To the Editor: Dr Sackeim and colleagues1 compared relapse rates after electroconvulsive therapy (ECT) among patients who received maintenance antidepressant therapy vs placebo. However, the very low baseline remission rate (55%) reported for ECT is highly atypical.
The authors briefly note that 90% of the patients entering the continuation phase initially received ECT, a method known for its low efficacy, with moderate-dose right unilateral ECT, administered at a dose of 150% above seizure threshold. However, this method is not very effective. In a prospective, randomized, double-blind clinical study reported less than a year ago, Sackeim et al2 were able to obtain only a 30% remission rate with right unilateral ECT administered at 150% above threshold, a remission rate no better than that typically obtained with placebo in controlled trials of antidepressant drugs. In this prior study,2 patients who did not show substantial improvement with 150% above the threshold for right unilateral ECT after 5 to 8 treatments were then switched to bilateral ECT. However, neither the number of patients requiring such a switch nor the efficacy of that switch was presented.
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