Therapeutic advantage of bifrontal electrode placement in ECT

Letemendia, F. J. J.; Delva, Nicholas J.; Rodenburg, Martin; Lawson, J. S.; Inglis, James; Waldron, J. J.; Lywood, D. W.

doi:10.1017/s0033291700028452

Cited by 128 publications

(63 citation statements)

References 27 publications

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“…Both were considerably more effective than either low-or moderate-dosage RUL ECT. These findings confirm earlier reports that the efficacy of RUL ECT is influenced by electrical dosage, 5,[14][15][16][17] and that fixed high-dosage RUL ECT can be as effective as BL ECT. 15 Specifically, this study indicates that, at sufficiently high stimulus intensity above the threshold, RUL matches BL ECT in efficacy.…”

Section: Commentsupporting

confidence: 91%

“…5,[14][15][16][17] In a 4-group study randomizing patients to RUL and BL placement and to an electrical dosage just above (0%) or 150% above the initial seizure threshold, we found that higher-dosage RUL ECT was considerably more effective than lowdosage RUL ECT and produced less severe cognitive effects than either form of BL ECT. 5 Nonetheless, the higherdosage RUL ECT did not match the efficacy of either type of BL ECT.…”

Section: Arch Genmentioning

confidence: 99%

See 1 more Smart Citation

A Prospective, Randomized, Double-blind Comparison of Bilateral and Right Unilateral Electroconvulsive Therapy at Different Stimulus Intensities

Sackeïm

Prudic²,

Devanand³

et al. 2000

Arch Gen Psychiatry

715

475

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Section: Commentsupporting

confidence: 91%

Section: Arch Genmentioning

confidence: 99%

A Prospective, Randomized, Double-blind Comparison of Bilateral and Right Unilateral Electroconvulsive Therapy at Different Stimulus Intensities

Sackeïm

Prudic²,

Devanand³

et al. 2000

Arch Gen Psychiatry

715

475

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“…Based on the results of randomized controlled trials (RCTs) comparing real ECT with sham ECT (that is, the repeated administration of anesthesia alone), it is well established that a generalized tonic-clonic seizure is necessary for ECT to exert its antidepressant effect (1). However, several studies have demonstrated that, while eliciting a generalized seizure is sufficient for the efficacy of bilateral ECT, this is not the case for RUL treatment (14)(15)(16)(17). In a landmark study, Sackeim and others (14) found that RUL ECT administered at either low-dose (that is, just above the determined seizure threshold) or moderate-dose (that is, 2.5 times seizure threshold) was significantly less effective than either of these doses of bitemporal ECT.…”

Section: Optimizing Ect Efficacymentioning

confidence: 99%

Effective Use of Electroconvulsive Therapy in Late-Life Depression

Flint

Gagnon

2002

Can J Psychiatry

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Objective: To review literature pertaining to the efficacy, safety, and tolerability of electroconvulsive therapy (ECT) in treating late-life depression. Method:We undertook a literature review with an emphasis on research studies published in the last 10 years.Results: There is a positive association between advancing age and ECT efficacy. Age per se does not necessarily increase the risk of cognitive side effects from ECT, but this risk is increased by age-associated neurological conditions such as Alzheimer's dementia and cerebrovascular disease. With appropriate evaluation and monitoring, ECT can be used safely in patients of very advanced age and in those with serious medical conditions. Several technical factors, including dose of electricity relative to a patient's seizure threshold, position of electrodes, frequency of administration, and total number of treatments, have an impact on the efficacy and cognitive side effects of ECT and need to be taken into account when administering ECT. Naturalistic studies have found that 50% or more of patients have a relapse of depression within 6 to 12 months of discontinuing acute ECT. Conclusions:In recent years, there has been substantial progress in our understanding of the effect of technical factors on the efficacy and cognitive side effects of ECT. When administered in an optimal manner, ECT is a safe, well-tolerated, and effective treatment in older patients. Relapse of depression after response to ECT remains a significant problem, and there is a need for further research into the prediction and prevention of post-ECT relapse. Clinical Implications · With appropriate evaluation and monitoring, electroconvulsive therapy (ECT) is a safe and effective treatment in elderly patients, including those of very advanced age and those with significant medical comorbidity. · Technical factors have a significant impact on the efficacy and side effects of ECT and need to be taken into account when administering the treatment. · Despite the use of continuation antidepressant medication, relapse of depression after ECT remains a significant problem. Limitations· Only 1 study, with a relatively small number of patients, has compared the efficacy and cognitive effects of high-dose right unilateral ECT with bilateral ECT. The findings of this study require replication in a larger group of patients recruited from more than 1 research centre. · The optimal electrical dose for right unilateral ECT remains to be established. · Data pertaining to the efficacy of continuation ECT are derived from uncontrolled or retrospective studies. However, data from the first controlled, prospective study of continuation ECT should soon be available.

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“…A recent review found that 62% of a sample of 659 elderly patients given ECT had a good outcome, and a further 21% derived some benefit [17], These studies were naturalistic and, therefore, rather better representative than controlled clinical trials of antidepressants although ad mittedly they did not benefit from the pres ence of a randomly assigned comparison group. A number of specific techniques have recently been advocated to increase the 'effi ciency' of ECT [18,19]. These deserve full evaluation in the elderly.…”

Section: Treatmentmentioning

confidence: 99%

Approaches to the Management of Depression in Old Age

Katona

1994

Gerontology

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Depression in old age is common, underdiagnosed and under-treated. It has a high rate of recurrence and is associated with significantly increased mortality. Its mismanagement stems in large part from the misconceptions that it is an inevitable condition, that old people are too inflexible to change, and that treatment is unacceptably hazardous. There is considerable potential for prevention, improved detection and appropriate treatment. In addition, it is increasingly clear that treatment can improve prognosis. Prevention requires education, and a political agenda to address aetiological factors such as poverty, loneliness, institutionalisation and poor physical health. Treatment with antidepressant drugs and/or psychological techniques is effective. Newer drugs may well be superior in safety and real-life tolerability but require better evaluation in representative samples, against placebo and incorporating cost-benefit and quality-of-life measures. Prophylaxis with antidepressants, electroconvulsive therapy and psychotherapy groups has been shown to be effective. The prophylactic efficacy of newer antidepressants has yet to be properly evaluated.

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Therapeutic advantage of bifrontal electrode placement in ECT

Cited by 128 publications

References 27 publications

A Prospective, Randomized, Double-blind Comparison of Bilateral and Right Unilateral Electroconvulsive Therapy at Different Stimulus Intensities

A Prospective, Randomized, Double-blind Comparison of Bilateral and Right Unilateral Electroconvulsive Therapy at Different Stimulus Intensities

Effective Use of Electroconvulsive Therapy in Late-Life Depression

Approaches to the Management of Depression in Old Age

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