Clinical efficacy and cognitive side effects of bifrontal versus right unilateral electroconvulsive therapy (ECT): a short-term randomised controlled trial in pharmaco-resistant major depression.
BACKGROUND
In most studies right unilateral electroconvulsive therapy (ECT) has been shown to cause fewer cognitive side effects but less antidepressant efficacy compared with bi(fronto)temporal ECT at certain intensities.


OBJECTIVE
To compare the short-term efficacy and side effects of right unilateral ECT and bifrontal ECT.


METHODS
In a double-blind randomised controlled clinical trial, 92 patients diagnosed with pharmaco-resistant major depression received either six right unilateral ECT treatments (250% stimulus intensity of titrated threshold) or six bifrontal ECT (150% of threshold) treatments over a 3-week period. Concomitant psychotropic medications were continued during ECT treatments. The severity of depression and cognitive status was assessed prior to the first ECT and one day after the sixth ECT using the 21-item Hamilton Depression Rating Scale and the modified Mini Mental State Examination.


RESULTS
Eight patients did not complete the course of the study due to minor side effects or withdrawal of consent. The mean Hamilton Depression score decreased from 27 to 17 points in both groups of 46 patients, resulting in 12 responders (primary endpoint defined as a decrease >50%) in each patient group (95% confidence interval for the odds ratio from 0.35 to 2.8). There was no reduction in the modified Mini Mental State score (mean score 86 of 100 points).


CONCLUSIONS
Both bifrontal and right unilateral electrode placements in ECT were reasonably safe and moderately efficacious in reducing symptoms of pharmaco-resistant major depression.
Eschweiler
Gerhard W
GW
Department of Psychiatry and Psychotherapy, Eberhard-Karls University Tuebingen, Germany. gerhard.eschweiler@med.uni-tuebingen.de
Vonthein
Reinhard
R
Bode
Ruediger
R
Huell
Michael
M
Conca
Andreas
A
Peters
Oliver
O
Mende-Lechler
Stefan
S
Peters
Julia
J
Klecha
Dorothee
D
Prapotnik
Michael
M
DiPauli
Jan
J
Wild
Barbara
B
Plewnia
Christian
C
Bartels
Mathias
M
Schlotter
Wilfried
W
D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D003071:Cognition / Q000502:physiology*; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D004292:Dominance, Cerebral / Q000502:physiology*; D004311:Double-Blind Method; D004351:Drug Resistance; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D009483:Neuropsychological Tests; D010552:Personality Assessment; D011446:Prospective Studies; D016896:Treatment Outcome
D000928:Antidepressive Agents