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High-Charge Right Unilateral Electroconvulsive Therapy Helps Some Older Depressed Patients

Older depressed patients who fail to respond to moderate-charge, right unilateral (RUL) electroconvulsive therapy (ECT) could benefit from being switched to high-charge RUL ECT, researchers in the United States say.

Larger studies are needed to compare clinical response in switched patients, however, say the investigators from the Western Psychiatric Institute and Clinic at the University of Pittsburgh in Pittsburgh, Pennsylvania.

Moderate-charge RUL ECT was defined as 150% above seizure threshold and high-charge as 450% above the threshold. Older patients were defined as more than 50 years old.

These patients are more likely to respond to ECT than are younger depressed patients, but are also more likely to develop cognitive impairment, the researchers note. They randomised 24 patients who failed to respond to five to eight moderate-charge RUL ECT treatments. Eleven patients received BL ECT and 13 received high-charge RUL ECT.

Depressive scores on the 24-item Hamilton Rating Scale for Depression (HAM-D) and cognitive scores on the Mini-Mental State Examination (MMSE) were compared at three phases of treatment.

Patients receiving BL ECT demonstrated significantly greater cognitive impairment than those receiving high-charge RUL ECT. But, results indicate there were no statistically significant differences in clinical response or in depressive symptom remission.
Journal of Clinical Psychiatry, 2002;63:1102-1105. "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."

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