Electrical Dosage and Efficacy in Electroconvulsive Therapy

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.