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

References

• Weaver LA, Williams RW. The electroconvulsive therapy stimulus. In: Abrams R, Esssman WB, editors. Electroconvulsive Therapy: Biological Foundations and Clinical Application. Lancaster (England): MTP Press Limited, International Medical Publishers; 1982. p.129–155.
   Google Scholar
• Rzesnitzek L, Lang S. A material history of electroshock therapy: electroshock technology in Europe until 1945. NTM. 2016;24(3):251–277.
   PubMed Web of Science ®Google Scholar
• Devanand DP, Lisanby SH, Nobler MS, et al. The relative efficiency of altering pulse frequency or train duration when determining seizure threshold. J ECT. 1998;14(4):227–235.
   PubMed Web of Science ®Google Scholar
• Girish K, Gangadhar BN, Janakiramaiah N, et al. Seizure threshold in ECT: effect of stimulus pulse frequency. J ECT. 2003;19(3):133–135.
   PubMed Web of Science ®Google Scholar
• Kotresh S, Girish K, Janakiramaiah N, et al. Gangadhar BN. Effect of ECT stimulus parameters on seizure physiology and outcome. J ECT. 2004;20(1):10–12.
   PubMed Web of Science ®Google Scholar
• Peterchev AV, Rosa MA, Deng ZD, et al. Electroconvulsive therapy stimulus parameters: rethinking dosage. J ECT. 2010;26(3):159–174.
   PubMed Web of Science ®Google Scholar
• Ravishankar V, Narayanaswamy JC, Thirthalli J, et al. Altering pulse frequency to enhance stimulus efficiency during electroconvulsive therapy. J ECT. 2013;29(1):e14– e15.
   PubMed Web of Science ®Google Scholar
• Roepke S, Luborzewski A, Schindler F, et al. Stimulus pulse-frequency-dependent efficacy and cognitive adverse effects of ultrabrief-pulse electroconvulsive therapy in patients with major depression. J ECT. 2011;27(2):109–113.
   PubMed Web of Science ®Google Scholar
• Swartz CM, Larson G. ECT stimulus duration and Its efficacy. Ann Clin Psychiatry. 1989;1:148–152.
   Google Scholar
• Thanki MV, Mitra S, Kumar CN, et al. Lower pulse frequency, and not longer stimulus duration, helps reduce seizure threshold in ECT. Brain Stimul. 2018;11(3):656–657.
   PubMed Web of Science ®Google Scholar
• Thirthalli J, Kumar CN, Mitra S, et al. Novel method of altering stimulus parameter to facilitate seizure induction during electroconvulsive therapy. Brain Stimul. 2017;10(6):1143–1144.
   PubMed Web of Science ®Google Scholar
• Petrides G, Fink M. The «half-age» stimulation strategy for ECT dosing. Convuls Ther. 1996;12(3):138–146.
   PubMedGoogle Scholar
• MECTA Corporation. MECTA Product and Company Overview: MECTA – Over 40 years of neuromodumation innovations. Secondary MECTA Product and Company Overview: MECTA – Over 40 years of neuromodumation innovations. 2017. Available from: http://www.mectacorp.com/home.html.
   Google Scholar
• Nilsen SM, Willis KW, Pettinati HM. Initial impression of two new brief-pulse electroconvulsive therapy machines. Convuls Ther. 1986;2(1):43–54.
   PubMedGoogle Scholar
• Somatics LLC. Welcome to Somatics, the World's leader in ECT innovation and sales. Secondary welcome to Somatics, the World's leader in ECT innovation and sales. 2003. Available from: http://www.thymatron.com/downloads/somatics.pdf.
   Google Scholar
• Braunmühl von A. Ein neues Gerät für die Heilkrampfbehandlung mittels elektrischen Stromen. Fortschr Neurol Psychiatr. 1951;19:325–332.
   Google Scholar
• d'Elia G, Ottosson JO, Strömgren LS. Present practice of electroconvulsive therapy in Scandinavia. Arch Gen Psychiatry. 1983;40(5):577–581.
   PubMed Web of Science ®Google Scholar
• Kellner CH, Borys EJ. The rush from bench to bedside in electroconvulsive therapy. Aust NZ J Psychiatry. 2018;52(5):498–499.
   PubMed Web of Science ®Google Scholar
• Landry M, Lafreniere S, Patry S, et al. The clinical relevance of dose titration in electroconvulsive therapy: a systematic review of the literature. Psychiatry Res. 2020;294:113497.
