THE ANTIDEPRESSANT EFFICACY OF HIGH-DOSE NONDOMINANT LONG-DISTANCE PARIETOTEMPORAL AND BITEMPORAL ELECTROCONVULSIVE-THERAPY

While unilateral electroconvulsive therapy (U-ECT) is generally consid ered to induce negligible disturbances of memory as compared with bila teral bitemporal ECT, its relative antidepressant efficacy has been qu estioned. The aim of the present study was to compare, in a double-bli nd design, clinicians' ratings of global clinical impression of the an tidepressant efficacy of the two treatment modalities. The treatment t echnique included avoidance of benzodiazepines, prolonged hyperventila tion with oxygen, intermittent unidirectional pulses distributed in a long pulse train, permitting individualized and relatively high doses of electrical charge at each treatment occasion, and nondominant long- distance (12-13 cm) parietotemporal (d'Elia) electrode placement in th e U-ECT group. The results indicated no therapeutic advantage for eith er treatment modality, which was also in accordance with the symptom r atings by an independent nonblinded rater. The findings encourage the continued use of nondominant long-distance parietotemporal ECT with a treatment technique that induces fully generalized seizures as the mod ality of choice in the convulsive treatment of depression.