Open trial on the efficacy of right unilateral electroconvulsive therapy with titration and high charge

The use of right unilateral electrode placement for electroconvulsive therapy (ECT) is one of the most important developments on the technique because it is considered to spare cognition. Nevertheless, the best way to determine the charge to be given to the individual patient is still controversial. We present an open study on the use of right unilateral ECT using the technique of method of limits and giving treatments with 6 times the seizure threshold. Of 30 patients, there was a response/remission rate of 53.33%, as measured by the Hamilton Depression Rating Scale, after a mean of 8 sessions. Half of the nonresponders (n = 7) received subsequent bilateral ECT, with improvement on 4. The data suggest that it is a good practice to start the treatment with unilateral ECT and, if no response is achieved, to switch to bilateral placement.