   PubMed Web of Science ®Google Scholar
• McLoughlin DM. I know not 'seems'. Aust NZ J Psychiatry. 2018;52(7):709–710.
   PubMed Web of Science ®Google Scholar
• Sienaert P. Time to replicate. Aust NZ J Psychiatry. 2018;52(7):710–711.
   PubMed Web of Science ®Google Scholar
• Cronholm B, Ottosson JO. Ultrabrief stimulus technique in electroconvulsive therapy. I. Influence on retrograde amnesia of treatments with the Elther ES electroschock apparatus, Siemens Konvulsator III and of lidocaine-modified treatment. J Nerv Ment Dis. 1963;137:117–123.
   PubMed Web of Science ®Google Scholar
• Cronholm B, Ottosson JO. Ultrabrief stimulus technique in electroconvulsive therapy. II. Comparative studies of therapeutic effects and memory disturbances in treatment of endogenous depression with the Elther ES electroshock apparatus and Siemens Konvulsator III. J Nerv Ment Dis. 1963;137:268–276.
   PubMed Web of Science ®Google Scholar
• Lamy S, Bergsholm P, d'Elia G. The antidepressant efficacy of high-dose nondominant long-distance parietotemporal and bitemporal electroconvulsive therapy. Convuls Ther. 1994;10(1):43–52.
   PubMedGoogle Scholar
• Tripathi C, Khan B, Youssef NA. Need for standardization of measurement of time to reorientation as a predictor of cognitive adverse effects of electroconvulsive. Therapy J Ect. 2021;37(1):13–17.
   PubMed Web of Science ®Google Scholar
• Bjølseth TM, Engedal K, Benth JS, et al. Speed of recovery from disorientation may predict the treatment outcome of electroconvulsive therapy (ECT) in elderly patients with major depression. J Affect Disord. 2016;190:178–186.
   PubMed Web of Science ®Google Scholar
• McCall WV, Reboussin DM, Weiner RD, et al. Titrated moderately suprathreshold vs fixed high-dose right unilateral electroconvulsive therapy: acute antidepressant and cognitive effects. Arch Gen Psychiatry. 2000;57(5):438–444.
   PubMed Web of Science ®Google Scholar
• Sackeim HA, Prudic J, Devanand DP, et al. Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. N Engl J Med. 1993;328(12):839–846.
   PubMed Web of Science ®Google Scholar
• Sackeim HA, Prudic J, Devanand DP, et al. A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities. Arch Gen Psychiatry. 2000;57(5):425–434.
   PubMed Web of Science ®Google Scholar
• d’Elia G. Unilateral electroconvulsive therapy. Acta Psychiatr Scand Suppl. 1970;215:1–98.
   PubMedGoogle Scholar
• Strömgren LS. Unilateral versus bilateral electroconvulsive therapy. Investigations into the therapeutic effect in endogenous depression. Acta Psychiatr Scand Suppl. 1973;240:1–65.
   Google Scholar
• Fromholt P, Christensen AL, Strömgren LS. The effects of unilateral and bilateral electroconvulsive therapy on memory. Acta Psychiatr Scand. 1973;49(4):466–478.
   PubMed Web of Science ®Google Scholar
• Strömgren LS. Electroconvulsive therapy in Aarhus, Denmark, in 1984: its application in nondepressive disorders. Convuls Ther. 1988;4(4):306–313.
   PubMedGoogle Scholar
• Strömgren LS. Is bilateral ECT ever indicated? Acta Psychiatr Scand. 1984;69(6):484–490.
   PubMed Web of Science ®Google Scholar
• Abrams R. Electroconvulsive therapy. 4th ed. Oxford: Oxford University Press; 2002.
   Google Scholar
• Farah A, McCall WV. Electroconvulsive therapy stimulus dosing: a survey of contemporary practices. Convuls Ther. 1993;9(2):90–94.
   PubMedGoogle Scholar
• Kellner CH. Handbook of ECT. A guide to electroconvulsive therapy for practitioners. Cambridge: Cambridge University Pressl; 2019.
   Google Scholar
• Swartz CM, editor. Electroconvulsive and neuromodulation therapies. Cambridge: Cambridge University Press; 2009.
