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Electroconvulsive Therapy Studies / Treatment of Major Depression / Bipolar Disorder and Treatment · Journal article
Frontiers in Psychiatry · August 26, 2026
Encouraging direction, but not yet definitive.
This retrospective cohort study of 217 adolescents with MDD found that bifrontal and bitemporal ECT were equivalent in antidepressant efficacy (response 85.6% vs 82.1%, p=0.478; remission 33.3% vs 33.0%, p=0.963) and anti-suicidal effect. Bifrontal ECT was associated with fewer subjective memory complaints (28.8% vs 67.9%, p<0.001, OR=0.20) and shorter post-ictal recovery time (23.7±7.7 min vs 33.4±9.9 min, p<0.001, Cohen's d=1.12), with bifrontal placement remaining protective after adjustment for age, baseline severity, and concurrent medications. The authors acknowledge that subjective memory reporting and post-ictal recovery do not capture the full spectrum of cognitive function and recommend prospective controlled trials to confirm findings.
Retrospective cohort study. 217 adolescents aged 12–18 years diagnosed with major depressive disorder enrolled at the Department of Psychiatry in a tertiary general hospital; baseline demographic and clinical characteristics including depression severity and suicidality were well-balanced between groups.. Intervention: Bifrontal electrode placement for ECT (n=111). Compared with: Bitemporal electrode placement for ECT (n=106). n = 217. Single tertiary general hospital, specific location not stated.
Bifrontal response rate 85.6% vs bitemporal 82.1% (p=0.478; OR=1.29, 95% CI 0.64–2.42) Bifrontal remission rate 33.3% vs bitemporal 33.0% (p=0.963) Subjective memory complaints: bifrontal 28.8% vs bitemporal 67.9% (p<0.001; OR=0.20, 95% CI 0.11–0.36)
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Bifrontal ECT may offer a cognitive safety advantage over bitemporal placement in adolescents (fewer subjective memory complaints, faster post-ictal recovery) without sacrificing antidepressant efficacy. However, the absence of objective neuropsychological testing and the retrospective design warrant confirmation in prospective controlled trials before changing practice.
A well-conducted retrospective cohort study with adequate sample size and multivariate adjustment showing safety advantages (fewer memory complaints, shorter recovery time) for bifrontal ECT in adolescents, though efficacy was equivalent and cognitive assessment was limited to subjective measures.
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Quoted from the source exactly as published.
Bifrontal ECT may offer a cognitive safety advantage over bitemporal placement in adolescents (fewer subjective memory complaints, faster post-ictal recovery) without sacrificing antidepressant efficacy. However, the absence of objective neuropsychological testing and the retrospective design warrant confirmation in prospective controlled trials before changing practice.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Background Electroconvulsive therapy (ECT) remains a rapid and highly effective treatment for severe, treatment-resistant depression in adolescents, particularly when immediate suicide risk is present. However, its clinical utilization in the pediatric population is still low, largely restricted by pervasive concerns regarding cognitive impairment. While randomized trials in adults suggest that bifrontal (BF) electrode placement offers a superior cognitive safety profile compared to the standard bitemporal (BT) placement, comparative evidence specifically regarding the developing adolescent brain remains scarce. Methods We conducted a retrospective cohort study at the Department of Psychiatry in a tertiary general hospital, analyzing 217 adolescents (aged 12–18 years) diagnosed with major depressive disorder (MDD) who underwent a course of ECT between January 2018 and June 2024. Patients were categorized into the BF group (n = 111) or BT group (n = 106) based on the electrode placement utilized. The primary efficacy outcomes were the response rate (≥50% reduction in 24-item Hamilton Depression Rating Scale (HAMD-24) scores) and remission rate (HAMD-24 score ≤8). Secondary outcomes included the reduction in suicidal ideation (Beck Scale for Suicide Ideation (BSSI) scores), the incidence of subjective memory complaints, and post-ictal recovery time. Multivariate logistic regression was performed to identify independent predictors of subjective memory complaints, adjusting for baseline severity and concurrent medications. Results Baseline demographic and clinical characteristics, including severity of depression and suicidality, were well-balanced between groups. The BF group achieved a numerically higher response rate (85.6%) compared to the BT group (82.1%), although this difference did not reach statistical significance (p = 0.478; odds ratio [OR] = 1.29, 95% CI 0.64–2.42). Remission rates were also comparable (33.3% vs. 33.0%; p = 0.963). Both groups showed equal efficacy in reducing suicidal ideation (p > 0.05). While efficacy outcomes were similar, the two modalities showed notable differences in two specific safety-related endpoints that are relevant to daily clinical practice: the incidence of subjectively reported memory complaints (28.8% in the BF group compared with 67.9% in the BT group; p < 0.001; OR = 0.20, 95% CI 0.11–0.36) and the objectively measured post-ictal recovery time (23.7 ± 7.7 min for BF compared with 33.4 ± 9.9 min for BT; p < 0.001; Cohen’s d = 1.12). After adjusting for age, baseline HAMD-24 scores, and concurrent use of benzodiazepines and antipsychotics, BF placement remained a significant independent protective factor against subjective memory complaints (adjusted OR = 0.21, 95% CI: 0.11–0.39, p < 0.001). Conclusion In adolescents with MDD, bifrontal ECT showed short-term antidepressant and anti-suicidal outcomes comparable to those of bitemporal ECT in this retrospective cohort. BF ECT appeared to be associated with fewer subjective memory complaints (as assessed by spontaneous patient reports and daily physician inquiries) and shorter post-ictal recovery time. These two endpoints, while clinically relevant in routine practice, do not capture the full spectrum of cognitive function; standardized neuropsychological assessment would be required for a comprehensive comparison. Given the retrospective design and non-random treatment allocation, these findings should be interpreted cautiously and confirmed in prospective controlled studies.
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