ArticleIndian journal of psychiatry
Effect of age and anticonvulsants on seizure threshold during bilateral electroconvulsive therapy with brief-pulse stimulus: A chart-based analysis.
Article in Indian journal of psychiatry. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Seizure threshold increases can be predicted by EEG quality in right unilateral ultrabrief ECT.European archives of psychiatry and clinical neuroscience · 2017Trial
- Clinical Outcomes and Treatment Characteristics of Seizure Threshold-Titrated Electroconvulsive Therapy in Depressive Disorder: A 3.5-Year Retrospective Naturalistic Course-Level Study.Journal of clinical medicine · 2026Article
- Electroconvulsive therapy research in India: A scoping review.Indian journal of psychiatry · 2026Review
- Initial Seizure Threshold in Brief-Pulse Bilateral Electroconvulsive Therapy in Patients with Schizophrenia or Schizoaffective Disorder.Psychiatry investigation · 2019Article
- Influence of depressed patients' expectations prior to electroconvulsive therapy on its effectiveness and tolerability (Exp-ECT): a prospective study.European archives of psychiatry and clinical neuroscience · 2018Article
- Effects of Psychotropic Drugs on Seizure Threshold during Electroconvulsive Therapy.Psychiatry investigation · 2017Article
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Authors and funding
4 authors.
Funding
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Abstract
backgroundEfficacy and adverse effects of electroconvulsive therapy (ECT) depend on the extent to which the electrical stimulus exceeds patients' seizure thresholds (STs). Titration method of estimating ST is recommended. Age and co-prescribed anticonvulsants (ACs) are known to affect ST. Literature on ST in bilateral ECT (BLECT) is sparse.
objectiveTo explore the clinical and demographic determinants of ST in a clinically representative sample of patients prescribed with BLECT. MATERIALS AND
methodsECT records of 640 patients who received BLECT in 2011 in an academic psychiatric setting were studied. Demographic, clinical, pharmacological, and ECT details were analyzed. As per the standard practice, during the 1(st) ECT session, ST was determined by titration method, starting with 30 milli-Coulombs (mC) and increasing by 30 mC and thence in steps of 60 mC. Increase in ST over up to 6(th) session of ECT was noted. Receiver operating characteristic curve was used to find age cut-off with high specificity for ST ≥120 mC. The associations of ST and increase in ST with the age cut-off and other clinical factors were assessed using Chi-square test and logistic regression analysis.
resultsThe mean age was 30.98 years (+11.23 years) and mean ST at 1(st) ECT session was 130.36 mC (+51.96 mC). There was significantly high positive correlation (r = 0.37, P < 0.001) between age and ST. Cut-off age of 45 years had high specificity: Only 4.6% of those older than 45 years had ST <120 mC. Higher proportion of patients on AC had ST ≥120 mC. These associations were seen even after controlling for potential confounds of each other using logistic regression analysis. The results were similar for increase in ST over the course of ECT. Sex, diagnosis, use of antipsychotics, antidepressants, lithium, and benzodiazepines (BZPs) had no effect on ST or its increase.
conclusionsFor BLECT using brief-pulse stimulus, ST depends on age and use of AC. For patients above the age of 45 years, ST estimation may be started at 120 mC with least risk of using unduly higher stimulus. Other medications including BZPs have little influence on ST.
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