   Google Scholar
• Kellner CH. Towards the modal ECT treatment. J ECT. 2001;17(1):1–2.
   PubMed Web of Science ®Google Scholar
• Sackeim HA, Decina P, Portnoy S, et al. Studies of dosage, seizure threshold, and seizure duration in ECT. Biol Psychiatry. 1987;22(3):249–268.
   PubMed Web of Science ®Google Scholar
• Weiner RD. The practice of electroconvulsive therapy. Recommendations for Treatment, Training, and privileging. 2nd ed. Washington, DC: American Psychiatric Association; 2001.
   Google Scholar
• Abrams R. Stimulus titration and ECT dosing and response to commentaries. J ECT. 2002;18(1):3–9.
   PubMed Web of Science ®Google Scholar
• Beyer JL, Weiner RD, Glenn MD. Electroconvulsive therapy: a programmed text. 2nd ed. Washington, DC: American Psychiatric Press, Inc.; 1998.
   Google Scholar
• Duthie AC, Perrin JS, Bennett DM, et al. Anticonvulsant mechanisms of electroconvulsive therapy and relation to therapeutic efficacy. J ECT. 2015;31(3):173–178.
   PubMed Web of Science ®Google Scholar
• Jeong SH, Youn T, Lee Y, et al. Initial seizure threshold in brief-pulse bilateral electroconvulsive therapy in patients with schizophrenia or schizoaffective disorder. Psychiatry Investig. 2019;16(9):704–712.
   PubMed Web of Science ®Google Scholar
• Luccarelli J, McCoy TH, Jr., Seiner SJ, et al. Charge required to induce a seizure during initial dose titration using right unilateral brief pulse electroconvulsive therapy. Brain Stimul. 2020;13(6):1504–1506.
   PubMed Web of Science ®Google Scholar
• van Waarde JA, van Oudheusden LJ, Verwey B, et al. Clinical predictors of seizure threshold in electroconvulsive therapy: a prospective study. Eur Arch Psychiatry Clin Neurosci. 2013;263(2):167–175.
   PubMed Web of Science ®Google Scholar
• van Waarde JA, Verwey B, van der Mast RC. Meta-analysis of initial seizure thresholds in electroconvulsive therapy. Eur Arch Psychiatry Clin Neurosci. 2009;259(8):467–474.
   PubMed Web of Science ®Google Scholar
• Bjølseth TM, Engedal K, Benth JS, et al. Clinical efficacy of formula-based bifrontal versus right unilateral electroconvulsive therapy (ECT) in the treatment of major depression among elderly patients: a pragmatic, randomized, assessor-blinded, controlled trial. J Affect Disord. 2015;175:8–17.
   PubMed Web of Science ®Google Scholar
• Schoeyen HK, Kessler U, Andreassen OA, et al. Treatment-resistant bipolar depression: a randomized controlled trial of electroconvulsive therapy versus algorithm-based pharmacological treatment. Am J Psychiatry. 2015;172(1):41–51.
   PubMed Web of Science ®Google Scholar
• Swartz CM, Nelson AI. Rational electroconvulsive therapy electrode placement. Psychiatry. 2005;2(7):37–43.
   PubMedGoogle Scholar
• Bennett DM, Perrin JS, Currie J, et al. A comparison of ECT dosing methods using a clinical sample. J Affect Disord. 2012;141(2-3):222–226.
   PubMed Web of Science ®Google Scholar
• Sackeim H, Decina P, Prohovnik I, et al. Seizure threshold in electroconvulsive therapy. Effects of sex, age, electrode placement, and number of treatments. Arch Gen Psychiatry. 1987;44(4):355–360.
   PubMed Web of Science ®Google Scholar
• Sackeim HA, Decina P, Kanzler M, et al. Effects of electrode placement on the efficacy of titrated, low-dose ECT. Am J Psychiatry. 1987;144(11):1449–1455.
   PubMed Web of Science ®Google Scholar
• Dunne RA, McLoughlin DM. Systematic review and meta-analysis of bifrontal electroconvulsive therapy versus bilateral and unilateral electroconvulsive therapy in depression. World J Biol Psychiatry. 2012;13(4):248–258.
   PubMed Web of Science ®Google Scholar
• Kolshus E, Jelovac A, McLoughlin DM. Bitemporal v. high-dose right unilateral electroconvulsive therapy for depression: a systematic review and meta-analysis of randomized controlled trials. Psychol Med. 2017;47(3):518–530.
