Need to titrate in ultrabrief electroconvulsive therapy--need for more evidence

A recent audit on ultrabrief electroconvulsive therapy (ECT) at our hospital revealed that most of the patients had an increase in seizure threshold during their routine dose retitration at session 7. These patients subsequently received an increased dose to sustain a therapeutic dose of 6 times the seizure threshold. Our results raise the possibility that patients may be receiving inadequate doses before retitration in the setting of rising seizure thresholds, thus potentially affecting the efficacy of ultrabrief ECT. Further studies are needed to provide more insight into the need for retitration and in determining the optimal therapeutic dose in ultrabrief ECT.