Unilateral electro-convulsive therapy

Abstract

A new technique of ECT was investigated, which attempts to reduce or abolish the usual confusion and amnesia which results from the standard method. This consisted of passing the current across the non-dominant lobe of the brain. A total of 154 depressed patients received 1,002 ECTs; 504 unilateral and 498 bilateral. The study was divided into three parts: a preliminary pilot scheme, a controlled trial and a small series of out-patients. In the pilot scheme, 40 patients received 252 unilateral treatments; retrospective comparison was then made with 5 patients who had received 265 bilateral treatments the year before in the same unit. No 'significant' difference (P = 0.05 level) was found in the response to treatment but a 'significant' reduction was found in the confusion and amnesia produced. No patient complained of memory disturbance following treatment. A controlled clinical trial was then carried out on classical lines with random sampling, bilateral ECT as a control, and double-blind assessment. The controlled trial treated 30 patients with 209 unilateral ECT and 20 patients with 133 bilateral ECT. Results were similar to those of the pilot scheme. There was no 'significant' difference in response to treatment at 0.05 level but a 'significant' difference in post-ECT confusion. At the same time the investigator was responsible for a separate group of out-patients who were receiving bilateral ECT. Of the 87 thus being treated, 13 complained of severe post-ECT amnesia and confusion, and wished to terminate their treatment. These patients were accordingly turned over to unilateral ECT and there were no further complaints of amnesia or confusion. I I of these recovered completely and two remained unchanged. It is concluded that unilateral ECT is as effective as bilateral ECT in the treatment of depressions hut produces a significant reduction in confusion and amnesia. It is thus a useful addition to tile treatment of depressed patients, and it is suggested should be the treatment of choice for all outpatients and for those intellectual workers who must earn their living by retained knowledge.