Individualized hybrid electroconvulsive therapy (i-HECT) shows rapid anti-depressant effect in young patients with depression

Abstract

Abstract Background For young patients with depression, electroconvulsive therapy (ECT) is highly effective but causes acute cognitive side effects. We designed a new individualized hybrid electroconvulsive therapy (i-HECT) combines ECT with low-charge electrotherapy (LCE) and individual symptom monitoring to reduce cognitive impairments. Methods i-HECT comprised two treatments: ECT and LCE. ECT utilized an energy set of 1.5 times the seizure threshold (ST), while LCE was set at 0.5 ST. The initial session employed standard bilateral ECT. Subsequent sessions involved ECT or LCE, depending on whether meeting the ECT-LCE transition criteria (Montgomery-Åsberg Depression Rating Scale (MADRS) total score < 22 or ≥ 50% reduction), assessed after each session. This trial employed a Simon’s optimal two-stage design with a 3-month follow-up period in 46 young patients (age 16–25) with depression (MADRS ≥ 22). Results The intention-to-treat analysis revealed an 80.4% response rate and a 58.7% remission rate, The reduction in MADRS score was 19.1 ± 7.0, with Hedges’ g = 3.29 (95% CI = 2.66 to 3.91). The orientation recovery tests (ORTs) took 22.7 ± 11.3 min after LCEs and 26.0 ± 10.3 min after ECTs. Improvements in cognitive functions were observed after i-HECT treatments and during the 3-month follow-up periods. Conclusion In conclusion, our i-HECT protocol shows promise as a simple and rapid treatment option for young patients with depression, with observed improvements in cognitive function. Trial registration This trial was registered in the Chinese Clinical Trial Registry (http://www.chictr.org.cn), registration number: ChiCTR2100045682. Date of registration on April 23, 2021.