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Unilateral ECT comparable to bilateral ECT for depression, lesser cognitive adverse effects

Twice-weekly high-dose unilateral electroconvulsive therapy was not inferior to bitemporal electroconvulsive therapy for depression, and may be preferable due to fewer cognitive adverse effects.

“[Electroconvulsive therapy (ECT)] is used to treat severe mental disorders in 1.4 million people annually worldwide, depression being the most common indication in Western countries. ECT is the most acutely effective treatment for treatment-resistant, sometimes life-threatening, depression. Nevertheless, its use remains limited, mainly because of cognitive side effects, especially concerns about retrograde amnesia,” Maria Semkovska, PhD, of Trinity College Dublin, St. Patrick’s University Hospital, Dublin, and colleagues wrote.

To assess efficacy and cognitive adverse effects of twice-weekly moderate-dose bitemporal electroconvulsive therapy (ECT) with high-dose unilateral ECT, researchers conducted a pragmatic, randomized, noninferiority trail of individuals with major depression in a national ECT service with 6-month follow-up. Study participants (mean age of 56.7 years) were randomly assigned to receive bitemporal ECT (n = 69) or unilateral ECT (n = 69). The primary outcome was change in the 24-item Hamilton Depression Rating Scale (HAM-D) score following ECT.

High-dose unilateral ECT was noninferior to bitemporal ECT, with a mean difference in HAM-D scores of 1.08 points (95% CI, –1.67 to 3.84) favoring unilateral therapy.

Response, remission and 6-month relapse status did not significantly differ between the two therapies.

Orientation recovery was quicker among individuals assigned unilateral ECT (median = 19.1 minutes) vs. those assigned bitemporal ECT (median = 26.4 minutes).

Bitemporal ECT was associated with a lower percentage recall of autobiographical information (OR = 0.66) that persisted for 6 months.

“In terms of harms/benefits ratio, high-dose unilateral ECT was noninferior to bitemporal ECT but showed a better cognitive profile, especially for preserving retrograde personal memories and fewer subjective cognitive side effects,” the researchers wrote. “While there is much interest in other modifications to maintain effectiveness but reduce side effects (eg, ultrabrief pulse-width ECT), these require further refinement and characterization for optimization. Our findings justify considering high-dose unilateral ECT as the preferred ECT option for treating depression and may help improve acceptability and availability of this effective treatment.” – by Amanda Oldt

Disclosure: Semkovska reports no relevant financial disclosures. Please see the full study for a list of all authors’ relevant financial disclosures.