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Ultrabrief pulse electroconvulsive therapy for depression: a systematic review and meta-analysis
Ana Jelovac1, Declan M McLoughlin2,3
1Department of Psychiatry, Trinity College Dublin, St Patrick's University Hospital, Dublin, Ireland.
Molecular Psychiatry
|November 8, 2025
Summary
Ultrabrief pulse electroconvulsive therapy (ECT) shows low remission and response rates for depression, with many patients switching to brief-pulse ECT. Long-term outcomes also indicate a high relapse rate, questioning its "state-of-the-art" status.
Area of Science:
- Neuroscience
- Psychiatry
- Clinical Medicine
Background:
- Ultrabrief pulse electroconvulsive therapy (ECT) was proposed as a cognition-sparing alternative.
- Recent trials suggest suboptimal remission rates with high-dose right unilateral ultrabrief pulse ECT.
Purpose of the Study:
- To systematically review and meta-analyze acute and long-term outcomes of right unilateral and bilateral ultrabrief pulse ECT for depression.
Main Methods:
- Searched major databases (PubMed, Embase, PsycINFO, CENTRAL, ClinicalTrials.gov) from 2007 to 2024.
- Included randomized controlled trials and observational studies.
- Pooled remission, response, relapse, and switching rates using random effects models.
Main Results:
- Pooled remission rate for ultrabrief pulse high-dose right unilateral ECT was 32.2%.
- Therapeutic response was achieved by 45.3% of patients.
- Switching to brief-pulse ECT occurred in 28.1%, and 44.1% of remitters relapsed within six months.
Conclusions:
- Ultrabrief pulse ECT acute outcomes are inferior to conventional brief-pulse ECT.
- Current evidence suggests ultrabrief pulse ECT is not a "state-of-the-art" treatment for depression.
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