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Electroconvulsive therapy (ECT), or shock therapy, remains a critical biomedical intervention for severe, treatment-resistant depression. While its origins can be traced back to Hippocrates' observations that malaria-induced convulsions alleviated mental illness, modern ECT has evolved significantly from its earlier, more primitive applications. First introduced in 1938 by Ugo Cerletti and his colleagues, ECT involves inducing controlled seizures using electrical currents. In its early...
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Dosing methods in electroconvulsive therapy: should the Scandinavian time-titration method be resumed?

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Summary

This review examines electroconvulsive therapy (ECT) dosing methods. While seizure threshold-based and benchmark dosing appear more accurate, time-titration offers session-by-session adjustments for potentially greater efficiency.

Keywords:
Electroconvulsive therapydosingpulse frequencypulse traintitration

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Area of Science:

  • Neuroscience
  • Psychiatry
  • Medical Devices

Background:

  • Electroconvulsive therapy (ECT) is a vital treatment for severe mental health conditions.
  • Optimizing ECT efficacy and safety relies heavily on appropriate dosing strategies.
  • Historically, various methods have been employed to determine optimal electrical stimulation parameters.

Purpose of the Study:

  • To comprehensively review and evaluate diverse electroconvulsive therapy (ECT) dosing methodologies.
  • To re-emphasize the Scandinavian time-titration method for ECT administration.
  • To compare the effectiveness and practicality of different ECT dosing approaches.

Main Methods:

  • A narrative, unsystematic, and selective review of existing literature on ECT dosing.
  • Discussion and comparative analysis of five distinct dosing methods.
  • Focus on historical and current practices in ECT dosing strategies.

Main Results:

  • Five dosing methods identified: Scandinavian time-titration, fixed high dosing, formula-based (Age/Half-Age), charge-dosing (multiple of seizure threshold), and benchmark dosing.
  • Scandinavian time-titration demonstrated high efficacy, particularly with right unilateral (RUL) ECT, but its associated device is obsolete.
  • Charge-dosing and benchmark dosing show promise for accuracy, while time-titration allows for per-session dose adjustment.

Conclusions:

  • No single ECT dosing method is definitively superior.
  • Seizure threshold-based and benchmark dosing methods appear more precise than fixed high or formula-based approaches.
  • Time-titration dosing, despite historical device limitations, offers personalized adjustments and potential efficiency gains in ECT.