title: Clinical efficacy of formula-based bifrontal versus right unilateral electroconvulsive therapy (ECT) in the treatment of major depression among elderly patients: a pragmatic, randomized, assessor-blinded, controlled trial.
abstract: BACKGROUND
  No prior study has compared the efficacy of bifrontal (BF) vs right unilateral (RUL) electroconvulsive therapy (ECT) by including the subgroup that is most likely to receive it: only elderly patients with major depression (MD).
  
  
  METHODS
  This single-site, randomized, assessor-blinded, controlled trial was conducted from 2009 to 2013. Seventy-three elderly patients with MD, unipolar and bipolar, were treated with a course of formula-based BF ECT or RUL ECT. The 17-item Hamilton Rating Scale for Depression (HRSD17) was used to measure efficacy. Safety was assessed with the Mini Mental State Examination (MMSE).
  
  
  RESULTS
  Both electrode placements resulted in highly significant downward trends in symptom severity (all p<0.001), with a non-significant difference between methods (p=0.703). At the end of the ECT course, response rates for the BF and RUL group were 63.9% and 67.6%, respectively. Short-term remission, defined as an HRSD17 score≤7, was achieved in 14 (38.9%) patients in the BF group and 19 (51.4%) patients in the RUL group. Global cognitive function, as measured by the MMSE, did not deteriorate in the two treatment groups.
  
  
  CONCLUSIONS
  The small number of subjects may have led to reduced power to detect real differences. The MMSE is not sufficient to ascertain the negative effect of ECT on cognition.
  
  
  CONCLUSIONS
  This study indicates that formula-based BF and RUL ECT are equally efficacious, and that remission rates of formula-based dosing are lower than those previously reported for titrated dosing, in a clinical sample of elderly patients with MD.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01559324.
authors.affiliation: Diakonhjemmet Hospital, Department of Geriatric Psychiatry, Pastor Fangens vei 18, 0854 Oslo, Norway. Electronic address: tormagne.bjolseth@diakonsyk.no.
authors.forename: Tor Magne
authors.initials: TM
authors.lastname: Bjølseth
authors.affiliation: Norwegian Centre for Aging and Health, Vestfold Health Trust, Tønsberg, Norway.
authors.forename: Knut
authors.initials: K
authors.lastname: Engedal
authors.affiliation: Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway; HØKH, Research Centre, Akershus University Hospital, Norway.
authors.forename: Jūratė Šaltytė
authors.initials: JŠ
authors.lastname: Benth
authors.affiliation: Diakonhjemmet Hospital, Department of Geriatric Psychiatry, Pastor Fangens vei 18, 0854 Oslo, Norway.
authors.forename: Gro Strømnes
authors.initials: GS
authors.lastname: Dybedal
authors.affiliation: Diakonhjemmet Hospital, Department of Geriatric Psychiatry, Pastor Fangens vei 18, 0854 Oslo, Norway.
authors.forename: Torfinn Lødøen
authors.initials: TL
authors.lastname: Gaarden
authors.affiliation: Department of Research and Development in Mental Health, Akershus University Hospital, Norway.
authors.forename: Lars
authors.initials: L
authors.lastname: Tanum
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition / Q000502:physiology; D003865:Major Depressive Disorder / Q000523:psychology / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005625:Frontal Lobe / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010352:Patient Dropouts; D012074:Remission Induction; D016037:Single-Blind Method; D016896:Treatment Outcome
keywords: Bifrontal ECT; Electroconvulsive therapy; Major depression; Old age; Right unilateral ECT; Treatment efficacy