Magazine article Clinical Psychiatry News

Depression Unaffected by ECT Configuration

Magazine article Clinical Psychiatry News

Depression Unaffected by ECT Configuration

Article excerpt

HOLLYWOOD, FLA. -- Placement configuration of the electrodes for electroconvulsive therapy does not make a significant difference in outcomes for older adults with major depression, according to preliminary findings from a study sponsored by the National Institute of Mental Health.

Dr. Charles H. Kellner and his colleagues in the Consortium for Research in Electroconvulsive Therapy (CORE) randomized 230 patients with unipolar or bipolar depression to bifrontal, bitemporal, or right unilateral electroconvulsive therapy (ECT) electrode placement. A total of 81 people were randomized to a bifrontal pattern, 72 people to bifrontal, and 77 others to right unilateral. Participants received ECT three times per week. Dose titration of the ECT was performed at the first session. Subsequent dosing was 1.5 times the seizure threshold for bifrontal and bitemporal placements and 6 times the threshold for right unilateral electrode placement.

Outcomes included depression symptom response, remission rates, and any effect on cognition.

Of those depression patients randomized to bifrontal ECT, 79% responded, as did 82% of the bitemporal group and 73% of the right unilateral group.

There were no significant differences in cognitive outcomes on the neuropsychiatric batteries used in the study. "It was a surprise that we failed to show a difference between the three placement groups," Dr. Kellner said.

Remissions occurred for 61% with bifrontal placement, 64% with bitemporal, and 55% with a right unilateral configuration. The differences were not statistically significant. All three configurations effectively improved symptoms, compared with a baseline mean Hamilton Depression Scale score of 35.

"This was a very sick cohort of patients," observed Dr. Kellner, a geriatric psychiatrist in the behavioral health sciences department at the University of Medicine and Dentistry of New Jersey in Newark. …

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