Skip to main content Accessibility help
×
Home

Bifrontal, bitemporal and right unilateral electrode placement in ECT: randomised trial

  • Charles H. Kellner (a1), Rebecca Knapp (a2), Mustafa M. Husain (a3), Keith Rasmussen (a4), Shirlene Sampson (a4), Munro Cullum (a3), Shawn M. McClintock (a3), Kristen G. Tobias (a1), Celena Martino (a5), Martina Mueller (a2), Samuel H. Bailine (a6), Max Fink (a7) and Georgios Petrides (a8)...

Abstract

Background

Electroconvulsive therapy (ECT) is an effective treatment for major depression. Optimising efficacy and minimising cognitive impairment are goals of ongoing technical refinements.

Aims

To compare the efficacy and cognitive effects of a novel electrode placement, bifrontal, with two standard electrode placements, bitemporal and right unilateral in ECT.

Method

This multicentre randomised, double-blind, controlled trial (NCT00069407) was carried out from 2001 to 2006. A total of 230 individuals with major depression, bipolar and unipolar, were randomly assigned to one of three electrode placements during a course of ECT: bifrontal at one and a half times seizure threshold, bitemporal at one and a half times seizure threshold and right unilateral at six times seizure threshold.

Results

All three electrode placements resulted in both clinically and statistically significant antidepressant outcomes. Remission rates were 55% (95% CI 43–66%) with right unilateral, 61% with bifrontal (95% CI 50–71%) and 64% (95% CI 53–75%) with bitemporal. Bitemporal resulted in a more rapid decline in symptom ratings over the early course of treatment. Cognitive data revealed few differences between the electrode placements on a variety of neuropsychological instruments.

Conclusions

Each electrode placement is a very effective antidepressant treatment when given with appropriate electrical dosing. Bitemporal leads to more rapid symptom reduction and should be considered the preferred placement for urgent clinical situations. The cognitive profile of bifrontal is not substantially different from that of bitemporal.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Bifrontal, bitemporal and right unilateral electrode placement in ECT: randomised trial
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Bifrontal, bitemporal and right unilateral electrode placement in ECT: randomised trial
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Bifrontal, bitemporal and right unilateral electrode placement in ECT: randomised trial
      Available formats
      ×

Copyright

Corresponding author

Charles H. Kellner, MD, Department of Psychiatry, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, New York, NY 10029, USA. Email: charles.kellner@mssm.edu

Footnotes

Hide All

See editorial, pp. 171–172, this issue.

C.H.K. research support from the National Institute of Mental Health (NIMH), loan of ECT device from Somatics LLC (no monies involved). M.M.H. research support from the NIMH, Stanley Medical Research Institute, Cyberonics, Inc, Magstim, Neuronetics and Advanced Neuromodulations Systems (ANS). S.M.M., K.G.T and C.M. research support from the NIMH. G.P. research support from AstraZeneca, Novartis, Corcept, NIMH. This study was supported by the NIMH (NCT00069407).

Declaration of interest

M.M.H. speakers bureau honoraria from AstraZeneca, BMS and Forest Lab.

