Comparison of High-Charge Protocol vs. Dose Titration Protocol in Bilateral ECT: Evaluation of Antidepressant Effectiveness and EEG Parameters

<b>Objectives:</b> Recently, we modified the method of dosing charge in daily practice for patients undergoing bilateral electroconvulsive treatment (BL ECT). The aim of this study is to compare the effectiveness of two charges' dosing protocols-High-Charge Protocol (HCP; based on the modified age-based method) and Dose Titration Protocol (DTP) in BL ECT for the treatment of patients with a depressive episode. <b>Methods:</b> The retrospective analysis compared the outcomes of BL ECT between patients receiving either HCP or DTP treatments. Patients' mental status was assessed retrospectively using the Clinical Global Impression-Severity (CGI-S) and Clinical Global Impression-Improvement (CGI-I) scales. EEG parameters, including seizure duration and EEG ictal activity were analyzed. <b>Results:</b> When compared to DTP, the HCP group was older (55 years ± SD 15 vs. 41 years ± SD 17), had lower initial CGI-S (5 [IQR 5-6] vs. 6 [IQR 5-6]) and longer disease duration (15 years [IQR 7-20] vs. 9 years [IQR 3-18]). The DTP group had a higher percentage of remission (n = 17 [77.3%]) compared to the HCP group (n = 23 [43.4%]), with the same average number of sessions performed. In addition, the DTP group had significantly longer average seizure duration (68.6 s [IQR 52.7-84.7] vs. 38.4 s [IQR 33.8-47.1], adj. <i>p</i> < 0.001). <b>Conclusions:</b> Our results suggest that in BL ECT, administering high-charge protocols may have a detrimental impact on ECT effectiveness. Based on our findings, we propose adjusting the dosing in BL ECT according to the individual seizure threshold and avoiding frequent charge increases during the course of treatment.