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Bifrontal, bitemporal and right unilateral electrode placement in ECT: randomised trial.
- Source :
-
The British journal of psychiatry : the journal of mental science [Br J Psychiatry] 2010 Mar; Vol. 196 (3), pp. 226-34. - Publication Year :
- 2010
-
Abstract
- Background: Electroconvulsive therapy (ECT) is an effective treatment for major depression. Optimising efficacy and minimising cognitive impairment are goals of ongoing technical refinements.<br />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.<br />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.<br />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.<br />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.
- Subjects :
- Adult
Aged
Aged, 80 and over
Cognition Disorders diagnosis
Cognition Disorders etiology
Double-Blind Method
Electroconvulsive Therapy adverse effects
Electrodes
Female
Humans
Male
Middle Aged
Neuropsychological Tests
Outcome Assessment, Health Care statistics & numerical data
Psychiatric Status Rating Scales
Remission Induction methods
Seizures
Severity of Illness Index
Young Adult
Cognition physiology
Depressive Disorder, Major therapy
Electroconvulsive Therapy methods
Subjects
Details
- Language :
- English
- ISSN :
- 1472-1465
- Volume :
- 196
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- The British journal of psychiatry : the journal of mental science
- Publication Type :
- Academic Journal
- Accession number :
- 20194546
- Full Text :
- https://doi.org/10.1192/bjp.bp.109.066183