Electroconvulsive Therapy Stimulus Parameters: Rethinking Dosage

Peterchev, Angel V.; Rosa, Moacyr A.; Deng, Zhi-De; Prudic, Joan; Lisanby, Sarah H.

doi:10.1097/yct.0b013e3181e48165

Cited by 213Electroconvulsive Therapy StudiesTranscranial Magnetic Stimulation StudiesNeurological disorders and treatments

Electroconvulsive Therapy Stimulus Parameters: Rethinking Dosage

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Peterchev, Angel V., Rosa, Moacyr A., Deng, Zhi-De, Prudic, Joan, Lisanby, Sarah H.·2010·The Journal of ECT

DOI 10.1097/yct.0b013e3181e48165PMC PMC2933093

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Abstract

In this article, we review the parameters that define the electroconvulsive therapy (ECT) electrical stimulus and discuss their biophysical roles. We also present the summary metrics of charge and energy that are conventionally used to describe the dose of ECT and the rules commonly deployed to individualize the dose for each patient. We then highlight the limitations of these summary metrics and dosing rules in that they do not adequately capture the roles of the distinct stimulus parameters. Specifically, there is strong theoretical and empirical evidence that stimulus parameters (pulse amplitude, shape, and width, and train frequency, directionality, polarity, and duration) exert unique neurobiological effects that are important for understanding ECT outcomes. Consideration of the distinct stimulus parameters, in conjunction with electrode placement, is central to further optimization of ECT dosing paradigms to improve the risk-benefit ratio. Indeed, manipulation of specific parameters, such as reduction of pulse width and increase in number of pulses, has already resulted in dramatic reduction of adverse effects, while maintaining efficacy. Furthermore, the manipulation of other parameters, such as current amplitude, which are commonly held at fixed, high values, might be productively examined as additional means of targeting and individualizing the stimulus, potentially reducing adverse effects. We recommend that ECT dose be defined using all stimulus parameters rather than a summary metric. All stimulus parameters should be noted in treatment records and published reports. To enable research on optimization of dosing paradigms, we suggest that ECT devices provide capabilities to adjust and display all stimulus parameters.

