Is Unilateral Nondominant ECT as Efficient as Bilateral ECT? A New Look at the Evidence

A survey of 24 comparisons of the antidepressive efficiency of bilateral and unilateral nondominant electroconvulsive therapy (ECT), fulfilling strict methodological criteria, shows a preponderance of studies in favor of bilateral ECT. However, the inferiority of unilateral nondominant ECT can be explained by submaximal seizure activity due to short interelectrode distance, barely suprathreshold stimulation, and combination with benzodiazepine drugs. With optimal technique, unilateral nondominant ECT may be as efficient as bilateral ECT. Furthermore, the cognitive dysfunction is less and of shorter duration. There is no reason to retain or return to bilateral ECT, but instead we should pay attention to technical improvements of unilateral nondominant ECT.