Unilateral and bilateral ECT in elderly patients A COMPARATIVE STUDY

Abstract

Twenty-nine depressed elderly patients receiving ECT were randomly assigned to a unilateral or bilateral group; post-ictal recovery times, memory changes, and clinical improvement during and after each course were measured by blind and independent observers. All patients but one showed full recovery on testing 3 weeks after treatment. There was no significant difference between the unilateral and bilateral groups either in terms of improvement or the number of treatments needed in each course. A good outcome was predicted by the presence of pathological guilt, impairment of work and interest, agitation, subjectively depressed mood, psychic anxiety and greater overall severity. Longer duration of illness predicted a relatively poor outcome. Memory functions showed uniform impairment before treatment, but during treatment all improved, with some changes reaching high statistical significance; on testing 3 weeks after treatment memory functions in all patients had reached normal values. There was no difference between the two groups. Post-ictal recovery times were significantly longer in the bilateral than in the unilateral group after the first treatment and after the fifth treatment more than three times as long. Recovery time showed a significant decrease during courses of unilateral treatment. There was a very low incidence of side-effects, and all were relatively mild. We conclude that unilateral ECT is a safe and highly effective treatment for selected elderly patients suffering from depression, but that there is nothing to be said for the continued use of bilateral ECT.

The effectiveness of real versus simulated electroconvulsive therapy in depressed elderly patients

“…Unilateral and bilateral ECT were both effective in those patients completing six study treatments. This result supports the report that unilateral was as effective as bilateral ECT after five treatments (Fraser and Glass, 1980).…”

The efficacy and safety of ECT in depressed older adults: a literature review

“…None of the case studies reported lack of efficacy of ECT. Folstein et al, 1975) were reported in two trials (Fraser and Glass, 1980;Kellner et al, 1992). Selfrated global memory function improved both in patients treated with titrated, moderate-dose and fixed, high-dose right unilateral ECT .…”

“…This study concerns a post-hoc analysis of data on elderly that participated in a trial by Gregory et al (1985). Unilateral ECT was more effective than bilateral ECT in the short-term (after five treatments), but not in the longer run (after three weeks of treatment) (Fraser et al, 1980). Significantly more patients improved in a three-times-weekly treatment than in the once weekly ECT condition (Kellner et al, 1992).…”

Suicide in Late Life: Review and Commentary

“…Many studies have documented the effectiveness of ECT in older adults (249)(250)(251). Some investigators report the response as good in elderly as in young people (252), whereas others suggest that the response is less optimal in the oldest old (253).…”