Pertinence of Titration and Age-Based Dosing Methods for Electroconvulsive Therapy: An International Retrospective Multicenter Study
The Journal of ECT. 2018-12-01; 34(4): 220-226
DOI: 10.1097/YCT.0000000000000508
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Lemasson M, Rochette L(1), Galvão F(2), Poulet E(2), Lacroix A(3), Lecompte M(2),
Auriacombe M, Patry S, Haesebaert F.
Author information:
(1)Bureau d’Information et d’Études en Santé des Populations, Institut National de Santé Publique du Québec, Quebec, Canada.
(2)PsyR2 Team, U 1028, INSERM and UMR 5292, CNRS, Center for Neuroscience Research of Lyon, CH Le Vinatier, Lyon-1 University, Bron, France.
(3)Institut Universitaire en Santé Mentale de Québec, CIUSSS Capitale-Nationale, Quebec, Canada.
Comment in
J ECT. 2018 Dec;34(4):209-210.
BACKGROUND: Although the dosage of electroconvulsive therapy (ECT) stimulus has a
major impact on the efficacy and safety of this treatment, the method used to
determine an optimal dosage remains a matter of debate.
OBJECTIVE: We investigated factors influencing the seizure threshold (ST) in a
large-sample study and compared age-based and titration dosing methods in terms
of charge.
METHODS: A retrospective study examined data from 503 patients across France and
Canada. The patients underwent right unilateral (RUL) or bitemporal (BT) ECT
during a titration session before undergoing ECT. Seizure threshold and charge
differences between age-based and titration-predicted methods were derived for
each RUL and BT patient and compared according to sex, age, and anesthetic
agents.
RESULTS: Based on our results, ST is a function of electrode placement, sex, age,
and anesthetic agents. Titration and age-based methods led to completely
different patterns of charges for the same electrode placement, especially in
elderly and in women in the RUL group. Regression models showed that differences
between the age-based and titration methods varied with respect to age, sex, and
anesthetic agent. Specifically, significant effects of sex and age were observed
for RUL ECT and of sex and anesthetics for BT ECT.
CONCLUSIONS: This study revealed that several factors significantly influence the
prediction of ECT dose, depending on individuals and treatment modalities.
Caution should be exercised when using nonindividualized methods to calculate ST.