This double-blind, random-assignment study contrasted the relative
efficacy of bilateral and unilateral right ECT with a low-dose titration
procedure. In 52 patients with primary major depressive disorder, bilateral
ECT was markedly superior in short-term symptom reduction to unilateral
right ECT. The two conditions did not differ in the duration of generalized
seizures or in the number of treatments administered to achieve clinical
response. The findings challenge the claim that the elicitation of
generalized seizure is, in and of itself, sufficient for the antidepressant
properties of ECT. Rather, a dose in excess of seizure threshold may
contribute to the efficacy of ECT, particularly with a unilateral right
electrode placement.Abstract Teaser