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Electroconvulsive Therapy Stimulus Parameters: Rethinking Dosage
Open accessAbstract
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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“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]
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Metadata
- 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.
- Venue
- The Journal of ECT
- Published
- 2010-09
- Volume
- 26
- Issue
- 3
- Pages
- 159-174
- ISSN
- 1095-0680 (ISSN-L)
- 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 › Clinical Neurology › Deep Brain Stimulation and Movement Disorders
- 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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