Footnotes

References

Hide All
1 Friedman, E. Unidirectional electrostimulated convulsive therapy. I: The effect of wave form and stimulus characteristics on the convulsive dose. Am J Psychiatry 1942; 99: 218–23.
2 Lancaster neuropsychological, Steinert RR, Frost I. Unilateral electroconvulsive therapy. J Ment Sci 1958; 104: 221–7.
3 Fink, M. Convulsive Therapy: Theory and Practice. Raven Press Books, 1979.
4 D'Elia, G, Frederiksen, SO, Raotma, H, Widepalm, K. Comparison of fronto-frontal and temporo-parietal unilateral ECT. Acta Psychiatr Scand 1977; 56: 233–9.
5 American Psychiatric Association. Task Force on Electroconvulsive Therapy. The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging. APA, 2001.
6 Abrams, R. Electroconvulsive Therapy (4th edn). Oxford University Press, 2002.
7 Fink, M, Taylor, MA. Electroconvulsive therapy: evidence and challenges. JAMA 2007; 298: 330–2.
8 Letemendia, FJ, Delva, NJ, Rodenburg, M, Lawson, JS, Inglis, J, Waldron, JJ, et al. Therapeutic advantage of bifrontal electrode placement in ECT. Psychol Med 1993; 23: 349–60.
9 Sackeim, HA, Prudic, J, Devanand, DP, Nobler, MS, Lisanby, SH, Peyser, S, et al. A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities. Arch Gen Psychiatry 2000; 57: 425–34.
10 Sackeim, HA, Prudic, J, Devanand, DP, Kiersky, JE, Fitzsimons, L, Moody, BJ, et al. Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. N Engl J Med 1993; 328: 839–46.
11 Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet 2003; 361: 799808.
12 McCall, WV, Reboussin, DM, Weiner, RD, Sackeim, HA. Titrated moderately suprathreshold vs fixed high-dose right unilateral electroconvulsive therapy: acute antidepressant and cognitive effects. Arch Gen Psychiatry 2000; 57: 438–44.
13 Bailine, SH, Rifkin, A, Kayne, E, Selzer, JA, Vital-Herne, J, Blieka, M, et al. Comparison of bifrontal and bitemporal ECT for major depression. Am J Psychiatry 2000; 157: 121–3.
14 Sackeim, HA. Memory and ECT: from polarization to reconciliation. J ECT 2000; 16: 8796.
15 Fink, M. Electroshock: Restoring the Mind. Oxford University, 1999.
16 Shorter, E, Healy, D. Shock Therapy: A History of Electroconvulsive Treatment in Mental Illness. Rutgers University Press, 2007.
17 Prudic, J. Strategies to minimize cognitive side effects with ECT: aspects of ECT technique. J ECT 2008; 24: 4651.
18 Petrides, G, Fink, M, Husain, MM, Knapp, RG, Rush, AJ, Mueller, M, et al. ECT remission rates in psychotic versus nonpsychotic depressed patients: a report from CORE. J ECT 2001; 17: 244–53.
19 Kellner, CH, Knapp, RG, Petrides, G, Rummans, TA, Husain, MM, Rasmussen, K, et al. Continuation electroconvulsive therapy vs pharmacotherapy for relapse prevention in major depression: a multisite study from the Consortium for Research in Electroconvulsive Therapy (CORE). Arch Gen Psychiatry 2006; 63: 1337–44.
20 First, MB, Spitzer, RL, Gibbon, M, Williams, JBW. Structured Clinical Interview for Axis I DSM–IV Disorders – Patient Edition (SCID–I/P, Version 2.0). Biometrics Research Department, 1995.
21 Hamilton, M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23: 5662.
22 Folstein, MF, Folstein, SE, McHugh, PR. ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatric Res 1975; 12: 189–98.
23 d'Elia, G. Unilateral electroconvulsive therapy. Acta Psychiatr Scand Suppl 1970; 215: 198.
24 Rey, A. L'Examen Clinique en Psychologie. Press Universitaire de France, 1964.
25 Schmidt, M. Rey Auditory Verbal Learning Test: A Handbook. Western Psychological Services, 1996.
26 Taylor, LB. Localisation of cerebral lesions by psychological testing. Clin Neurosurg 1969; 16: 269–87.
27 Rey, A, Osterrieth, PA. Translations of excerpts from Andre Rey's ‘Psychological examination of traumatic encephalopathy’ and PA Osterrieth's ‘The complex figure test’ (J Corwin, FW Bylsma, trans). Clin Neuropsychol 1993; 7: 321.
28 Sackeim, HA, Prudic, J, Devanand, DP, Kiersky, JF, Fitzsimons, L, Moody, BJ, et al. Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. New Engl J Med 1993; 328: 839–46.
29 Reitan, RM. Trail Making Test. Reitan Neuropsychological Laboratory, 1979.
30 Benton, AL, Hamsher, K. Multilingual Aphasia Examination. AJA Associates, 1983.
31 Stroop, JR. Studies of interference in serial verbal reaction. J Exp Psychol 1935; 18: 643–62.
32 Golden, CJ, Freshwater, SM. The Stroop Color and Word Test: A Manual for Clinical and Experimental Uses. Stoelting Co, 2002.
33 Strauss, E, Sherman, EMS, Spreen, O. A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary. Oxford University Press, 2006.
34 Delis, DC, Kaplan, E, Kramer, J. The D–KEFS Sorting Test. The Psychological Corporation, 2001.
35 Wilkinson, GS. Wide Range Achievement Test (WRAT-3) Administration Manual. Wide Range Inc, 1993.
36 Sobin, C, Sackeim, HA, Prudic, J, Devanand, DP, Moody, BJ, McElhlney, MC. Predictors of retrograde amnesia following ECT. Am J Psychiatry 1995; 152: 9951001.
37 Guy, W. ECDEU Assessment Manual for Psychopharmacology. Superintendent of Documents, US Government Printing Office, US Department of Health, Education and Welfare Publication, 1976.
38 Hedeker, D, Gibbons, RD. Longitudinal Data Analysis. John Wiley and Sons, 2006.
39 Sackeim, HA, Prudic, J, Nobler, MS, Fitzsimons, L, Lisanby, SH, Payne, N, et al. Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. Brain Stim 2008; 1: 7183.
40 Lisanby, SH, Devanand, DP, Nobler, MS, Prudic, J, Mullen, L, Sackeim, HA. Exceptionally high seizure threshold: ECT device limitations. Convuls Ther 1996; 12: 156–64.
41 Keisling, R. Successful treatment of an unidentified patient with one ECT. Am J Psychiatry 1984; 141: 148.
42 Rich, CL. Recovery from depression after one ECT. Am J Psychiatry 1984; 141: 1010–1.
43 Thomas, SG, Kellner, CH. Remission of major depression and obsessive-compulsive disorder after a single unilateral ECT. J ECT 2003; 19: 50–1.
44 McCall, WV, Dunn, A, Rosenquist, PB, Hughes, D. Markedly suprathreshold right unilateral ECT versus minimally suprathreshold bilateral ECT: antidepressant and memory effects. J ECT 2002; 18: 126–9.

Related content

Powered by UNSILO

Bifrontal, bitemporal and right unilateral electrode placement in ECT: randomised trial

  • Charles H. Kellner (a1), Rebecca Knapp (a2), Mustafa M. Husain (a3), Keith Rasmussen (a4), Shirlene Sampson (a4), Munro Cullum (a3), Shawn M. McClintock (a3), Kristen G. Tobias (a1), Celena Martino (a5), Martina Mueller (a2), Samuel H. Bailine (a6), Max Fink (a7) and Georgios Petrides (a8)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.