Table 2 Electrode placement and bipolar depression
From: Electroconvulsive therapy electrode placement for bipolar state-related targeted engagement
|  | Electrode placement, study design | N (age ± SD) | Stimulation parameters | Clinical assessment | Clinical outcome |
|---|---|---|---|---|---|
Electrode placement comparison | |||||
 Daly et al. (2001) (studies 2 and 3 with supra-threshold stimulations for RUL and BT) | RUL, six times threshold, bipolar and unipolar depression | 14 unipolar depression (overall age: 59 ± 15), 6 bipolar depression (overall age: 56 ± 16) | 1.5 ms pulse width, 800 mA pulse amplitude, thrice weekly | Hamilton Depression Rating Scale, initial response rate 60% reduction and maximal score of 16 | Initial response rate: 71% for unipolar depression (9 ± 1 treatments), 100% for bipolar depression (7 ± 2 treatments) |
BT, 1.5 times seizure threshold, bipolar and unipolar depression | 33 unipolar depression, 14 bipolar depression | Initial response rate: 73% for unipolar depression (9 ± 2 treatments), 86% for bipolar depression (8 ± 2 treatments) | |||
 Sienaert et al. (2009) | RUL, 1.5 times seizure threshold | 51 unipolar depression (55 ± 12), 13 bipolar depression (55 ± 13) randomized to either RUL or BF | 0.3 ms pulse width, 800 mA pulse amplitude, twice weekly | Hamilton Depression Rating Scale, moderate remission criteria < 10 | Response and remission rates did not differ by diagnosis (unipolar or bipolar diagnosis) or electrode placement; bipolar patients had a faster rate of response, which was independent of electrode placement |
BF, six times seizure threshold | |||||
 Bailine et al. (2010) | RUL, six times threshold; BF, 1.5 times seizure threshold, and BT, 1.5 times seizure threshold | 170 unipolar depression (55 ± 16) and 50 bipolar depression (49 ± 13) | 900 mA, thrice weekly | Hamilton Depression Rating Scale, moderate remission criteria < 10 | EP and diagnosis were not associated with study outcomes (continuous measure with HDRS or remission criteria) |
No electrode placement comparison | |||||
 Medda et al. (2009) | BT, unipolar depression | 17 (54 ± 17) | Age-based settings, 800 mA, pulse width not documented, twice weekly | Hamilton Depression Rating Scale, remission < 8 | 12/17 (71%) Remission |
BT, bipolar I mre depressed | 46 (51 ± 12) | 16/46 (35%) Remission (lower remission rates relative to unipolar depression) | |||
BT, bipolar II mre depressed | 67 (53 ± 14) | 29/67 (43%) Remission (lower remission rates relative to unipolar depression) | |||
 Schoeyen et al. (2015) (clinical results) | RUL ECT, bipolar I and II | 38 (48 ± 10) | Age-based settings, both Thymatron and Mecta ECT devices, 0.5 ms pulse width, thrice weekly | Montgomery-Asberg Depression Rating Scale, remission < 12 | Mean MADRS score 15 ± 7 (improved relative to pharmacotherapy), response rate 74% (improved relative to pharmacotherapy), and remission rate 35% (no difference relative to pharmacotherapy) |
Pharmacotherapy, bipolar I and II | 35 (48 ± 13) | Algorithm-based pharmacological treatment | Mean MADRS score 20 ± 10, response rate 35%, remission rate 30% | ||
 Perugi et al. (2017) | BT, age-based algorithm | 295 (49.8 ± 13) | 1 ms, pulse width 1.5–4 ms, 800 mA, twice weekly | Clinical Global Impression Improvement Scale, responder ≤ 2 | 68.1% responders |