Bifrontal Versus Right Unilateral and Bitemporal Electroconvulsive Therapy in Major Depressive Disorder

Ranjkesh, Fatemeh; Barekatain, Majid; Akuchakian, Shahla

doi:10.1097/01.yct.0000187041.79087.59

Cited by 55 publications

(34 citation statements)

References 13 publications

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“…Our findings for the primary outcome, the 24-item HAM-D score, are consistent with results of previous, nonpragmatic, thrice-weekly efficacy trials (8)(9)(10)(11)(12)(13). However, the overall remission rate (44.2%) was lower than the rate in some trials (range: 46%265%) (8, 9, 11-13) but similar to that in a large community study (46.7%) (33), while the overall 6-month relapse rate (31.1%) was at the lower limit reported in a recent meta-analysis of post-ECT relapse (26).…”

Section: Discussionsupporting

confidence: 81%

“…High-dose is more effective than low-dose ECT but more adversely affects memory (2,7). However, efficacy trials (8)(9)(10)(11)(12)(13) have demonstrated that unilateral ECT can be as effective as bitemporal ECT if delivered in high doses at multiples (e.g., 53-83) of seizure threshold, the minimum charge required to induce the generalized seizure needed for therapeutic effect.…”

mentioning

confidence: 99%

“…Relevant trials of brief-pulse (i.e., 1.0 msec-1.5 msec pulse width) ECT have obtained inconsistent results: some show comparable cognitive performance following highdose (53-83 threshold) unilateral ECT with reference to moderate-dose (1.03-1.53 threshold) bitemporal ECT (9,10,13), while others demonstrate less cognitive decline following high-dose (63 threshold) unilateral ECT (8,11,12), although the latter studies mostly compared it with higher-dose (2.53 threshold) bitemporal ECT that increases cognitive side effects (7). None of these studies were designed to determine unilateral noninferiority for antidepressant effect, and most had very limited follow-up.…”

mentioning

confidence: 99%

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Bitemporal Versus High-Dose Unilateral Twice-Weekly Electroconvulsive Therapy for Depression (EFFECT-Dep): A Pragmatic, Randomized, Non-Inferiority Trial

Semkovska¹,

Landau²,

Dunne³

et al. 2016

AJP

156

118

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Objective: ECT is the most effective treatment for severe depression. Previous efficacy studies, using thrice-weekly brief-pulse ECT, reported that high-dose (63 seizure threshold) right unilateral ECT is similar to bitemporal ECT but may have fewer cognitive side effects. The authors aimed to assess the effectiveness and cognitive side effects of twice-weekly moderate-dose (1.53 seizure threshold) bitemporal ECT with high-dose unilateral ECT in real-world practice.Method: This was a pragmatic, patient-and rater-blinded, noninferiority trial of patients with major depression (N=138; 63% female; age=56.7 years [SD=14.8]) in a national ECT service with a 6-month follow-up. Participants were independently randomly assigned to bitemporal or highdose unilateral ECT. The primary outcome was change in the 24-item Hamilton Depression Rating Scale (HAM-D) score after the ECT course; the prespecified noninferiority margin was 4.0 points. Secondary outcomes included response and remission rates, relapse status after 6 months, and cognition.Results: Of the eligible patients, 69 were assigned to bitemporal ECT and 69 to unilateral ECT. High-dose unilateral ECT was noninferior to bitemporal ECT regarding the 24-item HAM-D scores after the ECT course (mean difference=1.08 points in favor of unilateral ECT [95% CI=21.67 to 3.84]). There were no significant differences for response and remission or 6-month relapse status. Recovery of orientation was quicker following unilateral ECT (median=19.1 minutes versus 26.4 minutes). Bitemporal ECT was associated with a lower percent recall of autobiographical information (odds ratio=0.66) that persisted for 6 months.Conclusions: Twice-weekly high-dose unilateral ECT is not inferior to bitemporal ECT for depression and may be preferable because of its better cognitive side-effect profile.

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Section: Discussionsupporting

confidence: 81%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Bitemporal Versus High-Dose Unilateral Twice-Weekly Electroconvulsive Therapy for Depression (EFFECT-Dep): A Pragmatic, Randomized, Non-Inferiority Trial

Semkovska¹,

Landau²,

Dunne³

et al. 2016

AJP

156

118

View full text Add to dashboard Cite

show abstract

“…23 Other study randomized patients to three groups: moderate-dose BF-ECT (1.5 fold the CT), low-dose BT-ECT (immediately above the CT) and high-dose RUL-ECTL (five-fold the CT). 65 There was no significant difference regarding the efficacy to improve depressive symptoms (measured by the HRSD) between groups.…”

Section: Ect Techniques and Responsementioning

confidence: 85%

“…13 One study showed that patients who received moderate-dose BF-ECT showed higher Mini Mental scores when compared to patients who received high-dose RUL-ECT or low-dose BT-ECT. 65 …”

Section: Memory Deficit and Ect (Recent Studies)mentioning

confidence: 99%