title: Bitemporal v. high-dose right unilateral electroconvulsive therapy for depression: a systematic review and meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Brief-pulse electroconvulsive therapy (ECT) is the most acutely effective treatment for severe depression though concerns persist about cognitive side-effects. While bitemporal electrode placement is the most commonly used form worldwide, right unilateral ECT causes less cognitive side-effects though historically it has been deemed less effective. Several randomized trials have now compared high-dose (>5× seizure threshold) unilateral ECT with moderate-dose (1.0-2.5× seizure threshold) bitemporal ECT to investigate if it is as effective as bitemporal ECT but still has less cognitive side-effects. We aimed to systematically review these trials and meta-analyse clinical and cognitive outcomes where appropriate.
  
  
  METHODS
  We searched PubMed, PsycINFO, Web of Science, Cochrane Library and EMBASE for randomized trials comparing these forms of ECT using the terms 'electroconvulsive' OR 'electroshock' AND 'trial'.
  
  
  RESULTS
  Seven trials (n = 792) met inclusion criteria. Bitemporal ECT did not differ from high-dose unilateral ECT on depression rating change scores [Hedges's g = -0.03, 95% confidence interval (CI) -0.17 to 0.11], remission (RR 1.06, 95% CI 0.93-1.20), or relapse at 12 months (RR 1.42, 95% CI 0.90-2.23). There was an advantage for unilateral ECT on reorientation time after individual ECT sessions (mean difference in minutes = -8.28, 95% CI -12.86 to -3.70) and retrograde autobiographical memory (Hedges's g = -0.46, 95% CI -0.87 to -0.04) after completing an ECT course. There were no differences for general cognition, category fluency and delayed visual and verbal memory.
  
  
  CONCLUSIONS
  High-dose unilateral ECT does not differ from moderate-dose bitemporal ECT in antidepressant efficacy but has some cognitive advantages.
authors: Department of Psychiatry,Trinity College Dublin,St Patrick's University Hospital,Dublin,Ireland.
authors: E
authors: E
authors: Kolshus
authors: Department of Psychiatry,Trinity College Dublin,St Patrick's University Hospital,Dublin,Ireland.
authors: A
authors: A
authors: Jelovac
authors: Department of Psychiatry,Trinity College Dublin,St Patrick's University Hospital,Dublin,Ireland.
authors: D M
authors: DM
authors: McLoughlin
mesh_terms: D003866:Depressive Disorder / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*
keywords: Depression; electroconvulsive therapy; electrode placement; meta-analysis