A Randomized Comparison of High-Charge Right Unilateral Electroconvulsive Therapy and Bilateral Electroconvulsive Therapy in Older Depressed Patients Who Failed to Respond to 5 to 8 Moderate-Charge Right Unilateral Treatments
J Clin Psychiatry 2002;63(12):1102-1105
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Background: Electroconvulsive therapy (ECT) is
the treatment of choice in some older patients with severe
depression. When compared with younger depressed patients, older
patients have been shown to be as likely to respond to ECT but
more likely to develop cognitive impairment. This study addresses
whether adults aged 50 years and over who have already failed to
respond to at least 5 moderate-charge right unilateral (RUL) ECT
treatments (150% above seizure threshold) are more likely to
benefit from a switch to high-charge RUL ECT (450% above
threshold) or to bilateral (BL) ECT.
Method: Twenty-four patients who were treated
with 5 to 8 moderate-charge RUL ECT treatments and who failed to
improve sufficiently were randomly assigned to receive either BL
ECT (N=11) or high-charge RUL ECT (N=13). Depressive (24-item
Hamilton Rating Scale for Depression) and cognitive scores
(Mini-Mental State Examination [MMSE]) were compared under
double-blind conditions at 3 phases of treatment.
Results: Patients in the BL ECT group exhibited
significantly greater cognitive impairment (mean MMSE score
decrease of 1.13) than those receiving high-charge RUL ECT (mean
MMSE increase of 1.71). There were no statistically significant
differences in clinical response to BL or high-charge RUL ECT
(63.6% and 61.5%, respectively) or in depressive symptom
remission (18.1% and 46.2%).
Conclusion: These results suggest that older
patients who fail to respond to moderate-charge RUL ECT may
benefit from a switch to high-charge RUL ECT rather than BL ECT.
Larger future studies will be needed to compare clinical response
in patients switched from moderate-dose RUL ECT to higher-dose
RUL or to BL ECT.