Clinical efficacy and cognitive side effects of bifrontal versus right unilateral electroconvulsive therapy (ECT): a short-term randomised controlled trial in pharmaco-resistant major depression.

BACKGROUND: In most studies right unilateral electroconvulsive therapy (ECT) has been shown to cause fewer cognitive side effects but less antidepressant efficacy compared with bi(fronto)temporal ECT at certain intensities. AIMS: To compare the short-term efficacy and side effects of right unilateral ECT and bifrontal ECT. METHODS: In a double-blind randomised controlled clinical trial, 92 patients diagnosed with pharmaco-resistant major depression received either six right unilateral ECT treatments (250% stimulus intensity of titrated threshold) or six bifrontal ECT (150% of threshold) treatments over a 3-week period. Concomitant psychotropic medications were continued during ECT treatments. The severity of depression and cognitive status was assessed prior to the first ECT and one day after the sixth ECT using the 21-item Hamilton Depression Rating Scale and the modified Mini Mental State Examination. RESULTS: Eight patients did not complete the course of the study due to minor side effects or withdrawal of consent. The mean Hamilton Depression score decreased from 27 to 17 points in both groups of 46 patients, resulting in 12 responders (primary endpoint defined as a decrease >50%) in each patient group (95% confidence interval for the odds ratio from 0.35 to 2.8). There was no reduction in the modified Mini Mental State score (mean score 86 of 100 points). CONCLUSIONS: Both bifrontal and right unilateral electrode placements in ECT were reasonably safe and moderately efficacious in reducing symptoms of pharmaco-resistant major depression.

Simultaneous pattern of rCBF and rCMRGlu in continuation ECT: case reports.

This report presents the simultaneous pattern of cerebral blood flow and cerebral glucose metabolism in two patients with a major depressive disorder who were undergoing continuation ECT. The regional cerebral blood flow and regional cerebral metabolic rate of these patients were imaged using double isotope 18F-FDG and 99mTc-HMPAO single-photon emission computed tomography before acute ECT and after the completion of continuation ECT; bilateral electrode placement (11 and 12 sessions, respectively) was chosen for the acute treatment course whereas unilateral placement was the method chosen during the continuation phase (6 and 7 sessions, respectively). Baseline SPECT scans of our patients, who continued to receive treatment with medication, were normal as compared with controls; however, scans at the end of continuation ECT revealed decreased uptake activities of both isotopes in prefrontal regions on both sides, which might be associated with the therapeutic impact and efficacy. These results are consistent with previous brain imaging studies of acute ECT. Furthermore, marked changes in both basal ganglia regions were found. The pattern of the isotope uptake ratios did not show any similarities to neurodegenerative processes, which might confirm the high safety profile of ECT also during the continuation phase of treatment.

[Adverse cognitive effects and ECT]. / Kognitive Störungen und Elektrokrampftherapie.

Electroconvulsive therapy (ECT) is a rapidly acting and highly effective treatment for severe and life threatening conditions seen in affective and schizophrenic diseases. Notwithstanding its therapeutic benefits, ECT remains controversial because of seizure induction, cognitive side effects, memory dysfunction and effects on cerebral physiology. These factors have raised the concern that ECT produces structural and functional brain damages. This issue continues to have a major impact on the acceptance of ECT as a therapeutic modality, both within the medical community and in public opinion. A close look at incidence, type, severity, neurofunctional and -anatomical correlates, aetiology and therapeutic approaches of the adverse cognitive effects attributed to ECT may contribute to rational and objective handling of this topic. The final chapter deals with the issue of whether ECT causes brain damage.