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Cognitive Effects of Bifrontal Versus Right Unilateral Electroconvulsive Therapy in the Treatment of Major Depression in Elderly Patients: A Randomized, Controlled Trial

Dybedal, Gro Strømnes PsyD, PhD; Bjølseth, Tor Magne MD; Benth, Jūratė Šaltytė PhD; Tanum, Lars MD, PhD

doi: 10.1097/YCT.0000000000000310
Original Studies

Objectives Bifrontal (BF) electrode placement has been explored to refine the electroconvulsive therapy (ECT) technique. No previous study has compared the cognitive effects of BF versus right unilateral (RUL) ECT by only including the subgroup that is most likely to receive it: elderly patients with major depression.

Methods Nondemented patients (n = 65) with major depression, aged 60 to 85 years, were randomly allocated to BF ECT and RUL formula-based ECT. Cognitive function was assessed at baseline (T1), within 1 week after a course of ECT (T2), and 3 months after T2 (T3). Six neuropsychological test measures of memory, 5 of executive function, and 3 of information-processing speed were administered.

Results According to linear mixed models, there were no significant differences between the BF and RUL groups at any time. The retrograde memory score for public facts declined more for the RUL group (P < 0.001) than the BF group (P = 0.005) from baseline to the first retest and remained stable for both groups from T2 to T3. A rapid improvement in selective attention was observed in the RUL group from T1 to T2, but the scores remained stable from T2 to T3 (P < 0.001). This measure remained stable in the BF group from T1 to T3.

Conclusions Our findings indicate that there were negligible differences in the cognitive effects of formula-based BF or RUL ECT. The overall cognitive effects of ECT were equally favorable for each of the groups.

From the *Department of Geriatric Psychiatry, Diakonhjemmet Hospital; †Institute of Clinical Medicine, Campus Ahus, University of Oslo; ‡HØKH, Research Centre; and §Department of Research and Development in Mental Health, Akershus University Hospital, Lørenskog, Norway.

Received for publication November 2, 2015; accepted January 7, 2016.

Reprints: Gro Strømnes Dybedal, PsyD, PhD, Diakonhjemmet Hospital, Department of Geriatric Psychiatry, Pastor Fangens vei 18, 0854 Oslo, Norway (e-mail:

The authors have no conflicts of interest or financial disclosures to report. The work by Dr. Dybedal was previously supported by the Norwegian Extra Foundation for Health and Rehabilitation through the Norwegian Council for Mental Health under Grant number 2011/2/0009.

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