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Bifrontal, bitemporal and right unilateral ECT electrode placement are similarly effective for reducing depressive symptoms

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Question

Question

How does the efficacy of the new method of bifrontal electrode placement for electroconvulsive therapy (ECT) compare with standard bitemporal or right unilateral placement in people with depression?

Patients

237 adults (age 20–87 years) with acute depression and a DSM-IV diagnosis of primary major depressive disorder or bipolar disorder, with or without psychosis, who had been referred for ECT.

Setting

Five Consortium for Research in ECT centres in the USA; 2001–2006.

Intervention

ECT three times a week using bifrontal, bitemporal or right unilateral placement of the electrodes. ECT was delivered using the Thymatron DGx ECT device, bifrontal and bitemporal at one and a half times seizure threshold, right unilateral at six times seizure threshold. Patients were treated until they achieved prespecified remission criteria (≥60% decrease from baseline in HRSD-24 total score; HRSD-24 ≤10 on two consecutive ratings; and HRSD-24 not changing >3 points on the last two consecutive treatments). Participants were classed as non-remitters if they received at least 10 sessions without meeting remission criteria.

Outcomes

Depressive symptoms (Hamilton Rating Scale for Depression, HRSD-24), remission (defined above), …

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