Changing Tactics? Optimizing ECT in difficult-to-treat depression

This project entails the first-ever RCT comparing antidepressant efficacy and cognitive effects of an- ongoing treatment technique (unilateral ECT) with a change of treatment technique (from unilateral
to bitemporal ECT). This project will have an impact on the clinical practice, guiding clinical decision making. The project addresses a clinical conundrum ECT clinicians are faced with on a daily basis: what
to do in case a severely depressed patient fails to show the expected early response to treatment with ECT? How to improve the odds of achieving remission, while keeping the risk of cognitive side-effects
as low as possible? There is an absolute lack of evidence to support ECT clinicians in making this clinical decision. As such, our project addresses an unmet need, i.e. personalizing and optimizing the
treatment of the most severely ill. By situating the decision whether or not to change treatment technique earlier in the treatment course, i.e. after 4 sessions, remission might be achieved after a
lower number of treatment sessions, thus diminishing the cognitive burden. In Belgium, more than 15.000 ECT treatments are performed yearly, of which 12.910 treatments in Flanders, mainly for
severe depression. These numbers are expected to further increase.
Moreover, ECT is offered increasingly on an ambulatory basis. Offering an ambulatory treatment assumes that the treatment is well tolerated and safe. Minimizing the time-to-reorientation, and
cognitive sideeffects, eases the organization ofoutpatient ECT-care, reducing the time that is needed to observe the patient post-ECT. Because of the worldwide (growing) use of ECT we expect that the
impact of our results will extend beyond Flanders and have international impact.