Seizure threshold determination for electroconvulsive therapy: stimulus dose titration versus age‐based estimations

Objective: This study compared electroconvulsive therapy (ECT) seizure threshold determined by stimulus dose titration with age‐based estimations. Method: Patients with major depressive disorder had their initial seizure thresholds determined by stimulus dose titration and the results compared with age‐based estimations. There are no significant differences in thresholds determined by these methods. Results: Two hundred and three psychiatric patients (149 females, 54 males) had their seizure thresholds determined by stimulus dose titration. There was a significant positive correlation between seizure thresholds and age for males and females with male thresholds greater than female thresholds. Age determinations of seizure threshold would have resulted in excessive initial treatment stimuli for 30% of females and 8% of males. Ineffective stimulus doses would have been given to 2% of females and 7% of males on a full age basis and 64% using a half age strategy. Conclusions: For effective high‐dose right unilateral ECT, initial seizure threshold should be determined by stimulus dose titration.