The traditional view is that the elicitation of a series of generalized cerebral seizures is the essential requirement for efficacious electroconvulsive therapy (ECT). This theory is the basis of many recent recommendations that the minimum electrical dose required to elicit generalized seizures should be used. Evidence challenging this theory is reviewed, which suggests a role for supra-threshold electrical stimulation in ECT. Hypotheses to explain these findings are examined, and recommendations are made.
References
1.
FreemanC.P.L., BassonJ.V., CrightonA.A double-blind controlled trial of ECT and simulated ECT in depressive illness.Lancet1978; i: 738–740.
2.
JohnstoneE.C., DeakinJ.F., LawlerP.The Northwick Park electroconvulsive therapy trial.Lancet1980; ii: 1317–1320.
3.
WestE.D.Electric convulsive therapy in depression: a double-blind controlled trial.Br Med J1981; 282; 355–357.
4.
BrandonS., CowleyP., McDonaldC.Electroconvulsive therapy: results in depressive illness from the Leicestershire trial.Br Med J1984; 288: 22–25.
5.
GregoryS., ShawcrossC.R., GillD.The Nottingham ECT study: a double-blind comparison of bilateral, unilateraland simulated ECT in depressive illness.Br J Psychiatry1985; 146: 520–524.
6.
UlettG., SmithK., GleserG.Evaluation of convulsive and subconvulsive shock therapies utilizing a control group.Am J Psychiatry1956; 112: 795.
7.
FinkM., KahnR., GreenM.Experimental studies of the electro-shock process.Dis Nerv Syst1958; 19: 113–118.
8.
OttossonJ.O.Experimental studies of the mode of action of electroconvulsive therapy.Acta Psychiatr Neurol Scand(Suppl)1960; 35(145): 1–141.
9.
SmallJ.G., SmallI.F., SharpleyP.A double-blind comparative evaluation of flurothyl and ECT.Arch Gen Psychiatry1968; 19: 79–86.
RobinA., DeTisseraS.A double-blind controlled comparison of the therapeutic effects of low and high energy electroconvulsive therapies.Br J Psychiatry1982; 141: 357–366.
12.
AbramsR.A hypothosis to explain divergent findings among studies comparing the efficacy of unilateral and bilateral ECT in depression.Convulsive Therapy1986; 2: 253–258.
13.
SackeimH.A., MukherjeeS.Neurophysiological variability in the effects of the ECT stimulus.Convulsive Therapy1986; 2: 267–276.
14.
CronholmB., OttossonJ.O.Ultrabrief stimulus technique in electroconvulsive therapy.J Nerv Ment Dis1963; 137: 268–276.
15.
LambournJ., GillD.A controlled comparison of simulated and real ECT.Br J Psychiatry1978; 133: 514–519.
16.
RobinA.ECT — current status. In: PalmerR.L., ed. Electroconvulsive therapy: an appraisal.Oxford: Oxford Press, 1981: 65–78.
17.
MalitzS., SackeimH.A., DecinaP.The efficacy of electroconvulsive therapy: dose-response interactions with modalityAnn N Y Acad Sci1986; 462: 56–64.
18.
SackeimH.A., DecinaP., KanzlerM.Effects of electrode placement on the efficacy of titrated, low dose ECT.Am J Psychiatry1987; 144: 1449–1455.
19.
SackeimH.A., DecinaP., PortnoyS.Studies of dosage, seizure threshold and seizure duration in ECT.Biol Psychiatry1987; 22: 249–268.
20.
MalitzS., SackeimH.A., DecinaP.ECT in the treatment of major affective disorders: clinical and basic research issues.Psychiatr J Univ Ottawa1982; 7: 126–134.
21.
WeaverL., IvesJ., WilliamsR.The threshold number of pulses in bilateral and unilateral ECT.Biol Psychiatry1978; 13: 227–241.
22.
WeinerR.D.ECT and seizure threshold: effects of stimulus wave form and electrode placement.Biol Psychiatry1980; 15: 225–241.
23.
SackeimH.A., DecinaP., ProhovnikI.Seizure threshold in electroconvulsive therapy: effects of sex, age, electrode placement and number of treatments.Arch Gen Psychiatry1987; 44: 355–360.
24.
JanicakP.G., DavisJ.M., GibbonsR.D.Efficacy of ECT: a meta-analysis.Am J Psychiatry1985; 142: 297–302.
25.
PettinatiH.M., MathisenK.S., RosenbergJ.Meta-analytical approach to reconciling discrepancies in efficacy between bilateral and unilateral electroconvulsive therapy.Convulsive Therapy1986; 1: 7–17.
