Clinical efficacy of formula-based bifrontal versus right unilateral electroconvulsive therapy (ECT) in the treatment of major depression among elderly patients: a pragmatic, randomized, assessor-blinded, controlled trial

BACKGROUND

No prior study has compared the efficacy of bifrontal (BF) vs right unilateral (RUL) electroconvulsive therapy (ECT) by including the subgroup that is most likely to receive it: only elderly patients with major depression (MD).

METHODS

This single-site, randomized, assessor-blinded, controlled trial was conducted from 2009 to 2013. Seventy-three elderly patients with MD, unipolar and bipolar, were treated with a course of formula-based BF ECT or RUL ECT. The 17-item Hamilton Rating Scale for Depression (HRSD17) was used to measure efficacy. Safety was assessed with the Mini Mental State Examination (MMSE).

RESULTS

Both electrode placements resulted in highly significant downward trends in symptom severity (all p<0.001), with a non-significant difference between methods (p=0.703). At the end of the ECT course, response rates for the BF and RUL group were 63.9% and 67.6%, respectively. Short-term remission, defined as an HRSD17 score≤7, was achieved in 14 (38.9%) patients in the BF group and 19 (51.4%) patients in the RUL group. Global cognitive function, as measured by the MMSE, did not deteriorate in the two treatment groups.

LIMITATIONS

The small number of subjects may have led to reduced power to detect real differences. The MMSE is not sufficient to ascertain the negative effect of ECT on cognition.

CONCLUSIONS

This study indicates that formula-based BF and RUL ECT are equally efficacious, and that remission rates of formula-based dosing are lower than those previously reported for titrated dosing, in a clinical sample of elderly patients with MD.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01559324.

Bifrontal ECT for drug-induced psychosis in Parkinson's disease

Psychosis has been documented to occur during treatment for idiopathic Parkinson's disease (PD). This case report describes an elderly male who developed psychosis during the course of treatment for idiopathic PD. He was treated with clozapine but experienced significant adverse effects without clinical improvement. He was prescribed bifrontal electroconvulsive therapy (BF-ECT). Here, we report the efficacy of BF-ECT in treating psychosis and motor symptoms in PD, without producing cognitive side effects in an elderly male.