Benchmark

Reprinted from the German Journal of Psychiatry · http://www.gjpsy.uni-goettingen.de · ISSN 1433-1055 ECT Dosing by the Benchmark Method Conrad M. Swartz Department of Psychiatry Southern Illinois University School of Medicine Corresponding author: Conrad Swartz, Ph.D., M.D., Professor and Chief, Division of Psychiatric Research, Box 19642, Southern Illinois University School of Medicine, Springfield, Illinois 62794-9642 Abstract Background: The methods used to select ECT stimulus dose have no basis in physiology and are incomplete. They are not related to the quality of the ECT seizure, such as its intensity or its generalization through the brain. These methods are not substantially individualized and do not guide the dose along the course. A ra-tional system is described that does not have these shortcomings. Method: On the basis of the axioms that higher dose produces greater effect, and meaningful physiological measurements reflect efficacy, the principle to guide ECT dosing is that diminished physiological intensity indicates decreased treatment quality. Results: The corresponding strategy for dosing begins with a strong stimulus at the first ECT treatment. The measured resulting physiological effects should be intense, and these serve as benchmarks. At later treatments the electri-cal stimulus dose is gradually adjusted to approximate the lowest dose that produces physiological effects that are near these benchmarks. Smaller ...