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One hundred and thirty-four patients referred for electroconvulsive therapy (ECT) over a 2-year period underwent standardized stimulus dose-titration. No significant adverse events were associated with the dose-titration procedure. Our data demonstrate that seizure threshold increases with age (p = 0.0001) and is higher with bilateral electrode placement (p = 0.0001). Contrary to other studies, our data show the effect of gender is not statistically significant (p = 0.54). If consensus regarding optimal dosing strategies relative to seizure threshold can be achieved, dose-titration may be adopted as a clinically useful step in optimizing ECT technique.

The current literature on the interaction between antidepressant drugs and electroconvulsive therapy (ECT) is reviewed. Tricyclic antidepressants, atypical antidepressants, and monoamine oxidase inhibitors are discussed. The efficacy of combinations and possible adverse effects (mainly cardiovascular and seizure threshold effects) are considered. Many previous studies on the efficacy of combinations used inadequate methods, and the safety data consist largely of anecdotes and small case series. Additional studies are needed to assess the safety and efficacy of the combined use of antidepressants and ECT.

Fifteen elderly depressed psychiatric inpatients were randomly assigned to receive either standard three-times-weekly electroconvulsive therapy (ECT) or once-weekly ECT. Outcome measures included cognitive assessment and antidepressant response. Although both groups improved with treatment, the three-times-weekly group improved substantially more quickly. There was no difference in cognitive effect between the two groups. We conclude that the traditional three-times-weekly schedule of ECT may optimally balance speed of antidepressant response and cognitive impairment.