The clinical relevance of dose titration in electroconvulsive therapy: A systematic review of the literature

Landry, Marilyne; Lafrenière, Simon; Patry, Simon; Potvin, Stéphane; Lemasson, Morgane

doi:10.1016/j.psychres.2020.113497

Cited by 11 publications

(10 citation statements)

References 40 publications

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“…McLoughlin [20] commented that 'the best way to administer ECT with regard to optimizing therapeutic benefit and simultaneously minimizing cognitive side-effects is not known.' This was recently supported by Landry et al [19], who published a systematic review of the clinical relevance of the ST-based method compared to the age-and fixed dose methods, based on a literature search in March 2020. They concluded that no clear recommendations could be drawn regarding the clinical superiority of one method.…”

Section: Critique Of Seizure Threshold-based Dosingmentioning

confidence: 83%

“…Only in three series two to three supplementary BT sessions were given. The diagnoses were mania (15), mixed state (19), reactive psychosis (8), schizophrenia (6), delirium (1), and other (2). The effect was satisfactory in 53% and moderate in 30% of the series, although the relapse rate was 30% within three months.…”

Section: The Scandinavian Time-titration Dosingmentioning

confidence: 99%

“…In cases when formula/age-based or fixed dosing is applied, a significant number of patients will receive higher or lower doses than with ST-titration [19,78]. Titrated dosing makes it possible to detect patients who have extra high or low STs [79].…”

Section: Critique Of Seizure Threshold-based Dosingmentioning

confidence: 99%

“…The optimal method for individualizing the stimulus dose in ECT is not known [18][19][20][21]. Consequently, several techniques are in use.…”

Section: Introductionmentioning

confidence: 99%

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

Bergsholm

Bjølseth

2021

Nordic Journal of Psychiatry

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Aim: To describe and evaluate the different dosing methods in ECT, and bringing back into focus the Scandinavian time-titration method. Method: A narrative, unsystematic, and selective review and discussion. Results: There are five dosing methods: 1) The Scandinavian time-titration to tonic convulsion, using low-frequency pulses and a long maximal pulse train duration, was highly efficacious with right unilateral (RUL) ECT, comparable to bitemporal (BT) ECT. However, the device used went out of production in the 1990s. Because US devices until 1990 had a short maximal pulse train duration, time-titration went out of use. 2) Fixed high dosing at 50-100% of the device's maximal output, and 3) Formulabased dosing, initially the Age method, long prevailed in USA. Later, the Half-Age method was introduced for BT ECT. 4) Charge-dosing as a multiple of titrated seizure threshold (ST) demonstrated RUL and BT ECT to have comparable outcomes when dosed about six and two times the ST, respectively. 5) Dosing from benchmark is based on a high dose at the first session, to ensure a high peak heart rate and tonic-clonic convulsions. In later sessions the lowest dose producing similar outcomes is chosen. Conclusions: No dosing method is documented superior to the others. Seizure threshold-based and benchmark dosing seems to be more accurate than fixed high and formula-based dosing. However, time-titration dosing makes it possible to adjust the dose at every session, and may be the most efficient method.

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Section: Critique Of Seizure Threshold-based Dosingmentioning

confidence: 83%

Section: The Scandinavian Time-titration Dosingmentioning

confidence: 99%

Section: Critique Of Seizure Threshold-based Dosingmentioning

confidence: 99%

“…The optimal method for individualizing the stimulus dose in ECT is not known [18][19][20][21]. Consequently, several techniques are in use.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Bergsholm

Bjølseth

2021

Nordic Journal of Psychiatry

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“…Currently, in clinical practice, there are 2 commonly used methods to determine the electroconvulsive therapy (ECT) stimulus dose, one is based on the patient's age (5× or 2.5× age in years, in mC), the other is titration method (5-6× ST in right unilateral or 1.5-2× ST in bilateral, ST is defined as the minimum current dose required to induce a generalized seizure lasting 20-25 sec) (46)(47)(48)(49). It can be seen that some patients require more than 120 mC for treatment, which will incur more serious cognitive impairment.…”

Section: Discussionmentioning

confidence: 99%

Effects of N-Methyl-D-aspartate receptor (NMDAR) and Ca2+/ calmodulin-dependent protein kinase IIα (CaMKIIα) on learning and memory impairment in depressed rats with different charge by modified electroconvulsive shock

Zhang¹,

Ren²,

Min³

et al. 2021

Ann Transl Med

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Background: With the development of modified electroshock therapy (MECT), it has become necessary to increase the electric quantity in order to achieve a good antidepressant effect, but this increase will lead to more serious learning and memory impairment. The purpose of this study was to investigate the intrinsic mechanism of cognitive impairment induced by high-energy electroconvulsive shock (MECS, an animal model of MECT). Methods: Rats were randomly divided into 6 groups: control (C, n=6), M0, M60, M120, M180, and M240 groups (MECS at 0, 60, 120, 180, and 240 mC stimulation intensity after 80 mg/kg propofol, with 12 rats in each group). Their depression-like behavior and learning and memory ability were evaluated by sucrose preference test (SPT), open field test (OFT), and Morris water maze test (MWM). The expression of phospho-NMDA receptor 1 (GluN1), GluN2A, GluN2B, Ca 2+ /calmodulin-dependent protein kinase IIα (CaMKIIα), p-T305-CaMKII, and postsynaptic densities-95 (PSD-95) in hippocampus were detected by western blot. The co-expression of CaMKIIα and GluN2B subunit was detected by co-immunoprecipitation (CO-IP).Results: The chronic unpredictable mild stresses (CUMS) procedure successfully induced depression-like behavior in rats, which was improved in varying degrees after MECS. The results showed that the expression of GluN1, GluN2A, GluN2B, and PSD-95 decreased with the increase of charge, while p-T305-CaMKII increased, which led to the deterioration of learning and memory ability, but the expression change of CaMKIIα was not statistically significant.Conclusions: Increase in the MECS charge adjusts the synaptic plasticity by changing the binding amount of CaMKIIα and its subunit GluN2B and the level of CaMKII autophosphorylation, thereby impairing learning and memory functions.

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Modelling and Assessment of One-Drug Dose Titration

Riaño

Kamišalić

2021

Artificial Intelligence in Medicine

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The clinical relevance of dose titration in electroconvulsive therapy: A systematic review of the literature

Cited by 11 publications

References 40 publications

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

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

Effects of N-Methyl-D-aspartate receptor (NMDAR) and Ca2+/ calmodulin-dependent protein kinase IIα (CaMKIIα) on learning and memory impairment in depressed rats with different charge by modified electroconvulsive shock

Modelling and Assessment of One-Drug Dose Titration

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