The short-term outcome of electroconvulsive therapy (ECT) was studied in 24 patients with a current major depressive episode (DSM-IV). Patients were randomized to high dose (400% above the seizure threshold) right unilateral (RUL) ECT, to moderate dose (150% above seizure threshold) RUL ECT, and to low dose (just above seizure threshold) bifrontal (BF) ECT. Primary outcome measures included number of treatments, Hamilton Depression Rating Scale score, and Mini-Mental State Examination score. High dose RUL ECT was associated with a significantly faster response to treatment than low dose BF ECT. Moreover, there was a tendency to a higher response rate with high dose RUL ECT compared with either moderate dose RUL ECT or BF ECT.