Individualized Hybrid Electroconvulsive Therapy (i-HECT) Shows Rapid Anti-Depressant Effect and Improved Cognition in Young Patients with Depression

Background: For young patients with depression, electroconvulsive therapy (ECT) is highly effective but causes acute cognitive side effects. We designed a new i-HECT therapy combines ECT with low-charge electrotherapy (LCE) and individual symptom monitoring to reduce cognitive impairments. Methods: i-HECT comprised two treatments: ECT and LCE. ECT utilized an energy set of 1.5 times the seizure threshold (ST), while LCE was set at 0.5 ST. The initial session employed ECT. Subsequent sessions involved ECT or LCE, depending on whether meeting the ECT-LCE transition criteria (MADRS total score < 22 or ≥ 50% reduction), assessed after each session. Results: The intention-to-treat analysis revealed an 80.4% response rate and a 58.7% remission rate (Hedges' g = 3.29). Notably, both subjective and objective cognitive functions significantly improved post-i-HECT treatments and during the 3-month follow-up periods. Conclusion: The i-HECT protocol may provide a rapid antidepressant treatment option with cognitive benefits for young depression patients.