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Related Experiment Videos

ECT stimulus intensity: are present ECT devices too limited?

A D Krystal1, M D Dean, R D Weiner

  • 1Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA. krystal@cs.duke.edu

The American Journal of Psychiatry
|June 1, 2000
PubMed
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The maximum electrical stimulus for electroconvulsive therapy (ECT) may be insufficient for some patients, potentially hindering treatment effectiveness. Increasing the stimulus output could improve outcomes for individuals requiring higher levels.

Area of Science:

  • Neurology
  • Psychiatry
  • Medical Devices

Background:

  • The United States limits electroconvulsive therapy (ECT) device output to 576 millicoulombs.
  • Evidence is lacking to confirm this limit ensures consistent treatment efficacy.

Purpose of the Study:

  • To investigate if the maximum stimulus charge impacts therapeutic response in ECT.
  • To determine if a higher stimulus charge should be available for ECT devices.

Main Methods:

  • Retrospective review of 471 patients undergoing ECT at Duke University (1991-1998).
  • Analysis of patients receiving conservative stimulus dosing (2.25x threshold for unilateral, 1.5x for bilateral ECT).

Main Results:

  • 15% of patients required maximum stimulus intensity.

Related Experiment Videos

  • 5% of all patients had inadequate seizures (short or absent) at maximum stimulus.
  • Only 32% of these patients responded to ECT, compared to 66% of others.
  • Older age and pre-ECT EEG slowing predicted need for maximum stimulus.

    • Conclusions:

    • The current maximum ECT stimulus output is therapeutically insufficient for a subset of patients.
    • Increasing maximum stimulus output could enhance ECT treatment adequacy and response rates.