Bifrontal versus right unilateral and bitemporal electroconvulsive therapy in major depressive disorder.
OBJECTIVE
We sought to evaluate the safety and efficacy of three electroconvulsive therapy (ECT) methods: moderate-dose bifrontal, low-dose bitemporal, and high-dose right unilateral in the treatment of a major depressive episode.


METHODS
In an 8-session, double-blinded parallel group study, 45 consecutive depressive patients who were referred for ECT to Noor Hospital were assigned randomly to bifrontal, moderate dose (50% above seizure threshold; n = 15); bitemporal, low dose (just above seizure threshold; n = 15); and right unilateral, high dose (400% above the seizure threshold; n = 15) ECT applications. Primary outcome measures included assessment by Mini-Mental State Examination and Hamilton Depression Rating Scale.


RESULTS
Thirty-nine of the patients completed the course of treatment. Two patients in bifrontal, 1 in bitemporal, and 3 in right unilateral dropped out of the study. The 3 groups did not show any difference in baseline characteristics. There was a significant difference between standardized Mini-Mental State scores of patients in bifrontal group compared with bitemporal and right unilateral patients (P < 0.05). The effectiveness of the 3 ECT methods, assessed by Hamilton Depression Rating Scale, did not show any significant difference (P > 0.05).


CONCLUSIONS
Moderate-dose bifrontal ECT revealed fewer cognitive side effects in comparison with bitemporal and right unilateral. Moderate-dose bifrontal ECT had the same efficacy compared with low-dose bitemporal and high-dose right unilateral in the treatment of depression.
Ranjkesh
Farzad
F
Department of Psychiatry, Noor University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran. ranjkesh@resident.mui.ac.ir
Barekatain
Majid
M
Akuchakian
Shahla
S
D000328:Adult; D016009:Chi-Square Distribution; D003865:Major Depressive Disorder / Q000628:therapy*; D004311:Double-Blind Method; D004565:Electroconvulsive Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D018709:Statistics, Nonparametric; D016896:Treatment Outcome