Abstract
OBJECTIVES: To evaluate the efficacy and safety of super electroconvulsive therapy (ECT) for treatment-resistant depression (TRD). METHODS: This cohort study was conducted among 292 patients with TRD, who received super ECT from December, 2024 to June, 2025. Eighty-eight of the patients received one electrical stimulation in each super ECT procedure (E1 group), 89 had 2 electrical stimulations (E2 group), and 39 had 3 electrical stimulations (E3 group). The correlation between depression, anxiety and sleep quality at baseline was analyzed. The patients were evaluated using 17-items Hamilton Depression Scale (HAMD-17) at 1, 3, and 6 months after the first super ECT session, and the treatment remission rate and response rate were compared among the 3 groups. The number of sessions and incidences of adverse events within 6 months were compared, and the EEG seizure duration at the first super ECT session was analyzed. RESULTS: Seventy-four patients (84.09%) in group E1, 76 (76.40%) in group E2, and 32 (82.05%) in group E3 achieved remission within 6 months after super ECT. The average number of treatment sessions was 2.13±1.44 in Group E1, 2.23±2.01 in Group E2, and 2.41±2.15 in Group E3 within 6 months. The baseline HAMA, HAMD-17 and PSQI scores were significantly correlated (P<0.001). The first seizure duration in E1 group was significantly longer than that in E2 and E3 groups (P<0.001). The rehospitalization rates were significantly higher in E2 group than in E1 group at 3 months (P=0.012) and 6 months (P=0.026). The short-term adverse effects included fever, headache/dizziness, general pain and dry mouth. CONCLUSIONS: Super ECT is safe and effective for treatment of TRD patients with a total seizure duration longer than 180 s. The number of electrical stimulations in each treatment session does not significantly affect the therapeutic efficacy of super ECT.