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Focal Electroconvulsive Therapy for Depression (FEAST)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01589315
Recruitment Status : Completed
First Posted : May 1, 2012
Results First Posted : August 20, 2019
Last Update Posted : August 20, 2019
Information provided by (Responsible Party):
Medical University of South Carolina

Brief Summary:

This pilot, open label investigation evaluates the safety and efficacy of a new form of electroconvulsive therapy (ECT). Both the efficacy and adverse cognitive effects of ECT are highly contingent on the intracerebral current paths and current density of the ECT stimulus. However, the impedance of the skull and individual differences in skull anatomy severely limit the spatial targeting of stimulation, and create marked individual differences in intracerebral current density. To address these problems, the investigators are exploring various means of overcoming this limitation.

An approach is to modify the electrical stimulus to induce focal seizures. The most common methods of ECT administration in the US use a bidirectional, constant current, brief pulse, with large (approximately 3 sq. in. surface area) and identically sized and shaped electrodes. In contrast, in this protocol the investigators have coupled unidirectional current flow with an electrode geometry involving a small and large electrode that differ by more than 3:1 in surface area.

Unidirectional currents were widely used in ECT during the, 1940's and continue to be used in European and American devices today. Transcranial electrical stimulation can be made focal by stimulating with an anode-cathode arrangement, with the electrodes differing in surface area. The investigators have shown in nonhuman primates the capacity to produce focal frontal seizure induction under conditions when a unidirectional current flows from a small anterior anode (placed on the forehead over the nasion) to a large posterior cathode just anterior to the motor strip. Furthermore, the investigators expect that some, if not all, of these seizures do not result in motor convulsions.

Thirty outpatients referred for ECT will participate. Relative to concurrent reference data from our ongoing ECT protocols, the investigators hypothesize that acute and subacute adverse cognitive effects of FEAST will be substantially less than those in patients receiving state-of-the art ECT, but with a traditional bidirectional, nonfocal stimulus. The investigators also hypothesize that the majority of patients will remit with FEAST. Thus, by improving the efficiency of the ECT stimulus with the switch to unidirectional current and the use of a new electrode geometry, the investigators expect to be able to induce focal seizures. The investigators hypothesize that this pilot study will provide evidence that this treatment is superior to traditional ECT in having lower dosing requirements and a superior side effect profile.

Condition or disease Intervention/treatment Phase
Major Depressive Disorder Device: focal ECT Phase 2 Phase 3

Detailed Description:

This study will provide preliminary evaluation of the following:

  1. Determination of whether focal seizures can be induced with the FEAST methodology (unidirectional stimulation, small anterior and large posterior electrode).

    1. Focality will be assessed by the occurrence of non-motor seizures.
    2. Electroencephalographic evidence of pronounced asymmetry in frontal leads.
  2. Determination of whether the FEAST methodology results in reduced seizure threshold.

    a. Seizure threshold will be quantified at the start of the treatment course using the standard method of limits titration procedure and compared to threshold determinations in matched patients who were treated with conventional ECT methods.

  3. Characterization of dynamic impedance using the FEAST methodology.

    a. Dynamic impedance during the passage of the electrical stimulus will be quantified during each administration and compared to the values obtained in matched patients who were treated with conventional ECT methods.

  4. Characterization of the efficacy of the FEAST methods and the safety of the treatment.

    1. The primary efficacy measure will be the 24-item Hamilton Rating Scale for Depression. The changes in these scores from before to immediately following the treatment course will be compared in patients treated with the FEAST methodology and matched patients who were treated with conventional ECT methods.
    2. Acute, subacute, and long-term cognitive side effects following FEAST will be assessed with comprehensive neuropsychological batteries. The primary acute measures will include the time to return of orientation following seizure induction and retrograde amnesia for words and shapes. The primary subacute measures will include assessments of anterograde amnesia (forgetting over a delay) for a verbal list and for reproduction of a complex figure, as well as retrograde amnesia for autobiographical information. The primary long-term measure will be retrograde amnesia for autobiographical information, assessed 6-months following the FEAST course. The neuropsychological measures will be compared in the patients treated with the FEAST methodology and matched patients who were treated with conventional ECT methods, as well as in healthy participants who receive were administered the neuropsychological battery at the same intervals as the FEAST patients, but without Intervention.
    3. Safety will also be determined by examining the number and frequency of serious adverse advents and adverse events, as well as scores on the Columbia University ECT Side Effect Scale.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 17 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Focal Electrical Administered Seizure Therapy (FEAST) for Major Depression
Study Start Date : January 2007
Actual Primary Completion Date : August 2015
Actual Study Completion Date : August 2016

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: FEAST
Active right unilateral focal ECT
Device: focal ECT
FEAST, ECT, unidirectional stimulation
Other Name: FEAST, ultra-brief unidirectional right ECT

Primary Outcome Measures :
  1. Remission Based on HDRS, Hamilton Depression Rating Scale, 24 Item. [ Time Frame: up to 4 weeks ]

    The number of treatment sessions is not fixed and could extend up to 12 provided that patients show continued improvement and tolerate the treatment. With 3 FEAST sessions per week, the course may take up to 12 weeks to be completed.

    The Hamilton Rating Scale for Depression is a widely used clinician administered rating.Scores range from (Min) 0 to (Max) 52. Higher score means worse depression. The definition of remission was a Ham Depression Score (24 item) of < or equal to 10.

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years to 90 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Age between 18 and 90 years (inclusive)
  • Diagnosis of major depressive disorder
  • Pretreatment HRSD score ≥ 18
  • ECT indicated
  • Willing and capable of providing informed consent

Exclusion Criteria:

  • History of schizophrenia,
  • schizoaffective disorder,
  • other functional psychosis, or
  • rapid cycling bipolar disorder
  • History of neurological illness or insult other than conditions associated with psychotropic exposure (e.g., tardive dyskinesia)
  • Alcohol or substance abuse or dependence in the past year (RDC)
  • Secondary diagnosis of a delirium, dementia, or amnestic disorder (DSM-IV), pregnancy, or epilepsy
  • Requires especially rapid antidepressant response due to suicidality, psychosis, inanition, psychosocial obligations, etc.
  • Unable to tolerate psychotropic washout and no psychotropic medication during the ECT trial, other than lorazepam (up to 3 mg/d PRN)
  • ECT in the past six months

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01589315

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United States, South Carolina
Medical University of South Carolina
Charleston, South Carolina, United States, 29425
Sponsors and Collaborators
Medical University of South Carolina
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Principal Investigator: Ziad Nahas, MD Medical University of South Carolina

Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: Medical University of South Carolina Identifier: NCT01589315    
Other Study ID Numbers: FEAST for depression
First Posted: May 1, 2012    Key Record Dates
Results First Posted: August 20, 2019
Last Update Posted: August 20, 2019
Last Verified: August 2019
Keywords provided by Medical University of South Carolina:
brain stimulation
Additional relevant MeSH terms:
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Depressive Disorder
Depressive Disorder, Major
Behavioral Symptoms
Mood Disorders
Mental Disorders