Bifrontal versus right unilateral and bitemporal electroconvulsive therapy in major depressive disorder

OBJECTIVES: We sought to evaluate the safety and efficacy of three electroconvulsive therapy (ECT) methods: moderate-dose bifrontal, low-dose bitemporal, and high-dose right unilateral in the treatment of a major depressive episode. METHODS: In an 8-session, double-blinded parallel group study, 45 consecutive depressive patients who were referred for ECT to Noor Hospital were assigned randomly to bifrontal, moderate dose (50% above seizure threshold; n = 15); bitemporal, low dose (just above seizure threshold; n = 15); and right unilateral, high dose (400% above the seizure threshold; n = 15) ECT applications. Primary outcome measures included assessment by Mini-Mental State Examination and Hamilton Depression Rating Scale. RESULTS: Thirty-nine of the patients completed the course of treatment. Two patients in bifrontal, 1 in bitemporal, and 3 in right unilateral dropped out of the study. The 3 groups did not show any difference in baseline characteristics. There was a significant difference between standardized Mini-Mental State scores of patients in bifrontal group compared with bitemporal and right unilateral patients (P < 0.05). The effectiveness of the 3 ECT methods, assessed by Hamilton Depression Rating Scale, did not show any significant difference (P > 0.05). CONCLUSION: Moderate-dose bifrontal ECT revealed fewer cognitive side effects in comparison with bitemporal and right unilateral. Moderate-dose bifrontal ECT had the same efficacy compared with low-dose bitemporal and high-dose right unilateral in the treatment of depression.