Cited by 213Electroconvulsive Therapy StudiesTranscranial Magnetic Stimulation StudiesDeep Brain Stimulation and Movement Disorders

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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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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 › 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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Electroconvulsive Therapy Stimulus Parameters: Rethinking Dosage

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