Systematic review and meta-analysis of bifrontal electroconvulsive therapy versus bilateral and unilateral electroconvulsive therapy in depression

Abstract

Objectives. Our aim was to perform a meta-analysis of randomized controlled trials comparing efficacy and side effects of bifrontal (BF) ECT to bitemporal (BT) or unilateral (RUL) ECT in depression. Methods. We performed a systematic review of randomized controlled trials comparing BF ECT with RUL or BT ECT in depression. Eight trials (n = 617) reported some cognitive outcome. Efficacy was measured by reduction in Hamilton Depression Rating Scale score. Cognitive outcomes were limited to Mini-Mental State Examination (MMSE) in seven studies, with two studies measuring each of: Complex-figure delayed recall, Trail-making tests and verbal learning. Results. Efficacy was equal between BF and BT ECT (Hedges's g = 0.102, P = 0.345, confidence interval (CI): –0.110, 0.313) and BF and RUL ECT (standardized mean difference = –0.12, P = 0.365, CI: –0.378, 0.139). Post-treatment MMSE score decline was less for BF than BT ECT (g = 0.89, CI: 0.054, 1.724) but not RUL ECT. RUL ECT impaired Complex figure recall more than BF ECT (g = 0.76, CI :0.487, 1.035), but BF ECT impaired word recall more than RUL ECT (g = –1.45, CI: –2.75, –0.15). Conclusions. Bifrontal ECT is not more effective than BT or RUL ECT but may have modest short-term benefits for specific memory domains. BF ECT has potential advantages, but given longer experience with BT and RUL, bifrontal ECT requires better characterization.

Key words::

• Meta-analysis
• bifrontal
• electroconvulsive
• depression
• antidepressant

Acknowledgements

Our work is funded by the Health Research Board and the St. Patrick's Hospital Foundation. The authors wish to thank Dr J.S. Lawson for his assistance in retrieval of original trial data, Professor Leon Gleser for his advice in setting up the regression analysis and Professor J.F. Deakin for providing details of the Northwick Park ECT study that clarified electrode placement.

Statement of Interest

None to declare.