title: Bifrontal, bitemporal and right unilateral electrode placement in ECT: randomised trial.
abstract: BACKGROUND
  Electroconvulsive therapy (ECT) is an effective treatment for major depression. Optimising efficacy and minimising cognitive impairment are goals of ongoing technical refinements.
  
  
  OBJECTIVE
  To compare the efficacy and cognitive effects of a novel electrode placement, bifrontal, with two standard electrode placements, bitemporal and right unilateral in ECT.
  
  
  METHODS
  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.
authors.affiliation: Department of Psychiatry, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA. charles.kellner@mssm.edu
authors.forename: Charles H
authors.initials: CH
authors.lastname: Kellner
authors.forename: Rebecca
authors.initials: R
authors.lastname: Knapp
authors.forename: Mustafa M
authors.initials: MM
authors.lastname: Husain
authors.forename: Keith
authors.initials: K
authors.lastname: Rasmussen
authors.forename: Shirlene
authors.initials: S
authors.lastname: Sampson
authors.forename: Munro
authors.initials: M
authors.lastname: Cullum
authors.forename: Shawn M
authors.initials: SM
authors.lastname: McClintock
authors.forename: Kristen G
authors.initials: KG
authors.lastname: Tobias
authors.forename: Celena
authors.initials: C
authors.lastname: Martino
authors.forename: Martina
authors.initials: M
authors.lastname: Mueller
authors.forename: Samuel H
authors.initials: SH
authors.lastname: Bailine
authors.forename: Max
authors.initials: M
authors.lastname: Fink
authors.forename: Georgios
authors.initials: G
authors.lastname: Petrides
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology; D003865:Major Depressive Disorder / Q000628:therapy*; D004311:Double-Blind Method; D004565:Electroconvulsive Therapy / Q000009:adverse effects / Q000379:methods*; D004566:Electrodes; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales; D012074:Remission Induction / Q000379:methods; D012640:Seizures; D012720:Severity of Illness Index; D055815:Young Adult