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Repeated dose titration versus age-based method in electroconvulsive therapy: a pilot study

European Archives of Psychiatry and Clinical Neuroscience volume 265, pages 351–356 (2015)Cite this article

Abstract

In electroconvulsive therapy (ECT), a dose titration method (DTM) was suggested to be more individualized and therefore more accurate than formula-based dosing methods. A repeated DTM (every sixth session and dose adjustment accordingly) was compared to an age-based method (ABM) regarding treatment characteristics, clinical outcome, and cognitive functioning after ECT. Thirty-nine unipolar depressed patients dosed using repeated DTM and 40 matched patients treated with ABM were compared. Montgomery-Åsberg Depression Rating Scale (MADRS) and Mini-Mental State Examination (MMSE) were assessed at baseline and at the end of the index course, as well as the total number of ECT sessions. Both groups were similar regarding age, sex, psychotic features, mean baseline MADRS, and median baseline MMSE. At the end of the index course, the two methods showed equal outcome (mean end MADRS, 11.6 ± 8.3 in DTM and 9.5 ± 7.6 in ABM (P = 0.26); median end MMSE, 28 (25–29) and 28 (25–29.8), respectively (P = 0.81). However, the median number of all ECT sessions differed 16 (11–22) in DTM versus 12 (10–14.8) in ABM; P = 0.02]. Using regression analysis, dosing method and age were independently associated with the total number of ECT sessions, with less sessions needed in ABM (P = 0.02) and in older patients (P = 0.001). In this comparative cohort study, ABM and DTM showed equal outcome for depression and cognition. However, the median ECT course duration in repeated DTM appeared longer. Additionally, higher age was associated with shorter ECT courses regardless of the dosing method. Further prospective studies are needed to confirm these findings.

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Affiliations

  1. Department of Psychiatry, Rijnstate Hospital, P.O. Box 9555, 6800, TA, Arnhem, The Netherlands

    Jan Jaap Aten & Jeroen A. van Waarde

  2. GGZinGeest, VU Medical Center, Amsterdam, The Netherlands

    Mardien Oudega, Eric van Exel & Max L. Stek

  3. Albert Schweitzerlaan 31, 7334, DZ, Apeldoorn, The Netherlands

    Jan Jaap Aten

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  1. Jan Jaap Aten
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  2. Mardien Oudega
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  5. Jeroen A. van Waarde
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Correspondence to Jan Jaap Aten.

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Aten, J.J., Oudega, M., van Exel, E. et al. Repeated dose titration versus age-based method in electroconvulsive therapy: a pilot study. Eur Arch Psychiatry Clin Neurosci 265, 351–356 (2015). https://doi.org/10.1007/s00406-015-0591-3

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  • DOI: https://doi.org/10.1007/s00406-015-0591-3

Keywords

  • Electroconvulsive therapy (ECT)
  • Dose titration method
  • Age-based method
  • Outcome