How is electroconvulsive therapy (ECT) performed?

Updated: Sep 24, 2019
  • Author: Mehul V Mankad, MD; Chief Editor: Dennis M Popeo, MD  more...
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The electrical stimulus must be sufficient to induce a seizure. Modern ECT devices use either a brief square wave pulse (approximately 1 milisecond) or ultra-brief square wave pulse (less than 0.5 milisecond). Data suggests that brief pulse ECT requires fewer treatments but that ultra-brief pulse ECT is associated with fewer cognitive adverse effects. [88]  The dose is measured in millicoulombs of charge delivered. [42]

Three methods are used to determine stimulus intensity and dosing, as follows: [1, 42]

  • Empirical titration

  • Formula-based titration

  • Fixed dosages

In empirical titration, progressively higher doses are given during the first ECT session until seizure threshold is reached. This provides the most precise method for determining seizure threshold. [1] In formula-based titration, the dose is based on factors such as age, gender, and electrode placement. In the third method, a fixed dose is given independent of patient or other factors.

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