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A comparison of stimulus dosing methods for electroconvulsive therapy

Brownhill Centre, Swindon Road, Cheltenham GL51 9EZ

P. Bentham, Consultant Psychiatrist, G. Khan, Senior Registrar, V. Staples, Senior Registrar, A. Dhariwal, Senior Registrar, B. Coope, Senior Registrar and E. Day, Senior House Officer

Queen Elizabeth Psychiatric Hospital, Birmingham

C. Fear, Senior House Officer

Wotton Lawn, Gloucester

C. Marley, Senior House Officer and J. Stemman, Senior Registrar

Queen Elizabeth Psychiatric Hospital, Birmingham

AIMS AND METHODS

A 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).

RESULTS

Thirty-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 IMPLICATIONS

Either 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.