A Prospective, Randomized, Double-blind Comparison of Bilateral and Right Unilateral Electroconvulsive Therapy at Different Stimulus Intensities

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Abstract
FOR DECADES there has been a controversy concerning the use of right unilateral (RUL) or bilateral (BL) electroconvulsive therapy (ECT) in major depression.1 It has been established that RUL ECT causes less severe cognitive adverse effects than BL ECT.2-6 However, despite 40 comparative trials, the relative efficacy of both RUL and BL ECT remains uncertain.1,7-9 When efficacy differences have been found, they consistently favored BL ECT.10-12 Most patients in the United States receive BL treatment. Farah and McCall13 conducted a survey of US ECT practitioners and found that 52% initiated ECT with the BL placement. We recently conducted a survey of ECT directors at 59 facilities in the tristate New York metropolitan area (H.A.S. and J.P., unpublished data, January 1, 1997, to July 1, 1997). The mean percentage of patients receiving BL ECT was 79%.

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