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A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities.

Publication ,  Journal Article
Sackeim, HA; Prudic, J; Devanand, DP; Nobler, MS; Lisanby, SH; Peyser, S; Fitzsimons, L; Moody, BJ; Clark, J
Published in: Arch Gen Psychiatry
May 2000

BACKGROUND: Controversy persists about the use of right unilateral (RUL) and bilateral (BL) electroconvulsive therapy (ECT). While RUL ECT results in less severe short-term and long-term cognitive effects, there is concern that it is less efficacious than BL ECT. METHODS: In a double-blind study, 80 depressed patients were randomized to RULECT, with electrical dosages 50%, 150%, or 500% above the seizure threshold, or BL ECT, with an electrical dosage 150% above the threshold. Depression severity and cognitive functioning were assessed before, during, immediately after, and 2 months after ECT. Compared with baseline, responders had at least a 60% reduction in symptom scores 1 week after ECT, and were monitored for relapse for 1 year. RESULTS: High-dosage RUL and BL ECT were equivalent in response rate (65%) and approximately twice as effective as low-dosage (35%) or moderate-dosage (30%) unilateral ECT. During the week after the randomized phase, BL ECT resulted in greater impairment than any dosage of unilateral ECT in several measures of anterograde and retrograde memory. Two months after ECT, retrograde amnestic deficits were greatest among patients treated with BL ECT. Thirty-three (53%) of the 62 patients who responded to ECT relapsed, without treatment group differences. The relapse rate was greater in patients who had not responded to adequate pharmacotherapy prior to ECT and who had more severe depressive symptoms after ECT. CONCLUSION: Right unilateral ECT at high dosage is as effective as a robust form of BL ECT, but produces less severe and persistent cognitive effects.

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Published In

Arch Gen Psychiatry

DOI

ISSN

0003-990X

Publication Date

May 2000

Volume

57

Issue

5

Start / End Page

425 / 434

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Severity of Illness Index
  • Recurrence
  • Psychiatry
  • Psychiatric Status Rating Scales
  • Prospective Studies
  • Neuropsychological Tests
  • Humans
  • Functional Laterality
  • Follow-Up Studies
 

Citation

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Sackeim, H. A., Prudic, J., Devanand, D. P., Nobler, M. S., Lisanby, S. H., Peyser, S., … Clark, J. (2000). A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities. Arch Gen Psychiatry, 57(5), 425–434. https://doi.org/10.1001/archpsyc.57.5.425
Sackeim, H. A., J. Prudic, D. P. Devanand, M. S. Nobler, S. H. Lisanby, S. Peyser, L. Fitzsimons, B. J. Moody, and J. Clark. “A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities.Arch Gen Psychiatry 57, no. 5 (May 2000): 425–34. https://doi.org/10.1001/archpsyc.57.5.425.
Sackeim HA, Prudic J, Devanand DP, Nobler MS, Lisanby SH, Peyser S, et al. A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities. Arch Gen Psychiatry. 2000 May;57(5):425–34.
Sackeim, H. A., et al. “A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities.Arch Gen Psychiatry, vol. 57, no. 5, May 2000, pp. 425–34. Pubmed, doi:10.1001/archpsyc.57.5.425.
Sackeim HA, Prudic J, Devanand DP, Nobler MS, Lisanby SH, Peyser S, Fitzsimons L, Moody BJ, Clark J. A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities. Arch Gen Psychiatry. 2000 May;57(5):425–434.

Published In

Arch Gen Psychiatry

DOI

ISSN

0003-990X

Publication Date

May 2000

Volume

57

Issue

5

Start / End Page

425 / 434

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Severity of Illness Index
  • Recurrence
  • Psychiatry
  • Psychiatric Status Rating Scales
  • Prospective Studies
  • Neuropsychological Tests
  • Humans
  • Functional Laterality
  • Follow-Up Studies