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

Bergsholm, Per; Bjølseth, Tor Magne

doi:10.1080/08039488.2021.1946590

Cited by 5 publications

(3 citation statements)

References 76 publications

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“…The strength of the electric field induced by conventional ECT is above the excitation threshold of most neuronal tissue in the brain, resulting in activation of almost the entire brain, which may contribute to cognitive SEs 50 . The total charge, pulse width, frequency, train duration and current amplitude all contribute to treatment response, electric field intensity and seizure induction with ECT 51 , 52 . One area of research has focused on modification of stimulus pulse width to enhance efficacy and reduce cognitive SEs of ECT.…”

Section: Optimizing Dosing and Administration Of Ectmentioning

confidence: 99%

Recent advances in electroconvulsive therapy in clinical practice and research

Mukhtar¹,

Regenold²,

Lisanby³

2023

Fac Rev

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Electroconvulsive therapy (ECT), the oldest somatic therapy still in use in psychiatry today, remains one of the most effective therapeutic interventions for a wide variety of psychiatric disorders. In this article, we review some of the recent advances in ECT that are currently being researched and implemented in clinical practice. We explore recent studies that point to the potential therapeutic benefit and safety of ECT in COVID-19-related neuropsychiatric complications and special populations (such as the elderly and pregnant persons) that are generally at higher risk of having adverse effects from psychotropic medications. We highlight studies that performed a head-to-head comparison of ECT and ketamine, which has shown promise for treatment-resistant depression and acute suicidality. Researchers continue to explore different ways of using ECT by modifying the treatment parameters to maintain efficacy and decrease side effects. Neurocognitive side effects remain one of the major drawbacks to its use and contribute to the negative stigma of this highly effective treatment. In this regard, we describe attempts to improve the safety of ECT by modifying dosing parameters, novel electrode placements, and the addition of augmenting agents with the aim of decreasing side effects and improving efficacy. This review identifies some of the recent advances in the last few years in ECT research while also highlighting areas where further research is needed.

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Section: Optimizing Dosing and Administration Of Ectmentioning

confidence: 99%

Recent advances in electroconvulsive therapy in clinical practice and research

Mukhtar¹,

Regenold²,

Lisanby³

2023

Fac Rev

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“…The optimal method for individualizing the stimulus dose in ECT is, however, not known. Dose titration at the first treatment, primarily for RUL electrode placement, has been proposed as a feasible option [ 49 , 50 ]. Age-based dosing is standard in Sweden, but the mean total charge found in this study is comparable to or slightly higher than that reported in clinical trials where dose-titration was used [ 51 ].…”

Section: Discussionmentioning

confidence: 99%

Electroconvulsive therapy in children and adolescents: results from a population‑based study utilising the Swedish National Quality Register

Rask

Nordenskjöld

Johansson

et al. 2022

Eur Child Adolesc Psychiatry

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Electroconvulsive therapy (ECT) is effective and safe for adults with severe depression, but less studied in adolescents. Here, we examined the indications, prevalence, practice, response and remission rates, and side effects in young people treated with ECT in Sweden. We also examined the usage of ECT in the transition to adult psychiatry. Using data from national patient registers and the Swedish National Quality Register for ECT (Q-ECT), we identified patients aged up to 19 years treated with ECT over a 5-year study period. Response and remission rates were analysed using the Clinical Global Impression (7-point scale)-Improvement (CGI-I) and Severity (CGI-S). A total of 118 individuals were identified, of which 105 were also enrolled in the Q-ECT. The most common indication for ECT was depression (68%; n = 80). Adolescents aged < 18 years were more severely ill before treatment than those aged 18 years (P < 0.01). Three of the hospitals in Sweden treated the majority of adolescents < 18 years old. The median number of sessions in each ECT series was seven. Unilateral placement of the electrodes was the most common (88%; n = 99). Fifty-seven percent (n = 54) of the patients responded (CGI-I, 1–2) to the treatment; remission (CGI-S, 1–2) was achieved by 32% (n = 30). Psychotic symptoms were associated with a higher response rate in patients with depression (P = 0.038). A deterioration of memory compared to pre-treatment was reported in six patients. ECT was associated with high response and remission rates in adolescents with severe psychiatric disorders after non-response to medication.

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“…We may argue that we do not know whether the magnitude of the effect with less invasive load calculation techniques (such as titration or the half-age method). Seizure threshold-based and benchmark dosing seems to be more accurate than fixed high and formulabased dosing [34]. We consider this highly important, as the use of different charge calculation techniques can affect both the duration of the seizure and the effectiveness of ECT [35].…”

Section: Limitationsmentioning

confidence: 99%

Does Lidocaine Shorten Seizure Duration in Electroconvulsive Therapy?

López-Ilundain,

Prados,

Enriquez

et al. 2023

Pharmacopsychiatry

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Background Electroconvulsive therapy (ECT) is an effective short-term treatment for schizophrenia and depression, amongst other disorders. Lidocaine is typically added to reduce pain from intravenous propofol injection. However, depending on the dose used in the ECT setting, it can shorten seizure duration. The aim of this study was to investigate the effect of lidocaine dose on seizure duration. Methods This retrospective, naturalistic cohort study included 169 patients treated with ECT. We examined 4714 ECT sessions with propofol or propofol plus lidocaine. Ictal quality was manually rated by visual inspection. The main outcome of this study was the relation of lidocaine with seizure duration after controlling for socio-demographic, ECT, and other anesthetic variables. Results There was a significant negative association between lidocaine usage and seizure duration. Multivariate analyses showed that seizure duration was shortened by an average of 3.21 s in sessions with lidocaine. Moreover, in this subgroup, there was a significant negative dose-dependent association between lidocaine dose and seizure length. Complementarily, a significant positive association between preictal BIS and seizure length was found in the subgroup of sessions where preictal was used. Conclusions We provide additional evidence highlighting the importance of caution regarding lidocaine dosing due to the effect on seizure length in the ECT setting. It is advisable for clinicians to exercise caution when administering lidocaine regarding its dosing and seizure length in ECT settings. Future investigation is needed to assess causal relationships by studying certain vulnerable groups or employing other charge calculation techniques, such as the titration method.

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

Cited by 5 publications

References 76 publications

Recent advances in electroconvulsive therapy in clinical practice and research

Recent advances in electroconvulsive therapy in clinical practice and research

Electroconvulsive therapy in children and adolescents: results from a population‑based study utilising the Swedish National Quality Register

Does Lidocaine Shorten Seizure Duration in Electroconvulsive Therapy?

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