A comparison of ECT dosing methods using a clinical sample

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. (C) 2012 Elsevier B.V. All rights reserved.