Unilateral and bilateral ECT in elderly patients A COMPARATIVE STUDY

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Abstract
Depressed elderly patients [29] receiving ECT (electroconvulsive therapy) were randomly assigned to a unilateral or bilateral group; post-ictal recovery times, memory changes and clinical improvement during and after each course were measured by blind and independent observers. All patients but one showed full recovery on testing 3 wk after treatment. There was no significant difference between the unilateral and bilateral groups either in terms of improvement or the number of treatments needed in each course. A good outcome was predicted by the presence of pathological guilt, impairment of work and interests, agitation, subjectively depressed mood, psychic anxiety and greater overall severity. Longer duration of illness predicted a relatively poor outcome. Memory functions showed uniform impairment before treatment, but during treatment all improved, with some changes reaching high statistical significance; on testing 3 wk after treatment memory functions in all patients had reached normal values. There was no difference between the 2 groups. Post-ictal recovery times were significantly longer in the bilateral than in the unilateral group after the 1st treatment and after the 5th treatment more than 3 times as long. Recovery time showed a significant decrease during courses of unilateral treatment. There was a very low incidence of side-effects, and all were relatively mild. Unilateral ECT is a safe and highly effective treatment for selected elderly patients suffering from depression, but that there is nothing to be said for the continued use of bilateral ECT.

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