{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T06:36:43Z","timestamp":1776839803181,"version":"3.51.2"},"reference-count":33,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T00:00:00Z","timestamp":1757894400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: 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\u2019 dosing protocols\u2014High-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. Methods: The retrospective analysis compared the outcomes of BL ECT between patients receiving either HCP or DTP treatments. Patients\u2019 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. Results: When compared to DTP, the HCP group was older (55 years \u00b1 SD 15 vs. 41 years \u00b1 SD 17), had lower initial CGI-S (5 [IQR 5\u20136] vs. 6 [IQR 5\u20136]) and longer disease duration (15 years [IQR 7\u201320] vs. 9 years [IQR 3\u201318]). 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\u201384.7] vs. 38.4 s [IQR 33.8\u201347.1], adj. p &lt; 0.001). Conclusions: 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.<\/jats:p>","DOI":"10.3390\/jcm14186490","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T11:51:43Z","timestamp":1757937103000},"page":"6490","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Comparison of High-Charge Protocol vs. Dose Titration Protocol in Bilateral ECT: Evaluation of Antidepressant Effectiveness and EEG Parameters"],"prefix":"10.3390","volume":"14","author":[{"given":"Piotr","family":"Ja\u017cd\u017cyk","sequence":"first","affiliation":[{"name":"Second Department of Psychiatry, Institute of Psychiatry and Neurology in Warsaw, 02-957 Warsaw, Poland"},{"name":"Department of Psychiatry, Amsterdam UMC, Location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands"},{"name":"Department of Old Age Psychiatry, GGZinGeest Mental Health Care, 1062 HN Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agnieszka","family":"Kuc","sequence":"additional","affiliation":[{"name":"Second Department of Psychiatry, Institute of Psychiatry and Neurology in Warsaw, 02-957 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Albert","family":"Stachura","sequence":"additional","affiliation":[{"name":"Center for Preclinical Research, Department of Methodology, Medical University of Warsaw, 02-097 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7978-3893","authenticated-orcid":false,"given":"Agnieszka","family":"Segiet-\u015awi\u0119cicka","sequence":"additional","affiliation":[{"name":"Department of Coronary Artery Disease and Cardiac Rehabilitation, Cardinal Stefan Wyszynski Institute of Cardiology, 04-628 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0609-9657","authenticated-orcid":false,"given":"Marcin","family":"Kosmalski","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology, Medical University of Lodz, 90-419 Lodz, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u0141ukasz","family":"\u015awi\u0119cicki","sequence":"additional","affiliation":[{"name":"Second Department of Psychiatry, Institute of Psychiatry and Neurology in Warsaw, 02-957 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"van Exel","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Amsterdam UMC, Location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands"},{"name":"Department of Old Age Psychiatry, GGZinGeest Mental Health Care, 1062 HN Amsterdam, The Netherlands"},{"name":"Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Stress and Sleep, 1081 HV Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tadeusz","family":"Pietras","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology, Medical University of Lodz, 90-419 Lodz, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1056\/NEJMra2034954","article-title":"Electroconvulsive Therapy","volume":"386","author":"Espinoza","year":"2022","journal-title":"N. 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