The current status of seizure duration in the practice of electroconvulsive therapy.

OBJECTIVE To critically review data relating the seizure duration in electroconvulsive therapy (ECT) to its therapeutic effect in the treatment of depressive illness. METHOD The authors used MEDLINE, PSYCHINFO on CDROM, and their own knowledge of the literature to find studies or reviews concerning the role of seizure duration in ECT efficacy. RESULTS Rigorous studies cast doubt on the usefulness of seizure duration as a clinical marker. Some medications that decrease seizure time have deleterious treatment effects but also affect other seizure dynamics. Several medications dramatically shorten seizures but have no influence on treatment efficacy. CONCLUSION The guidelines of ECT seizure length are arbitrary, suggesting exaggerated durations for ECT treatment.