Research report 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 Gerhard W. Eschweiler a, ⁎ , Reinhard Vonthein b , Ruediger Bode c , Michael Huell d , Andreas Conca e , Oliver Peters c , Stefan Mende-Lechler c , Julia Peters d , Dorothee Klecha d , Michael Prapotnik e , Jan DiPauli e , Barbara Wild a , Christian Plewnia a , Mathias Bartels a , Wilfried Schlotter a a Department of Psychiatry and Psychotherapy, Eberhard-Karls University Tuebingen, Germany b Department of Medical Biometry, Eberhard-Karls University Tuebingen, Germany c Hospital of Psychiatry, Psychosomatic Medicine and Psychotherapy, Ludwigsburg, Germany d Department of Psychiatry and Psychotherapy, Albert-Ludwigs-University of Freiburg, Germany e Regional Hospital Rankweil, Department of Psychiatry I, Rankweil, Austria Received 26 August 2006; received in revised form 10 November 2006; accepted 13 November 2006 Available online 28 December 2006 Abstract 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 N 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. © 2006 Elsevier B.V. All rights reserved. Keywords: Major depression; Electroconvulsive therapy; Electrode position; Neuropsychology; Randomised clinical trial Journal of Affective Disorders 101 (2007) 149 – 157 www.elsevier.com/locate/jad ⁎ Corresponding author. Department of Psychiatry and Psychotherapy, Eberhard-Karls University Tuebingen, Osianderstraβe 24, 72076 Tübingen, Germany. Tel.: +49 7071 2985222, 151-2459 Funk (intern); fax: +49 7071 294141. E-mail address: gerhard.eschweiler@med.uni-tuebingen.de (G.W. Eschweiler). 0165-0327/$ - see front matter © 2006 Elsevier B.V. All rights reserved. doi:10.1016/j.jad.2006.11.012