26.
FinkM.F.Convulsive therapy: theory and practice.New York: Raven Press,1979.
27.
AndradeC., GangadharB.N., SubbakrishnaD.K.Doubleblind comparison of sinusoidal wave and brief pulse electroconvulsive therapy in endogenous depression.Convulsive Therapy1988; 4: 297–305.
28.
McAllisterT.W., PriceT.R.P., FerrellR.B.Bilateral sinusoidal ECT following poor response to five unilateral brief pulse ECTs.J Clin Psychiatry1985; 46: 430–431.
29.
WeinerR., RogersH., DavidsonJ.Effects of stimulus parameters on cognitive side effects.Ann N Y Acad Sci1986; 462: 315–325.
30.
WeinerR.D., CoffeyC.E.Comparison of brief pulse and sine wave ECT stimuli.Convulsive Therapy1989; 5: 184–185.
31.
SackeimH.A.Mechanisms of action of electrocunvulsive therapy. In: FrancisA.J., HalesR., eds. Review of psychiatry, volume 7.Washington DC: American Psychiatric Press, Inc.,1988: 436–457.
32.
AbramsR.Electroconvulsive therapy.New York: Oxford University Press,1988.
33.
AbramsR., TaylorM.A.Diencephalic stimulation and the effects of ECT in endogenous depression.Br J Psychiatry1976; 129: 482–485.
34.
AbramsR., SwartzC.M.ECT and prolactin release. Paper presented at C.I.N.P., Puerto Rico, December 1986.
35.
RobinA., MontaguJ., JolleyA.Rising trends and current policy Paper presented at the International Conference on New Directions in Affective Disorders, Jerusalem, 1987.
36.
SackeimH.A.Stimulus intensity and electrode placement: efficacy and side effects. Paper presented at the International Conference on New Directions in Affective Disorders, Jerusalem, 1987.
37.
d'EliaG., OttossonJ.O., StromgrenL.S.Present practice of electroconvulsive therapy in Scandinavia.Arch Gen Psychiatry1983; 40: 577–581.
38.
MartinB.A.Electroconvulsive therapy: contemporary standards of practice.Can J Psychiatry1986; 31(8): 759–771.
39.
StromgrenL.S., DahlJ., FjeldburgN.Factors influencing seizure duration and number of seizures applied in unilateral electroconvulsive therapy: anaesthetics and benzodiazepines.Acta Psychiatr Scand1980; 62: 158–165.
40.
AbramsR., SwartzC.M.ECT and prolactin release: effects of stimulus parameters.Convulsive Therapy1985; 1: 115–119.
41.
AbramsR., SwartzC.M.ECT and prolactin release: relation to treatment response in melancholia.Convulsive Therapy1985; 1: 38–42.
42.
ScottA.I.F., WhalleyL.J., BennieJ.Oestrogen-stimulated neurophysin and outcome after electroconvulsive therapy.Lancet1986; ii: 1411–1414.
43.
StatonR.D., HassP.J., BrumbackR.A.Electroencephalographic recording during bitemporal and unilateral non-dominant hemisphere electroconvulsive therapy.J Clin Psychiatry1981; 42: 264–269.
44.
GerstJ.W., EnderleJ.D., StatonR.D.The electroencephalographic pattern during electroconvulsive therapy. Preliminary analysis of spectal energy.Clin Electroencephalogr1982; 13: 251–256.
45.
SwartzC.M., LarsonG.Generalization of the effects of unilateral and bilateral ECT.Am J Psychiatry1986; 143: 1040–1041.
46.
RobinA., BinnieC.D., CopasJ.B.Electrophysiological and hormonal responses to three types of electroconvulsive therapy.Br J Psychiatry1985; 147: 707–712.
47.
ValentineM., KeddieK., DunneD.A comparison of techniques in electroconvulsive therapy.Br J Psychiatry1968; 114: 989–996.
48.
WeinerR.D., CoffeyC.E.Minimizing therapeutic differences between bilateral and unilateral non-dominent ECT.Convulsive Therapy1986; 2: 261–265.
49.
KendellR.E.The present status of electroconvulsive therapyBr J Psychiatry1981; 139: 265–283.
50.
GordonD.Electroconvulsive therapy with minimum hazard.Br J Psychiatry1982; 141: 12–18.
51.
SackeimH.A., DecinaP., PronovnikI.Dosage, seizure threshold, and the antidepressannt efficacy of electroconvulsive therapy.Ann N Y Acad Sci1986; 462: 398–410.