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Preclinical research has suggested that lower-frequency ranges may be more effective in seizure induction, with magnetic seizure therapy at approximately 22 Hz.
“Furthermore, preclinical research has suggested that lower-frequency ranges may be more effective in seizure induction, with MST at approximately 22 Hz.27”
From Magnetic seizure therapy is efficacious and well tolerated for treatment-resistant bipolar depression: An open-label clinical trial (2020) · cites this paper as [27]
Section III.2 says lower frequencies may be more efficient than higher frequencies for seizure induction, while noting that an optimum has not been determined. The evidence discussed there concerns ECT and related stimulation; our copy does not support the specific attribution to preclinical MST research at approximately 22 Hz. (LLM, conf=0.86)
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Comparison of electric field strength and spatial distribution of electroconvulsive therapy and magnetic seizure therapy in a realistic human head model
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Electroconvulsive therapy (ECT) in schizophrenia
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How electroconvulsive therapy works in the treatment of depression: is it the seizure, the electricity, or both?
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Electroconvulsive Therapy: Mechanisms of Action, Clinical Considerations, and Future Directions
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A systematic review of the neurocognitive effects of magnetic seizure therapy
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A review of ultrabrief pulse width electroconvulsive therapy
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Efficacy of ultrabrief pulse electroconvulsive therapy for depression: A systematic review
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Effect of Anatomical Variability on Electric Field Characteristics of Electroconvulsive Therapy and Magnetic Seizure Therapy: A Parametric Modeling Study
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Predictors of Seizure Threshold in Right Unilateral Ultrabrief Electroconvulsive Therapy: Role of Concomitant Medications and Anaesthesia Used
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Exploring how extracellular electric field modulates neuron activity through dynamical analysis of a two-compartment neuron model
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Controlling Stimulation Strength and Focality in Electroconvulsive Therapy via Current Amplitude and Electrode Size and Spacing
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High-Frequency Stimulation at the Subthalamic Nucleus Suppresses Excessive Self-Grooming in Autism-Like Mouse Models
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A Review of Computational Models of Transcranial Electrical Stimulation
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A two-site, open-label, non-randomized trial comparing Focal Electrically-Administered Seizure Therapy (FEAST) and right unilateral ultrabrief pulse electroconvulsive therapy (RUL-UBP ECT)
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Neuronal Spike Initiation Modulated by Extracellular Electric Fields
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Electroconvulsive Therapy for Super Refractory Status Epilepticus
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Intracranial alternating current stimulation facilitates neurogenesis in a mouse model of Alzheimer’s disease
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Novel rapid treatment options for adolescent depression
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Total Charge Required to Induce a Seizure in a Retrospective Cohort of Patients Undergoing Dose Titration of Right Unilateral Ultrabrief Pulse Electroconvulsive Therapy
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A Computational Assessment of Target Engagement in the Treatment of Auditory Hallucinations with Transcranial Direct Current Stimulation
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Cognitive functioning in patients treated with electroconvulsive therapy
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Electroconvulsive Therapy Across Nations
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The impact of electroconvulsive therapy on brain grey matter volume: What does it mean?
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Rate of continuing acute course treatment using right unilateral ultrabrief pulse electroconvulsive therapy at a large academic medical center
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A Critical Review and Synthesis of Clinical and Neurocognitive Effects of Noninvasive Neuromodulation Antidepressant Therapies
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How Does Electroconvulsive Therapy Work?
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Neurobiological Mechanisms of Electroconvulsive Therapy: Molecular Perspectives of Brain Stimulation
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Ictal Theta Power as an Electroconvulsive Therapy Safety Biomarker
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Electroconvulsive therapy stimulus titration: Not all it seems
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Maternal Hypoxia Increases the Excitability of Neurons in the Entorhinal Cortex and Dorsal Hippocampus of Rat Offspring
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Non-invasive brain stimulation for fibromyalgia: current trends and future perspectives
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Early Complete Remitters After Electroconvulsive Therapy
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Antiepileptics in Electroconvulsive Therapy
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An adaptive h-refinement method for the boundary element fast multipole method for quasi-static electromagnetic modeling
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The clinical relevance of dose titration in electroconvulsive therapy: A systematic review of the literature
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Authors: Peterchev, A. V., Rosa, M. A., Deng, Z.-D., Prudic, J., & Lisanby, S. H.
Affiliations: New York State Psychiatric Institute (US)
Corresponding author: Peterchev, Angel V.
Rosa, Moacyr A.
Deng, Zhi-De
Prudic, Joan
Lisanby, Sarah H.
ORCID: Peterchev, Angel V.
Rosa, Moacyr A.
Deng, Zhi-De
Lisanby, Sarah H.
Venue: The Journal of ECT
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2010-09
Volume: 26
Issue: 3
Pages: 159-174
ISSN: 1095-0680 (ISSN-L)
DOI: 10.1097/yct.0b013e3181e48165
PMC: PMC2933093
OpenAlex: W2409179351
Cited by: 213
References: 182
Citations by year: 2026: 17 · 2025: 15 · 2024: 9 · 2023: 28 · 2022: 7 · 2021: 15 · 2020: 19 · 2019: 15 · 2018: 9 · 2017: 11 · 2016: 13 · 2015: 11 · 2014: 12 · 2013: 14 · 2012: 8
FWCI: 1.45
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Journal of Ect (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute of Mental Health (MH60884, R01MH060884, R01MH091083)
National Center for Research Resources (TL1RR024158)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
Health Sciences › Medicine › Neurology › Neurological disorders and treatments
Keywords: electroconvulsive therapy, pulse amplitude, pulse duration, train frequency, polarity, electrode placement, individualized dosing, adverse effects
MeSH terms: Electroconvulsive Therapy, Evoked Potentials, Humans, Neurobiology, Treatment Outcome

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Electroconvulsive Therapy Stimulus Parameters: Rethinking Dosage

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