ECT Dosing by the Benchmark Method

Background: The methods used to select ECT stimulus dose have no basis in physiology and are incomplete. They are not related to the quality of the ECT seizure, such as its intensity or its generalization through the brain. These methods are not substantially individualized and do not guide the dose along the course. A rational system is described that does not have these shortcomings. Method: On the basis of the axioms that higher dose produces greater effect, and meaningful physiological measurements reflect efficacy, the principle to guide ECT dosing is that diminished physiological intensity indicates decreased treatment quality. Results: The corresponding strategy for dosing begins with a strong stimulus at the first ECT treatment. The measured resulting physiological effects should be intense, and these serve as benchmarks. At later treatments the electrical stimulus dose is gradually adjusted to approximate the lowest dose that produces physiological effects that are near these benchmarks. Smaller physiological effects suggest increase in stimulus dose. Conclusions: This method uses physiological measurements in a manner analogous to blood drug levels in pharmacotherapy. A strong first-ECT stimulus typically has a dose 3.5 to 4 times age with bilateral or 5 times age with unilateral electrodes at 0.5ms pulsewidth and 30-70 Hz; wider pulsewidths necessitate higher dosage. Recent studies suggest that peak seizure heart rate and several computer-processed EEG aspects are suitable physiological measurements to use in this method. The use of peak heart rate requires no special EEG equipment or EEG training (German J Psychiatry 2002; 5: 1-4)