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Psychogeriatrics. 2010 Dec;10(4):187-90. doi: 10.1111/j.1479-8301.2010.00340.x. Epub 2010 Nov 26.

The change in electrical energy delivered to aged patients over a course of moderate dose unilateral electroconvulsive therapy.

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School of Psychology and Psychiatry, Monash University, Melbourne, Victoria, Australia.



To prove effective, the electrical energy delivered as part of unilateral electroconvulsive therapy (ECT) must exceed the seizure threshold. Although high dose treatment (six times the threshold) is most effective, it results in more cognitive deficits to which aged patients are especially vulnerable. As a compromise, Australian psychogeriatricians often prescribe moderate dose (three times the threshold) treatment. However, older patients' thresholds sometimes rise steeply as treatment progresses. If energy levels are kept low to make treatment safer, the result might be that patients' recovery is delayed. We report here on changes in prescribed energy over a course of six unilateral treatments.


A retrospective review of data collected routinely on 42 depressed patients aged ≥ 65 years given moderate dose unilateral ECT in five aged psychiatry services in Victoria, Australia.


Prescribed energy rose with time, but only 31% of patients reached high dose levels by their sixth treatment.


We cannot comment on the safety or effectiveness of moderate dose ECT. We focus instead just on changes in prescribed energy levels. These did not rise quickly in most cases, suggesting that moderate dose ECT cannot be dismissed as a treatment option simply because of the rate of change in electrical stimulation.

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