The authors compared the clinical and cognitive effects of bifrontal electrode placement with standard bitemporal electrode placement in the treatment of patients with major depression. Forty-eight patients with unipolar or bipolar depression were treated with a course of bifrontal or bitemporal ECT. The Hamilton Rating Scale for Depression and the standardized Mini-Mental State were administered at baseline and repeated during the course of treatment. Forty-seven of the 48 patients who completed the course of treatment met remission criteria by the 12th treatment. There were no differences between the patients given bifrontal ECT and those given bitemporal ECT in the number of treatments required to reach remission criteria. The standardized Mini-Mental State scores of the patients given bitemporal ECT worsened more after treatment than did those of the patients given bifrontal ECT. Bifrontal electrode placement was as efficacious as bitemporal placement and resulted in less cognitive impairment. A study of the two placements with more cognitive measures is indicated.