Electroconvulsive therapy (ECT) is an effective treatment for major
depression. Optimising efficacy and minimising cognitive impairment are
goals of ongoing technical refinements.
To compare the efficacy and cognitive effects of a novel electrode
placement, bifrontal, with two standard electrode placements, bitemporal
and right unilateral in ECT.
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.
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.
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.