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The pitfalls of dose titration as used in electroconvulsive therapy

Regional Medical Physics Department

R. G. Farquharson, Consultant Psychiatrist and I. S. Schofield, Consultant Neurophysiologist

Newcastle General Hospital, Newcastle Upon Tyne NE4 6BE

Dose titration is the new colloquialism in ECT circles. The technique, as generally applied, assumes that current and the time for which it is passed, are equally important in the depolarisation of nerve cells. The units used to quantify its measurement, namely the milliCoulomb (mC) reflect this. We think this is misleading and suggest it ought not to be used as a parameter to describe a treatment regime. It is the aim of this communication to explain, in general terms, the physical parameters that control the current flowing in the patient's head, to suggest a more appropriate method to describe the treatment administered and outline the requirements of a good ECT machine.

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