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Bifrontal, bitemporal and right unilateral electrode placement in ECT: randomised trial
Open accessAbstract
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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“Patients who fail repeated medication trials, hospitalisation, and psychotherapy sometimes go on to try neurostimulatory treatments, such as electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), or deep brain stimulation, all of which can be effective to some extent; but none are 100% effective.”
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Metadata
- 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
- 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
- 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
- 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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