Dosing methods in electroconvulsive therapy: should the Scandinavian time-titration method be resumed?

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time-titration demonstrated high efficacy, particularly with right unilateral (RUL) ECT, but its associated device is obsolete.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.