Ultrabrief pulse electroconvulsive therapy for depression: a systematic review and meta-analysis.
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Authors
Jelovac, Ana
McLoughlin, Declan M
Issue Date
2025-11-08
Type
Journal Article
Systematic Review
Systematic Review
Language
en
Keywords
Alternative Title
Abstract
Ultrabrief pulse (<0.5 millisecond pulse width) electroconvulsive therapy (ECT) is regarded as a cognition-sparing form of ECT. Contrary to some early research, recent randomised trials have reported low remission rates with ultrabrief pulse high-dose right unilateral ECT. The aim of the present systematic review and meta-analysis was to assess acute and long-term outcomes following right unilateral and bilateral forms of ultrabrief pulse ECT in depression. We searched PubMed, Embase, PsycINFO, CENTRAL and ClinicalTrials.gov databases from 01 January 2007 to 17 September 2024 for randomised controlled trials and observational studies reporting on one or more relevant outcomes. Remission, response, relapse and switching rates to other forms of ECT were pooled using random effects models. 30 studies provided data on one or more outcomes. The pooled remission rate (kâ=â23, nâ=â1478) was 32.2% (95% CI 26.1%-39.0%) with ultrabrief pulse high-dose right unilateral ECT. Less than half of patients (45.3% [95% CI 39.0%-51.7%]) treated with this form of ECT achieved therapeutic response. Switching to brief-pulse ECT due to perceived inadequate response was common and occurred in 28.1% of patients (95% CI 20.6%-37.0%). Of remitters with ultrabrief pulse high-dose right unilateral ECT treated with continuation pharmacotherapy, 44.1% (95% CI 34.4%-54.3%) relapsed or withdrew within six months of completion of an acute course of ECT. The results of this meta-analysis indicate that acute outcomes following ultrabrief pulse ECT fall short of those expected with conventional brief-pulse ECT. As such, ultrabrief pulse ECT cannot be regarded as "state-of-the-art" ECT.
Description
Citation
Jelovac, A., & McLoughlin, D. M. (2025). Ultrabrief pulse electroconvulsive therapy for depression: a systematic review and meta-analysis. Molecular psychiatry, 10.1038/s41380-025-03327-z. Advance online publication. https://doi.org/10.1038/s41380-025-03327-z
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License
Âİ 2025. The Author(s).
Journal
Molecular psychiatry
Volume
Issue
PubMed ID
DOI
10.1038/s41380-025-03327-z
10.1016/S0140-6736(03)12705-5
10.1136/bmj.l1079
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10.1016/j.pnpbp.2014.02.004
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10.12703/r/12-13
10.1097/YCT.0000000000000980
10.1192/bjp.141.4.357
10.1097/00005053-196309000-00008
10.1097/00124509-199806000-00002
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10.1016/j.jad.2012.12.005
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10.1016/j.brs.2020.07.015
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10.1016/j.eurpsy.2017.06.015
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10.1016/j.jad.2020.03.010
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10.1016/j.jad.2012.04.032
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10.1016/j.jpsychires.2022.08.011
10.1016/j.jpsychires.2017.03.016
10.1016/j.jad.2021.04.028
10.1097/01.pra.0000452569.92449.76
10.1016/j.jad.2015.05.022
10.1176/appi.ajp.2016.16010118
10.1097/YCT.0000000000000348
10.1097/YCT.0b013e3181da8412
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10.1038/npp.2013.149
10.1097/YCT.0b013e318276591f
10.1016/j.cnr.2004.06.013
10.1038/s41380-022-01757-7
10.1126/scitranslmed.abe1376
10.1016/j.brs.2024.02.019
10.1186/s12888-023-05033-y
10.1017/S2045796021000731
10.1001/jamapsychiatry.2024.0994
10.1093/ijnp/pyab088
10.1080/08039488.2023.2292245
10.1016/S0140-6736(03)12705-5
10.1136/bmj.l1079
10.1192/bjp.2021.37
10.1016/j.pnpbp.2014.02.004
10.1017/S0033291716002737
10.12703/r/12-13
10.1097/YCT.0000000000000980
10.1192/bjp.141.4.357
10.1097/00005053-196309000-00008
10.1097/00124509-199806000-00002
10.1016/j.brs.2008.03.001
10.4088/JCP.13m08538
10.1093/ijnp/pyu045
10.1016/j.jad.2012.12.005
10.1001/jamapsychiatry.2023.4599
10.1016/j.brs.2020.07.015
10.1097/YCT.0000000000001018
10.1186/s13063-021-05730-7
10.1056/NEJMoa2302399
10.1001/jamapsychiatry.2024.0692
10.1016/j.eurpsy.2017.06.015
10.1016/j.jad.2013.05.072
10.4088/JCP.14r09145
10.1177/2040622311432493
10.1186/s13643-021-01626-4
10.1016/j.jad.2007.06.012
10.3389/fnhum.2022.1044917
10.1097/EDE.0000000000001232
10.1002/jrsm.1547
10.1002/hsr2.178
10.1192/bjp.2017.28
10.1016/j.jclinepi.2014.03.003
10.1136/ebmental-2019-300117
10.1016/j.jagp.2020.06.008
10.1176/appi.neuropsych.18080177
10.1007/s00406-021-01301-8
10.1097/YCT.0000000000000081
10.1016/j.jad.2020.03.010
10.1176/appi.ajp.2016.15081101
10.3389/fpsyt.2018.00092
10.1017/S1461145708009292
10.1016/j.jad.2012.04.032
10.1002/hbm.24895
10.1097/YCT.0000000000000080
10.1016/j.jpsychires.2021.12.028
10.1038/s41598-019-41175-4
10.1016/j.jpsychires.2010.08.006
10.1016/j.jad.2008.11.001
10.1016/j.nicl.2019.102080
10.1097/YCT.0b013e31827e0d02
10.1038/srep37461
10.1016/j.jpsychires.2022.08.011
10.1016/j.jpsychires.2017.03.016
10.1016/j.jad.2021.04.028
10.1097/01.pra.0000452569.92449.76
10.1016/j.jad.2015.05.022
10.1176/appi.ajp.2016.16010118
10.1097/YCT.0000000000000348
10.1097/YCT.0b013e3181da8412
10.1017/S0033291719000989
10.1038/npp.2013.149
10.1097/YCT.0b013e318276591f
10.1016/j.cnr.2004.06.013
10.1038/s41380-022-01757-7
10.1126/scitranslmed.abe1376
10.1016/j.brs.2024.02.019
10.1186/s12888-023-05033-y
10.1017/S2045796021000731
10.1001/jamapsychiatry.2024.0994
10.1093/ijnp/pyab088
10.1080/08039488.2023.2292245
ISSN
1476-5578