Study Procedure
nausea, seizure, headache, bitemporal, Depression, muscle aches
REMISSION, MUSCLE RELAXATION, SIDE EFFECTS, BLIND
After baseline assessments and screening, patients were randomly assigned to the 3 ECT protocols by STATA software (StataCorp, College Station, TX, USA). The evaluator remained blind to patient allocation. Brief-pulse (1.0-ms pulse width; current amplitude 800 mA) ECT treatment was applied 3 times per week for 4 weeks. Propofol (1.0–1.5 mg/kg) anesthesia and succinylcholine (0.5 mg/kg–1.0 mg/kg) were applied for muscle relaxation. The seizure threshold was established by dose titration in the first session. Subsequent treatments were 1.5× thresholds for bitemporal and 6× thresholds for unilateral (d’Elia placement) ECT. The stimulus charge was titrated upward as required during the treatment course. Patients’ medication information before enrolling in or during ECT treatment was collected, including antidepressants, mood stabilizers, antipsychotics, and benzodiazepines. Only the antidepressants were received during the ECT treatment. The mood stabilizers, antipsychotics, and benzodiazepines were only received before enrolling in the ECT treatment. Side effects, such as headache, muscle aches, and nausea, were recorded on the last ECT treatment session (treatment session 12 or treatment session 9). The patients who terminated the ECT treatment and did not reach remission (most of them missed >3 times) or who terminated the ECT treatment when intolerable side effects occurred were regarded as withdrawn. The remission was defined as a Hamilton Depression Scale-17 (HAMD-17) score <8.