To achieve an adequate antidepressant effect with right unilateral (RUL) electrode placement ECT, equivalent to that of bilateral (BL) electrode placement, the authors of 2 reports find it necessary to increase the stimulating energy at least 5-fold above the seizure threshold (ST).%1,2 They recommend that ECT now be done with unilateral electrode placement after first determining the ST and delivering subsequent treatments with energies at 6 × ST. The authors see their findings as resolving a 30-year controversy. The discussant, Richard Abrams, MD, agrees and reminds us that to achieve the benefits of this modification in practice, we need relief from arbitrary Food and Drug Administration (FDA) rulings that artificially limit the energy output of US ECT devices.
Fink M, Bailine S, Petrides G. Electrode Placement and Electroconvulsive Therapy: A Search for the Chimera. Arch Gen Psychiatry. 2001;58(6):607-608. doi: