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Low-Dose Right Unilateral Electroconvulsive Therapy (ECT): Effectiveness of the First Treatment

Lapidus, Kyle A.B. MD, PhD; Shin, Joseph S.W.; Pasculli, Rosa M. BA; Briggs, Mimi C. BA; Popeo, Dennis M. MD; Kellner, Charles H. MD

doi: 10.1097/YCT.0b013e31827e0b51
Original Studies

Background Electroconvulsive therapy (ECT) is a widely used, highly effective antidepressant treatment. Except for the most severely ill patients, right unilateral (RUL) electrode placement is the most frequent initial treatment choice. In current practice, RUL ECT is administered at several multiples of seizure threshold (ST) based on reports that lower stimulus intensity results in lower response/remission rates. Many patients, as part of an initial dose titration to determine ST, will receive a single treatment with low-dose RUL ECT and subsequent treatments with a stimulus at a multiple of ST.

Objective To assess response to the first ECT.

Methods A retrospective analysis of charts from clinical practice at Mount Sinai Medical Center was performed.

Results A single treatment with low-dose (presumably near ST) RUL ECT had a significant and immediate antidepressant effect in our sample of patients with major depression. We determined that this response is similar to that of patients receiving a single initial treatment with high-dose RUL ECT (at a multiple of ST).

Conclusions These data suggest, contrary to commonly held belief, that RUL ECT may be effective at a low stimulus dose. This argues against restimulating at 6 times ST in the initial session, based on the belief that the near-threshold seizure has no antidepressant efficacy. Our findings suggest a need for further investigation of cases in which low-dose RUL ECT may be an effective antidepressant treatment. Further prospective studies, including larger numbers of patients who receive randomized treatment with low- or high-dose RUL with longer follow-up, are indicated.

From the Mount Sinai Medical Center, New York, NY.

Received for publication November 1, 2011; accepted November 14, 2012.

Reprints: Kyle A. B. Lapidus, MD, PhD, Mount Sinai Medical Center, Box 1230, One Gustave Levy Place, New York, NY 10128 (e-mail:

The authors have no conflicts of interest or financial disclosures to report.

© 2013 by Lippincott Williams & Wilkins