Bifrontal, bitemporal and right unilateral electrode placement in ECT

Randomised trial

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

Research output: Contribution to journalArticle

213 Citations (Scopus)

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 43-46%) 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.

Original languageEnglish (US)
Pages (from-to)226-234
Number of pages9
JournalBritish Journal of Psychiatry
Volume196
Issue number3
DOIs
StatePublished - Mar 2010

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Electroconvulsive Therapy
Electrodes
Seizures
Antidepressive Agents
Depressive Disorder
Bipolar Disorder
Depression

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Bifrontal, bitemporal and right unilateral electrode placement in ECT : Randomised trial. / 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.

In: British Journal of Psychiatry, Vol. 196, No. 3, 03.2010, p. 226-234.

Research output: Contribution to journalArticle

Kellner, CH, Knapp, R, Husain, MM, Rasmussen, K, Sampson, S, Cullum, M, McClintock, SM, Tobias, KG, Martino, C, Mueller, M, Bailine, SH, Fink, M & Petrides, G 2010, 'Bifrontal, bitemporal and right unilateral electrode placement in ECT: Randomised trial', British Journal of Psychiatry, vol. 196, no. 3, pp. 226-234. https://doi.org/10.1192/bjp.bp.109.066183
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. / Bifrontal, bitemporal and right unilateral electrode placement in ECT : Randomised trial. In: British Journal of Psychiatry. 2010 ; Vol. 196, No. 3. pp. 226-234.
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AU - Knapp, Rebecca

AU - Husain, Mustafa M.

AU - Rasmussen, Keith

AU - Sampson, Shirlene

AU - Cullum, Munro

AU - McClintock, Shawn M.

AU - Tobias, Kristen G.

AU - Martino, Celena

AU - Mueller, Martina

AU - Bailine, Samuel H.

AU - Fink, Max

AU - Petrides, Georgios

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