Decision making regarding the choice of stimulus dose for a session of electroconvulsive therapy (ECT) has become increasingly complicated, making it difficult to make specific recommendations in selecting a stimulus dose. Variability in ECT provider awareness of new data, and differences between early adopters and late adopters of new information, will add to the already great variability in the practice of ECT, at least in the short term (Prudic et al., 2004). Still, some general recommendations can be made, and these are presented at the end of this chapter. Unless stated otherwise, all comments in this chapter pertain to the acute treatment of depressive disorders. Questions about the proper management of the electrical stimulus have been central to the science and practice of ECT since the inception of the treatment. Problems in stimulus dosing include (a) whether the stimulus should be subconvulsive or convulsive; (b) defining the optimal stimulus waveform; (c) if a convulsive stimulus is desired, to what degree should the stimulus intensity be in excess of the convulsive threshold; and (d) which physiological parameters, if any, provide useful feedback to continuously refine stimulus dosing throughout the ECT course.
|Original language||English (US)|
|Title of host publication||Electroconvulsive and Neuromodulation Therapies|
|Publisher||Cambridge University Press|
|Number of pages||21|
|Publication status||Published - Jan 1 2009|
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