A comparison of ECT dosing methods using a clinical sample

Daniel Mark Bennett (Corresponding Author), Jennifer Perrin, James Currie, Lisa Blacklaw, Joji Kuriakose, Ahsan Rao, Ian Cameron Reid

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background
Several methods have been used to determine ECT dose based on formulae, protocols or fixed-dosing. This study aims to explore the relative utility of these ECT dosing methods.

Methods
A sample of ECT patients from Aberdeen was analysed. Seizure thresholds derived empirically were used to calculate the proportions of patients who would have had a therapeutic stimulus had Half-Age or a fixed-dosing method (200 mC for those < 65 years old and 250 mC for those > 65 years old) been used.

Results
62 patients were included. Initial seizure threshold varied 6 fold across the sample. Using the Half Age method 19.4% would have had a therapeutic seizure at first stimulation compared with 61.3% using an age based fixed protocol and 0% using the Royal College recommended dose titration method. Half Age and Fixed Dosing would have significantly (p < .0001) reduced the number of stimulations, the cumulative electrical dose delivered, the complexity of the procedure and the number of treatment sessions required.

Limitations
This study applies only to patients receiving bilateral ECT for a major depressive episode. It uses a pragmatic design to explore a common clinical issue. This allows the feasibility of further work to be explored as this would be precluded by ethical concerns otherwise. It also uses ECT parameters which are common in UK practice which may limit its applicability internationally.

Conclusions
Age based fixed-dosing would simplify the ECT process and result in more patients receiving effective treatment at first stimulation.
Original languageEnglish
Pages (from-to)222-226
Number of pages5
JournalJournal of Affective Disorders
Volume141
Issue number2-3
Early online date15 Mar 2012
DOIs
Publication statusPublished - 10 Dec 2012

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Seizures
Therapeutics
Electric Stimulation

Keywords

  • ECT
  • seizure threshold
  • stimulus dosing
  • fixed-dosing
  • depression

Cite this

Bennett, D. M., Perrin, J., Currie, J., Blacklaw, L., Kuriakose, J., Rao, A., & Reid, I. C. (2012). A comparison of ECT dosing methods using a clinical sample. Journal of Affective Disorders, 141(2-3), 222-226. https://doi.org/10.1016/j.jad.2012.02.033

A comparison of ECT dosing methods using a clinical sample. / Bennett, Daniel Mark (Corresponding Author); Perrin, Jennifer; Currie, James; Blacklaw, Lisa; Kuriakose, Joji; Rao, Ahsan; Reid, Ian Cameron.

In: Journal of Affective Disorders, Vol. 141, No. 2-3, 10.12.2012, p. 222-226.

Research output: Contribution to journalArticle

Bennett, DM, Perrin, J, Currie, J, Blacklaw, L, Kuriakose, J, Rao, A & Reid, IC 2012, 'A comparison of ECT dosing methods using a clinical sample', Journal of Affective Disorders, vol. 141, no. 2-3, pp. 222-226. https://doi.org/10.1016/j.jad.2012.02.033
Bennett DM, Perrin J, Currie J, Blacklaw L, Kuriakose J, Rao A et al. A comparison of ECT dosing methods using a clinical sample. Journal of Affective Disorders. 2012 Dec 10;141(2-3):222-226. https://doi.org/10.1016/j.jad.2012.02.033
Bennett, Daniel Mark ; Perrin, Jennifer ; Currie, James ; Blacklaw, Lisa ; Kuriakose, Joji ; Rao, Ahsan ; Reid, Ian Cameron. / A comparison of ECT dosing methods using a clinical sample. In: Journal of Affective Disorders. 2012 ; Vol. 141, No. 2-3. pp. 222-226.
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AB - Background Several methods have been used to determine ECT dose based on formulae, protocols or fixed-dosing. This study aims to explore the relative utility of these ECT dosing methods. Methods A sample of ECT patients from Aberdeen was analysed. Seizure thresholds derived empirically were used to calculate the proportions of patients who would have had a therapeutic stimulus had Half-Age or a fixed-dosing method (200 mC for those < 65 years old and 250 mC for those > 65 years old) been used. Results 62 patients were included. Initial seizure threshold varied 6 fold across the sample. Using the Half Age method 19.4% would have had a therapeutic seizure at first stimulation compared with 61.3% using an age based fixed protocol and 0% using the Royal College recommended dose titration method. Half Age and Fixed Dosing would have significantly (p < .0001) reduced the number of stimulations, the cumulative electrical dose delivered, the complexity of the procedure and the number of treatment sessions required. Limitations This study applies only to patients receiving bilateral ECT for a major depressive episode. It uses a pragmatic design to explore a common clinical issue. This allows the feasibility of further work to be explored as this would be precluded by ethical concerns otherwise. It also uses ECT parameters which are common in UK practice which may limit its applicability internationally. Conclusions Age based fixed-dosing would simplify the ECT process and result in more patients receiving effective treatment at first stimulation.

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