Objective:

To compare the efficacy and cognitive safety of bifrontal (BF) versus bitemporal (BT) electroconvulsive therapy (ECT) in adolescents with major depressive disorder (MDD).

Approach:

• Study Design: A retrospective cohort study involving 217 adolescents aged 12–18 years with MDD who received ECT between January 2018 and June 2024.
• Group Assignment: Participants were assigned to BF (n = 111) or BT (n = 106) groups based on electrode placement.
• Efficacy Assessment: Efficacy was assessed by response (≥50% decrease in HAMD-24 scores) and remission (HAMD-24 score ≤8).
• Safety Assessment: Secondary measures included changes in suicidal ideation, subjective memory complaints, and post-ictal recovery time.
• Statistical Analysis: Multivariate logistic regression identified predictors of subjective memory complaints.

Key Findings:

• Response rates were 85.6% for BF and 82.1% for BT, with no significant difference (p = 0.478; OR = 1.29, 95% CI 0.64–2.42).
• Remission rates were similar: 33.3% for BF and 33.0% for BT (p = 0.963).
• BF ECT resulted in fewer subjective memory complaints (28.8% vs. 67.9%; p < 0.001; OR = 0.20, 95% CI 0.11–0.36).
• Post-ictal recovery time was shorter with BF (23.7 ± 7.7 min) compared to BT (33.4 ± 9.9 min; p < 0.001; Cohen’s d = 1.12).
• BF placement was an independent protective factor for subjective memory complaints (adjusted OR = 0.21, 95% CI: 0.11–0.39, p < 0.001).

Interpretation:

BF ECT produced comparable short-term antidepressant and anti-suicidal outcomes to BT ECT, with fewer subjective memory complaints and shorter recovery time.

Limitations:

• The study was retrospective and non-randomized.
• Findings may not encompass the full spectrum of cognitive function without standardized neuropsychological assessments.

Conclusion:

BF ECT appears to be associated with fewer subjective memory complaints and shorter recovery time in adolescents with MDD, but further prospective controlled studies are needed for confirmation.