Electroconvulsive Therapy Stimulus Dosing: A Survey of Contemporary Practices

Area of Science:

• Psychiatry
• Neuroscience
• Clinical Practice

Background:

• The American Psychiatric Association recommends moderately suprathreshold stimulus intensity for electroconvulsive therapy (ECT).
• There is limited understanding of how clinicians determine initial ECT stimulus doses in practice.
• Optimizing electroconvulsive therapy (ECT) remains a subject of debate within the psychiatric community.

Purpose of the Study:

• To investigate common electroconvulsive therapy (ECT) practices across the United States.
• To identify variability in electrode placement, stimulus intensity determination, and device usage.
• To compare the practices of ECT specialists versus nonspecialists regarding stimulus titration.

Main Methods:

• A nationwide survey was conducted among ECT practitioners.
• Respondents reported their most frequent electrode placement, method for determining stimulus intensity, and ECT device type.
• Data were analyzed to identify common practices and variations.

Main Results:

• Significant variability exists in electroconvulsive therapy (ECT) methods employed nationwide.
• Practitioners commonly use diverse approaches for determining initial stimulus intensity, including fixed high-dose stimulus, stimulus titration, and formula-based calculations.
• No significant difference was observed between ECT specialists and nonspecialists in their likelihood to titrate stimulus intensity for the first treatment.

Conclusions:

• Current electroconvulsive therapy (ECT) practices exhibit considerable heterogeneity.
• The selection of initial stimulus intensity methods is varied among clinicians, irrespective of specialization.
• Further research is needed to establish standardized and evidence-based protocols for optimizing electroconvulsive therapy (ECT) stimulus dosing.