Cited by 432Electroconvulsive Therapy StudiesTreatment of Major DepressionTranscranial Magnetic Stimulation Studies

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Bifrontal, bitemporal and right unilateral electrode placement in ECT: randomised trial

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Kellner, Charles H., Knapp, Rebecca, Husain, Mustafa M., Rasmussen, Keith, Sampson, Shirlene, Cullum, Munro, McClintock, Shawn M., Tobias, Kristen G., Martino, Celena, Mueller, Martina, Bailine, Samuel H., Fink, Max, Petrides, Georgios·2010·British Journal of Psychiatry

DOI 10.1192/bjp.bp.109.066183PMC PMC2830057

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Abstract

Background: Electroconvulsive therapy (ECT) is an effective treatment for major depression. Optimising efficacy and minimising cognitive impairment are goals of ongoing technical refinements. Aims: To compare the efficacy and cognitive effects of a novel electrode placement, bifrontal, with two standard electrode placements, bitemporal and right unilateral in ECT. Method: 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.

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Authors: Kellner, C. H., Knapp, R., Husain, M. M., Rasmussen, K., Sampson, S., Cullum, M., McClintock, S. M., Tobias, K. G., Martino, C., Mueller, M., Bailine, S. H., Fink, M., & Petrides, G.
Affiliations: Icahn School of Medicine at Mount Sinai (US)
Medical University of South Carolina (US)
The University of Texas Southwestern Medical Center (US)
Mayo Clinic (US)
Rutgers New Jersey Medical School (US)
Northwell Health (US)
Stony Brook University (US)
Corresponding author: Kellner, Charles H.
ORCID: Kellner, Charles H.
Knapp, Rebecca
Husain, Mustafa M.
Sampson, Shirlene
McClintock, Shawn M.
Mueller, Martina
Fink, Max
Venue: British Journal of Psychiatry
Publisher: Royal College of Psychiatrists
Published: 2010-03
Volume: 196
Issue: 3
Pages: 226-234
ISSN: 0007-1250 (ISSN-L)
1472-1465
DOI: 10.1192/bjp.bp.109.066183
PMC: PMC2830057
OpenAlex: W2149516065
Cited by: 432
References: 52
Citations by year: 2026: 19 · 2025: 20 · 2024: 28 · 2023: 18 · 2022: 22 · 2021: 40 · 2020: 30 · 2019: 39 · 2018: 13 · 2017: 33 · 2016: 36 · 2015: 27 · 2014: 18 · 2013: 17 · 2012: 24
FWCI: 19.19
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.cambridge.org/core/terms (unspecified, 2864 d)
Locations: The British Journal of Psychiatry (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: AstraZeneca
National Institute of Mental Health
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
Keywords: electroconvulsive therapy, electrode placement, major depressive disorder, bipolar disorder, seizure threshold, antidepressant efficacy, cognitive impairment, neuropsychological outcomes
MeSH terms: Adult, Aged, Aged, 80 and over, Cognition, Cognition Disorders, Major Depressive Disorder, Double-Blind Method, Electroconvulsive Therapy, Electrodes, Female, Humans, Male, Middle Aged, Neuropsychological Tests, Psychiatric Status Rating Scales, Remission Induction, Seizures, Severity of Illness Index, Outcome Assessment, Health Care, Young Adult

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Bifrontal, bitemporal and right unilateral electrode placement in ECT: randomised trial

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