Trial reportThe British journal of psychiatry : the journal of mental science2010
Bifrontal, bitemporal and right unilateral electrode placement in ECT: randomised trial.
Trial report in The British journal of psychiatry : the journal of mental science, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 115 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Comparing Three Electrode Placements to Optimize ECT
Randomized Controlled Comparison of Bifrontal and Right Unilateral ECT as to Effects on Depression, Global Cognitive Function and Biomarkers.
Changing Tactics? Optimizing ECT in Difficult-to-treat Depression: A Randomized Trial Comparing Continuation of Right Unilateral ECT and Switching to Bitemporal ECT in Case of Early Non-response During an Acute Course of ECT for Difficult-to-treat Depression
Who cites it
115 citing papers in PubMed, 5 syntheses or guidelines pooled it, 421 citations in OpenAlex.
- Modified electroconvulsive therapy for perinatal depression: scoping review.Frontiers in psychiatry · 2025Pooled it
- Neuromodulation in new-onset refractory status epilepticus.Frontiers in neurology · 2023Pooled it
- Effects of Hesel-coil deep transcranial magnetic stimulation for depression - a systematic review.Nordic journal of psychiatry · 2016Pooled it
- Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 4. Neurostimulation Treatments.Canadian journal of psychiatry. Revue canadienne de psychiatrie · 2016Pooled it
- Relapse following successful electroconvulsive therapy for major depression: a meta-analysis.Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology · 2013Pooled it
- Electroconvulsive Therapy in Schizophrenia: Exploratory Study on the Efficacy, Cognitive Effects, and Safety of Right Unilateral Versus Bitemporal Techniques.Brain and behavior · 2026Trial
- Racemic Ketamine as an Alternative to Electroconvulsive Therapy for Unipolar Depression: A Randomized, Open-Label, Non-Inferiority Trial (KetECT).The international journal of neuropsychopharmacology · 2022Trial
- Electroconvulsive therapy, electric field, neuroplasticity, and clinical outcomes.Molecular psychiatry · 2022Trial
- Electroconvulsive Therapy Pulse Amplitude and Clinical Outcomes.The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry · 2021Trial
- Magnetic Seizure Therapy for Suicidality in Treatment-Resistant Depression.JAMA network open · 2020Trial
- Right Unilateral Ultrabrief Pulse ECT in Geriatric Depression: Phase 1 of the PRIDE Study.The American journal of psychiatry · 2016Trial
- Trial
- The benefits and costs of changing treatment technique in electroconvulsive therapy due to insufficient improvement of a major depressive episode.Brain stimulationTrial
- Clinical Outcomes and Treatment Characteristics of Seizure Threshold-Titrated Electroconvulsive Therapy in Depressive Disorder: A 3.5-Year Retrospective Naturalistic Course-Level Study.Journal of clinical medicine · 2026Article
- Diverging Trajectories of Depressive Symptoms During Electroconvulsive Therapy: Toward Personalized Treatment.Biological psychiatry global open science · 2026Article
- Confirmatory efficacy and safety trial of magnetic seizure therapy versus right unilateral ultra-brief electroconvulsive therapy in depression (CREST-MST): a randomised, double-blind, non-inferiority trial in Canada and the USA.The lancet. Psychiatry · 2026Article
- Brain morphometry, stimulation charge, and seizure duration in electroconvulsive therapy.Molecular psychiatry · 2026Article
- Review and Update of Anesthetic Management for Electroconvulsive Therapy: A Narrative Review.Neuropsychiatric disease and treatment · 2026Review
- Advances in the Clinical Application of Neurostimulation in Major Depression.Advances in experimental medicine and biology · 2026Review
- The effects of electroconvulsive therapy on cognition: an exploratory retrospective study.CNS spectrums · 2025Article
55 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
13 authors at 7 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundElectroconvulsive therapy (ECT) is an effective treatment for major depression. Optimising efficacy and minimising cognitive impairment are goals of ongoing technical refinements.
aimsTo compare the efficacy and cognitive effects of a novel electrode placement, bifrontal, with two standard electrode placements, bitemporal and right unilateral in ECT.
methodThis multicentre randomised, double-blind, controlled trial (NCT00069407) was carried out from 2001 to 2006. A total of 230 individuals with major depression, bipolar and unipolar, were randomly assigned to one of three electrode placements during a course of ECT: bifrontal at one and a half times seizure threshold, bitemporal at one and a half times seizure threshold and right unilateral at six times seizure threshold.
resultsAll three electrode placements resulted in both clinically and statistically significant antidepressant outcomes. Remission rates were 55% (95% CI 43-66%) with right unilateral, 61% with bifrontal (95% CI 50-71%) and 64% (95% CI 53-75%) with bitemporal. Bitemporal resulted in a more rapid decline in symptom ratings over the early course of treatment. Cognitive data revealed few differences between the electrode placements on a variety of neuropsychological instruments.
conclusionsEach electrode placement is a very effective antidepressant treatment when given with appropriate electrical dosing. Bitemporal leads to more rapid symptom reduction and should be considered the preferred placement for urgent clinical situations. The cognitive profile of bifrontal is not substantially different from that of bitemporal.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.