   PubMed Web of Science ®Google Scholar
• McCall WV, Dunn A, Rosenquist PB, et al. Markedly suprathreshold right unilateral ECT versus minimally suprathreshold bilateral ECT: antidepressant and memory effects. J ECT. 2002;18(3):126–129.
   PubMed Web of Science ®Google Scholar
• Lane RD, Zeitlin SB, Abrams R, et al. Differential effects of right unilateral and bilateral ECT on heart rate. Am J Psychiatry. 1989;146(8):1041–1043.
   PubMed Web of Science ®Google Scholar
• Swartz CM. Electroconvulsive therapy (ECT) stimulus charge rate and its efficacy. Ann Clin Psychiatry. 1994;6(3):205–206.
   PubMedGoogle Scholar
• Swartz CM. Disconnection of electroencephalographic, motoric, and cardiac evidence of ECT seizure. Convuls Ther. 1996;12(1):25–30.
   PubMedGoogle Scholar
• Swartz CM. Variations of peak and baseline heart rates. J ECT. 1999;15(3):222–225.
   PubMed Web of Science ®Google Scholar
• Swartz CM. Physiological response to ECT stimulus dose. Psychiatry Res. 2000;97(2-3):229–235.
   PubMed Web of Science ®Google Scholar
• Swartz CM. ECT dosing by the benchmark method. German J Psychiatry. 2002;5(1):1–4.
   Google Scholar
• Swartz CM, Abrams R, Lane RD, DuBois MA, et al. Heart rate differences between right and left unilateral electroconvulsive therapy. J Neurol Neurosurg Psychiatry. 1994;57(1):97–99.
   PubMed Web of Science ®Google Scholar
• Swartz CM, Manly DT. Endpoint of ECT-induced elevation in heart rate. J ECT. 1999;15(2):125–128.
   PubMed Web of Science ®Google Scholar
• Swartz CM, Shen WW. ECT generalized seizure drives heart rate above treadmill stress test maximum. J ECT. 2007;23(2):71–74.
   PubMed Web of Science ®Google Scholar
• Swartz CM. Asymmetric bilateral right frontotemporal left frontal stimulus electrode placement for electroconvulsive therapy. Neuropsychobiology. 1994;29(4):174–178.
   PubMed Web of Science ®Google Scholar
• Swartz CM, Evans CM. Beyond bitemporal and right unilateral electrode placements. Psychiatr Ann. 1996;26(11):705–708.
   Web of Science ®Google Scholar
• Manly DT, Swartz CM. Asymmetric bilateral right frontotemporal left frontal stimulus electrode placement: comparisons with bifrontotemporal and unilateral placements. Convuls Ther. 1994;10(4):267–270.
   PubMedGoogle Scholar
• Weiss AM, Hansen SM, Safranko I, et al. Effectiveness of left anterior right temporal electrode placement in electroconvulsive therapy: 3 case reports. J ECT. 2015;31(1):e1– e3.
   PubMed Web of Science ®Google Scholar
• Steward B, Bakir AA, Martin D, et al. The left anterior right temporal (LART) placement for electroconvulsive therapy: a computational modelling study. Psychiatry Res Neuroimaging. 2020;304:111157.
   PubMed Web of Science ®Google Scholar
• Dunne RA, O’Neill-Kerr A, McLoughlin DM, et al. Practical aspects of ECT. In: Ferrier IN, Waite J, editors. The ECT Handbook. Cambridge: Cambridge University Press; 2019. p.183–201.
   Google Scholar
• Weiss A, Hussain S, Ng B, et al. Royal Australian and New Zealand College of Psychiatrists professional practice guidelines for the administration of electroconvulsive therapy. Aust NZ J Psychiatry. 2019;53(7):609–623.
   PubMed Web of Science ®Google Scholar
• Milev RV, Giacobbe P, Kennedy SH, CANMAT Depression Work Group, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: Section 4. Neurostimulation treatments. Can J Psychiatry. 2016;61(9):561–575.
   PubMed Web of Science ®Google Scholar
• Ferrier IN, Waite J, editors. The ECT handbook. 4th ed. Cambridge: Cambridge University Press; 2019.
   Google Scholar
• Swartz CM. Stimulus dosing in electroconvulsive therapy and the threshold multiple method. J ECT. 2001;17(2):87–90.
