Fine-tuning electroconvulsive therapy: A cognitive comparison of brief and ultra-brief pulse widths

Background: Electroconvulsive therapy (ECT) has been a cornerstone in managing severe psychiatric illnesses. However, concerns about its cognitive side effects have led to evolving techniques aimed at minimizing cognitive impairments. Specifically, the use of ultra-brief pulse width (0.5 ms) compared to brief pulse width (1.5 ms) in bitemporal modified ECT (MECT) offers a promising avenue for cognitive preservation. Aims and Objectives: To compare the cognitive outcomes associated with brief and ultra-brief pulse widths in bitemporal MECT. Materials and Methods: This prospective, randomized comparative study was conducted at a rural tertiary care hospital in Northern India. Sixty-six patients aged 18–60 years, diagnosed with schizophrenia, schizoaffective disorder, bipolar disorder, or severe depression, were randomly assigned to receive either brief or ultra-brief pulse MECT. Cognitive functions were assessed using standardized tools, including the Hindi mental status examination and Battery for ECT-related cognitive deficits. Pre- and post-treatment evaluations were compared to determine changes in cognitive performance. Results: Both groups exhibited some level of cognitive change following treatment. However, patients receiving ultra-brief pulse MECT demonstrated significantly better preservation of cognitive functions, notably in memory retention, attention, and executive functioning (P<0.05). Domains such as verbal learning, processing speed, and short-term recall were notably less affected in the ultra-brief group compared to the brief pulse group. Conclusion: Ultra brief pulse width in bitemporal MECT appears to offer a cognitive advantage over brief pulse width, suggesting it may be the preferred choice when cognitive preservation is a clinical priority.