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Bitemporal v. high-dose right unilateral electroconvulsive therapy for depression: a systematic review and meta-analysis of randomized controlled trials

Published online by Cambridge University Press:  26 October 2016

E. Kolshus ,
A. Jelovac  and
D. M. McLoughlin
E. Kolshus
Affiliation:
Department of Psychiatry, Trinity College Dublin, St Patrick's University Hospital, Dublin, Ireland Trinity College Institute of Neuroscience, Trinity College Dublin, Ireland
A. Jelovac
Affiliation:
Department of Psychiatry, Trinity College Dublin, St Patrick's University Hospital, Dublin, Ireland
D. M. McLoughlin*
Affiliation:
Department of Psychiatry, Trinity College Dublin, St Patrick's University Hospital, Dublin, Ireland Trinity College Institute of Neuroscience, Trinity College Dublin, Ireland
*
*Address for correspondence: Dr D. M. McLoughlin, Department of Psychiatry, Trinity College Dublin, St Patrick's University Hospital, James's Street, Dublin 8, Ireland. (Email: d.mcloughlin@tcd.ie)
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Abstract

Background

Brief-pulse electroconvulsive therapy (ECT) is the most acutely effective treatment for severe depression though concerns persist about cognitive side-effects. While bitemporal electrode placement is the most commonly used form worldwide, right unilateral ECT causes less cognitive side-effects though historically it has been deemed less effective. Several randomized trials have now compared high-dose (>5× seizure threshold) unilateral ECT with moderate-dose (1.0–2.5× seizure threshold) bitemporal ECT to investigate if it is as effective as bitemporal ECT but still has less cognitive side-effects. We aimed to systematically review these trials and meta-analyse clinical and cognitive outcomes where appropriate.

Method

We searched PubMed, PsycINFO, Web of Science, Cochrane Library and EMBASE for randomized trials comparing these forms of ECT using the terms ‘electroconvulsive’ OR ‘electroshock’ AND ‘trial’.

Results

Seven trials (n = 792) met inclusion criteria. Bitemporal ECT did not differ from high-dose unilateral ECT on depression rating change scores [Hedges's g = −0.03, 95% confidence interval (CI) −0.17 to 0.11], remission (RR 1.06, 95% CI 0.93–1.20), or relapse at 12 months (RR 1.42, 95% CI 0.90–2.23). There was an advantage for unilateral ECT on reorientation time after individual ECT sessions (mean difference in minutes = −8.28, 95% CI −12.86 to −3.70) and retrograde autobiographical memory (Hedges's g = −0.46, 95% CI −0.87 to −0.04) after completing an ECT course. There were no differences for general cognition, category fluency and delayed visual and verbal memory.

Conclusions

High-dose unilateral ECT does not differ from moderate-dose bitemporal ECT in antidepressant efficacy but has some cognitive advantages.

Keywords

Depressionelectroconvulsive therapyelectrode placementmeta-analysis
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 3 , February 2017 , pp. 518 - 530
Copyright
Copyright © Cambridge University Press 2016 

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