Bitemporal v. high-dose right unilateral electroconvulsive therapy for depression: a systematic review and meta-analysis of randomized controlled trials

@article{Kolshus2016BitemporalVH,
  title={Bitemporal v. high-dose right unilateral electroconvulsive therapy for depression: a systematic review and meta-analysis of randomized controlled trials},
  author={Erik Kolshus and Ana Jelovac and Declan M. McLoughlin},
  journal={Psychological Medicine},
  year={2016},
  volume={47},
  pages={518 - 530}
}
Background Brief-pulse electroconvulsive therapy (ECT) is the most acutely effective treatment for severe depression though concerns persist about cognitive side-effects. While bitemporal electrode placement is the most commonly used form worldwide, right unilateral ECT causes less cognitive side-effects though historically it has been deemed less effective. Several randomized trials have now compared high-dose (>5× seizure threshold) unilateral ECT with moderate-dose (1.0–2.5× seizure… 

Letter to the Editor: Electrode placement in electroconvulsive therapy – bilateral is still the ‘gold standard’ for some patients: a reply

Concerns are raised that these results are misleading at the individual patient level and the important issue of what to do if a patient does not respond sufficiently well to high-dose unilateral, or indeed bitemporal, ECT is highlighted.

Letter to the Editor: Electrode placement in electroconvulsive therapy – bilateral is still the ‘gold standard’ for some patients

There is no ‘“gold standard” form of ECT that suits every patient’s need’, and practitioners are advised to offer patients bilateral electrode placement when right unilateral is inadequately effective; meta-analytic data are helpful and important for revealing population trends; clinical judgment must still be exercised for optimum individual patient care.

Is There Evidence That Stimulus Parameters and Electrode Placement Affect the Cognitive Side Effects of Electroconvulsive Therapy in Patients With Schizophrenia and Schizoaffective Disorder?: A Systematic Review.

The evidence suggests that RUL or BF ECT have more favorable cognitive outcomes than BT ECT, and Definitive larger clinical trials are needed to optimize parameter and electrode placement selection to minimize adverse cognitive effects.

ECT: a new look at an old friend

Modern ECT is streamlined by augmentation with drugs, hyperventilation, optimizing anesthesia-ECT time interval, and various stimulus parameters guided by seizure adequacy markers, along with their impact on clinical outcomes.

Ketamine Versus Midazolam for Depression Relapse Prevention Following Successful Electroconvulsive Therapy: A Randomized Controlled Pilot Trial.

The proposed treatment protocol for ketamine for depression relapse prevention is not suitable for a definitive trial in this center, and information collected on reasons for dropout may inform future clinical trials of intravenous ketamine.

Duration of Treatment in Electroconvulsive Therapy Among Patients Beginning With Acute Course Right Unilateral Brief Pulse Stimuli

Among patients who begin treatment with RUL-BP ECT, more than 60% use exclusively those parameters throughout their acute course, and the overall number of treatments did not differ based on age or primary diagnosis.

I know not ‘seems’

  • D. McLoughlin
  • Psychology
    The Australian and New Zealand journal of psychiatry
  • 2018
It is better to avoid fixed-dose forms of ECT and risk under/over-dosing patients, and instead attempt to empirically establish each patient’s individual seizure threshold and tailor subsequent treatments to that, which dosing method is best for ECT.
...

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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.

A Systematic Review and Meta-Analysis of Brief Versus Ultrabrief Right Unilateral Electroconvulsive Therapy for Depression.

BP compared with UBP RUL ECT was slightly more efficacious in treating depression and required fewer treatment sessions, but led to greater cognitive side effects.

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

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Bifrontal ECT is not more effective than BT or RUL ECT but may have modest short-term benefits for specific memory domains and BF ECT has potential advantages, but given longer experience with BT and RUL, bif prefrontal ECT requires better characterization.

Titrated moderately suprathreshold vs fixed high-dose right unilateral electroconvulsive therapy: acute antidepressant and cognitive effects.

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Bifrontal, bitemporal and right unilateral electrode placement in ECT: randomised trial

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High-dose, right-sided, unilateral ECT is at least equivalent to moderate-dosage bilateral ECT in efficacy, but retains advantages with respect to cognitive adverse effects.
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