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={E. Kolshus and A. Jelovac and D. 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… Expand
Letter to the Editor: Electrode placement in electroconvulsive therapy – bilateral is still the ‘gold standard’ for some patients: a reply
TLDR
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. Expand
Letter to the Editor: Electrode placement in electroconvulsive therapy – bilateral is still the ‘gold standard’ for some patients
TLDR
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. Expand
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TLDR
Formula-based RUL ECT does not differ from BT in antidepressant efficacy and has an advantage in terms of safety (lower incidence of increased blood pressure and fewer disturbances of consciousness) and tolerability (impact on cognitive functions). Expand
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.
TLDR
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. Expand
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In the largest samples of E CT nonresponders studied to date, a second course of ECT had marked antidepressant effects, and since the therapeutic effects were independent of the technique first administered, it is possible that many patients may benefit simply from longer courses of EECT. Expand
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TLDR
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. Expand
The left anterior right temporal (LART) placement for electroconvulsive therapy: A computational modelling study
TLDR
The original LART placement is a promising montage for further clinical investigation, and two novel variants (LART - F3 and LART - Frontal) compared to the more common bilateral placements of bitemporal and bifrontal ECT are explored. Expand
Ketamine Versus Midazolam for Depression Relapse Prevention Following Successful Electroconvulsive Therapy: A Randomized Controlled Pilot Trial.
TLDR
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. Expand
I know not ‘seems’
  • D. McLoughlin
  • Medicine
  • The Australian and New Zealand journal of psychiatry
  • 2018
TLDR
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. Expand
ECT non-remitters: prognosis and treatment after 12 unilateral electroconvulsive therapy sessions for major depression.
TLDR
When patients with major depression do not achieve remission after 12 RUL ECT sessions, they have still a reasonable chance of remission within 6 months, and continuing ECT has the best chance of success. Expand
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