Abstract
Aims and MethodsA prospective study comparing initial electroconvulsive therapy treatment doses determined by empirical dose titration with estimates derived from two simple dose prediction methods and a fixed-dose regimen (275 mC).ResultsThirty-three patients had seizure thresholds between 25 mC and 403 mC. The dose titration method led to a mean initial treatment dose of 195 mC that was intermediate between those predicted by the age method (275 mC) and the half-age method (137 mC). Estimates were within acceptable limits in 33% of cases for the age method, 64% for the half-age method and 40% for the fixed-dose method.Clinical ImplicationsEither dose prediction or dose titration methods may be more appropriate in different clinical situations. The half-age method appears to be a more accurate predictor of optimum initial treatment dose.
Highlights
403 mC.The dose titration method led to a mean initial treatment dose of 195 mC that was intermediate between those predicted by the age method (275 mC) and the half-age method (137 mC)
The Royal College of Psychiatrists' guidelines advocate that the electrical dose given in electroconvulsive therapy (ECT) is adjusted for each patient to take into account variations in seizure threshold (Royal College of Psychiatrists, 1995)
Empirical dose titration is currently the most accurate method for determining seizure threshold allowing the initial treatment stimulus to be set with similar accuracy within atherapeutic window' for both unilateral (2.25^4.5 times seizure threshold) and bilateral ECT (1.5^2.25 times seizure threshold)
Summary
403 mC.The dose titration method led to a mean initial treatment dose of 195 mC that was intermediate between those predicted by the age method (275 mC) and the half-age method (137 mC). The Royal College of Psychiatrists' guidelines advocate that the electrical dose given in electroconvulsive therapy (ECT) is adjusted for each patient to take into account variations in seizure threshold (Royal College of Psychiatrists, 1995). This technique is called stimulus dosing and two methods are used. Voluntary, English-speaking patients, aged over 17 years, referred for ECT and giving informed consent for the main study They all met DSM ^ IV criteria for major depressive episode (American Psychiatric Association, 1994) and had not had ECT within the previous three months. In a previous audit (Bentham et al, 1998) 97% of stimuli were given with a dose of 275 mC (50% above mean seizure threshold), comparisons were made with this fixed-dose regimen
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