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Electroconvulsive therapy stimulus parameters: rethinking dosage.

Publication ,  Journal Article
Peterchev, AV; Rosa, MA; Deng, Z-D; Prudic, J; Lisanby, SH
Published in: J ECT
September 2010

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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Published In

J ECT

DOI

EISSN

1533-4112

Publication Date

September 2010

Volume

26

Issue

3

Start / End Page

159 / 174

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Psychiatry
  • Neurobiology
  • Humans
  • Evoked Potentials
  • Electroconvulsive Therapy
  • 5203 Clinical and health psychology
  • 3209 Neurosciences
  • 3202 Clinical sciences
  • 1701 Psychology
 

Citation

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Peterchev, A. V., Rosa, M. A., Deng, Z.-D., Prudic, J., & Lisanby, S. H. (2010). Electroconvulsive therapy stimulus parameters: rethinking dosage. J ECT, 26(3), 159–174. https://doi.org/10.1097/YCT.0b013e3181e48165
Peterchev, Angel V., Moacyr A. Rosa, Zhi-De Deng, Joan Prudic, and Sarah H. Lisanby. “Electroconvulsive therapy stimulus parameters: rethinking dosage.J ECT 26, no. 3 (September 2010): 159–74. https://doi.org/10.1097/YCT.0b013e3181e48165.
Peterchev AV, Rosa MA, Deng Z-D, Prudic J, Lisanby SH. Electroconvulsive therapy stimulus parameters: rethinking dosage. J ECT. 2010 Sep;26(3):159–74.
Peterchev, Angel V., et al. “Electroconvulsive therapy stimulus parameters: rethinking dosage.J ECT, vol. 26, no. 3, Sept. 2010, pp. 159–74. Pubmed, doi:10.1097/YCT.0b013e3181e48165.
Peterchev AV, Rosa MA, Deng Z-D, Prudic J, Lisanby SH. Electroconvulsive therapy stimulus parameters: rethinking dosage. J ECT. 2010 Sep;26(3):159–174.

Published In

J ECT

DOI

EISSN

1533-4112

Publication Date

September 2010

Volume

26

Issue

3

Start / End Page

159 / 174

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Psychiatry
  • Neurobiology
  • Humans
  • Evoked Potentials
  • Electroconvulsive Therapy
  • 5203 Clinical and health psychology
  • 3209 Neurosciences
  • 3202 Clinical sciences
  • 1701 Psychology