Fronto-medial ultrabrief electroconvulsive therapy in major depression: a prospective pilot case series

Electroconvulsive therapy (ECT) remains the most effective treatment for severe depression, but its cognitive adverse effects, particularly on memory, constrain its use. Contemporary practice mitigates these effects largely through modified electrode placement: right unilateral placement spares the left medial temporal lobe and reduces verbal-memory impairment [1], and bifrontal placement stimulates frontal cortex [2]. Extending this logic, fronto-medial placement—both electrodes on the midline, at Fpz and the vertex (Cz)—could avoid direct stimulation of both medial temporal lobes while still engaging mid-sagittal structures, potentially reducing memory effects further without sacrificing efficacy.