Electroconvulsive Therapy Stimulus Dosing: A Survey of Contemporary Practices

There is debate in the psychiatric community regarding how to optimize electroconvulsive therapy (ECT). American Psychiatric Association recommendations suggest a moderately suprathreshhold stimulus intensity, yet little information is available regarding how practitioners select initial ECT stimulus doses. We report the results of a nationwide study of common ECT practices. Respondents provided their most commonly used electrode placement, method of determining stimulus intensity, and type of ECT device. Our results showed a high degree of variability in ECT methods, and those practitioners "specializing" in ECT were no more likely than nonspecialists to titrate stimulus intensity at the first treatment. Indeed, a fixed high-dose stimulus, stimulus titration, and stimulus intensity calculated by formula were each widely used by both ECT specialists and nonspecialists.