Unilateral or bilateral electroconvulsive therapy for depression? A survey of practice and attitudes in Australia and New Zealand

Abstract

Objective: We report the findings of the first survey of the practice of electroconvulsive therapy (ECT) for the treatment of depression in Australia and New Zealand. The major aim was to examine the frequency of use of unilateral and bilateral electrode placement, as bilateral ECT has been recently recommended as the treatment of choice by the Royal College of Psychiatrists (UK).

Design: A questionnaire about details of ECT given in the second half of 1989 was forwarded to the medical superintendents of 130 psychiatric hospitals and units in Australia and New Zealand.

Results: Reports were received from 96 psychiatric institutions representing a response rate of 74%. In these units, 915 patients were treated with ECT during the study period. In contrast to depressed patients in the United Kingdom or the United States, a majority of Australian and New Zealand patients given ECT were found to receive unilateral ECT (63%). There were marked regional differences in practice, with patients in New South Wales being more likely to receive unilateral ECT, and those in Queensland and New Zealand bilateral ECT. In the majority of units, bilateral ECT was not considered to be indicated in preference to unilateral ECT for either severe, suicidal or psychotic depression.

Conclusion: The discrepancies between regional practices probably reflect the current uncertainty regarding the balance between the relative efficacy and morbidity of these two forms of treatment. Until these central issues of relative efficacy and morbidity are clarified, it would be inappropriate for local professional bodies to recommend a preferred mode of ECT administration.