study reveals that the therapy, with standard amplitude, relieves suicidal thoughts and doesn’t affect cognitive or memory function. The study was a randomized pilot study involving people living with major depression and bipolar depression.
It was during 2017 that more than 47,000 suicide cases were reported in the United States. Note this figure is double the number of registered homicides. Suicide has become the 10th leading cause of death in the U.S. Moreover, it is the second leading cause of death in people aged between 10 and 34 years.
Acute suicidal ideation includes thinking about, considering, or planning suicide. Electroconvulsive therapy (ECT) is one of the treatments available for it. However, there is a considerable stigma around the use of ECT for suicidal thoughts. Even though experts officially recognize ECT as a legal form of treatment and studies back its effectiveness, people feel ashamed of approaching it as a treatment.
People often suspect ECT because of their concerns regarding the side effects that it may have on cognition and memory. However, the findings of this study suggest that lowering the amplitude of ECT can help evade these side effects.
How is low-amp ECT effective?
The researchers investigated the productivity of low-amp ECT by administering it to the study participants. Before undergoing ECT, the participants received general anesthesia and a muscle relaxant to send them to sleep. Afterward, the electrodes were placed on specific areas of the participants’ scalp precisely. Following the electrode placement, short bursts of electrical pulses were generated to stimulate the patients’ brain while they were asleep. This stimulation triggers brief convulsions that last for about a minute.
Three of the participants got low-amp ECT (500 milliamps) and the remaining four participants received the standard 900 milliamps. The results showed that those who received low-amp ECT exhibited fewer suicidal thoughts by the third treatment session. On the other hand, the standard amp group reported feeling better after four sessions, on average.
The time taken by the patients to wake up from ECT predicts the possible cognitive side effects of the treatment. 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. Significantly, the researchers found no side effects on cognition or memory in the low-amp group. In addition, low-amp participants reported more relief from their suicidal thoughts as compared to the standard-amp group.
The researchers used the suicidal ideation questionnaire, both at baseline and following the treatment, to compare the results. Participants in the low-amp group improved their score by 5.1 points on average. While the average improvement in the standard group was around 3 points.
Concluding the possible advantages
According to the researchers, depression centers in the brain tend to be more superficial than the brain’s memory areas. Thus, avoiding higher amplitude could be a good strategy to target depression without harming memory. Furthermore, placing electrodes on both sides of the brain increased the risk of affecting memory. Therefore, the researchers placed electrodes on only one side of the brain i.e. the right side.
The left side of the brain usually comprises of the areas associated with speech and writing. For this reason, the scientists applied ECT on the opposite side. The researchers suggest that people with their linguistic centers in the right-hand side of the brain can be treated to the left side.
The research team plans to conduct a multicenter trial comparing the two approaches in a larger cohort and clinically following the participants for longer.