Comparative efficacy and cognitive safety of bifrontal versus bitemporal electroconvulsive therapy in adolescents with major depressive disorder: a retrospective cohort study - Report - MDSpire
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Efficacy and Cognitive Safety Comparison of Bifrontal and Bitemporal Electroconvulsive Therapy in Adolescents with Major Depressive Disorder: A Retrospective Cohort Analysis
Clinical Report: Efficacy and Cognitive Safety of ECT in Adolescents
Overview
This retrospective cohort study compares bifrontal and bitemporal electroconvulsive therapy (ECT) in adolescents with major depressive disorder (MDD). While both methods showed similar efficacy in reducing depression and suicidal ideation, bifrontal ECT was associated with fewer subjective memory complaints and shorter post-ictal recovery times.
Background
Major depressive disorder (MDD) in adolescents poses significant public health challenges, with high rates of treatment resistance and suicide risk. Electroconvulsive therapy (ECT) is recognized as an effective treatment for severe, treatment-resistant depression, yet its use in pediatric populations is limited due to concerns about cognitive side effects. Understanding the cognitive safety profiles of different ECT electrode placements is crucial for optimizing treatment in this vulnerable population.
Data Highlights
Measure
Bifrontal (BF)
Bitemporal (BT)
P-value
Response Rate
85.6%
82.1%
0.478
Remission Rate
33.3%
33.0%
0.963
Subjective Memory Complaints
28.8%
67.9%
<0.001
Post-ictal Recovery Time (min)
23.7 ± 7.7
33.4 ± 9.9
<0.001
Key Findings
Bifrontal ECT showed a response rate of 85.6% compared to 82.1% for bitemporal ECT (p = 0.478).
Remission rates were similar between bifrontal (33.3%) and bitemporal (33.0%) ECT (p = 0.963).
Subjective memory complaints were significantly lower in the bifrontal group (28.8%) compared to the bitemporal group (67.9%) (p < 0.001).
Post-ictal recovery time was shorter with bifrontal ECT (23.7 min) than with bitemporal ECT (33.4 min) (p < 0.001).
Bifrontal ECT was identified as a significant independent protective factor for subjective memory complaints (adjusted OR = 0.21, p < 0.001).
Clinical Implications
The findings indicate differences in subjective memory complaints and recovery times between bifrontal and bitemporal ECT. Clinicians should consider these factors when discussing ECT options with patients and their families.
Conclusion
This study indicates that bifrontal ECT is comparable to bitemporal ECT in efficacy for treating MDD in adolescents. Further research is needed to assess cognitive outcomes.