   PubMed Web of Science ®Google Scholar
• Fink M. What was learned: studies by the consortium for research in ECT (CORE) 1997–2011. Acta Psychiatr Scand. 2014;129(6):417–426.
   PubMed Web of Science ®Google Scholar
• O'Neill-Kerr A, Yassin A, Rogers S, et al. Switching from age-based stimulus dosing to dose titration protocols in electroconvulsive therapy: empirical evidence for better patient outcomes with lower peak and cumulative energy doses. J ECT. 2017;33(3):181–184.
   PubMed Web of Science ®Google Scholar
• Rasmussen KG. Stimulus titration and ECT dosing: commentary. J ECT. 2002;18(1):10–11.
   Google Scholar
• Nishikawa K, Yamakage M. Effects of the concurrent use of a reduced dose of propofol with divided supplemental remifentanil and moderate hyperventilation on duration and morphology of electroconvulsive therapy-induced electroencephalographic seizure activity: A randomized controlled trial. J Clin Anesth. 2017;37:63–68.
   PubMed Web of Science ®Google Scholar
• Semple D. Pragmatic guidance for EEG interpretation. Electroconvulsive therapy in practice. 2nd ed; 2017.
   Google Scholar
• Semple DM, Devlin RA. Seizure monitoring in ECT. In: Ferrier N, Waite J, editors. The ECT Handbook. 4th ed. Cambridge: Cambridge University Press; 2019. p.234–246.
   Google Scholar
• Luccarelli J, McCoy TH, Jr., Seiner SJ, et al. Total charge required to induce a seizure in a retrospective cohort of patients undergoing dose titration of right unilateral ultrabrief pulse electroconvulsive therapy. J ECT. 2021;37(1):40–45.
   PubMed Web of Science ®Google Scholar
• Rosenman SJ. Electroconvulsive therapy stimulus titration: not all it seems. Aust NZ J Psychiatry. 2018;52(5):410–414.
   PubMed Web of Science ®Google Scholar
• Somatics L. Thymatron system IV instruction manual. 14th ed; Lake Bluff IL, USA: Somatics, LLC, 1999–2019.
   Google Scholar
• Chanpattana W, Buppanharun W, Raksakietisak S, et al. Seizure threshold rise during electroconvulsive therapy in schizophrenic patients. Psychiatry Res. 2000;96(1):31–40.
   PubMed Web of Science ®Google Scholar
• Chanpattana W, Yatapootanon W, Techakasem P, et al. Seizure threshold in electroconvulsive therapy: III. A long-term study. J Med Assoc Thai. 2000;83(7):748–755.
   PubMedGoogle Scholar
• Coffey CE, Lucke J, Weiner RD, et al. Seizure threshold in electroconvulsive therapy (ECT) II. The anticonvulsant effect of ECT. Biol Psychiatry. 1995;37(11):777–788.
   PubMed Web of Science ®Google Scholar
• Krystal AD, Coffey CE, Weiner RD, et al. Changes in seizure threshold over the course of electroconvulsive therapy affect therapeutic response and are detected by ictal EEG ratings. J Neuropsychiatry Clin Neurosci. 1998;10(2):178–186.
   PubMed Web of Science ®Google Scholar
• Scott AI, Boddy H. The effect of repeated bilateral electroconvulsive therapy on seizure threshold. J ECT. 2000;16(3):244–251.
   PubMed Web of Science ®Google Scholar
• Suetani S, Waite S. Need to titrate in ultrabrief electroconvulsive therapy-need for more evidence. J ECT. 2014;30(1):e1.
   PubMed Web of Science ®Google Scholar
• Brunner I, Grözinger M. Brief vs. ultrabrief pulse ECT: focus on seizure quality. Eur Arch Psychiatry Clin Neurosci. 2018;268(8):831–838.
   PubMed Web of Science ®Google Scholar
• Taib S, Levy A, Arbus C, et al. Reconsidering the seizure threshold? a retrospective study about seizure quality among patients with maintenance ECT. Acta Neuropsychiatr. 2019;31(1):52–55.
   PubMed Web of Science ®Google Scholar
• Wild B, Eschweiler GW, Bartels M. Electroconvulsive therapy dosage in continuation/maintenance electroconvulsive therapy: when is a new threshold titration necessary? J ECT. 2004;20(4):200–203.
   PubMed Web of Science ®Google Scholar