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. 2023 Jul 24;49(1):150–162. doi: 10.1038/s41386-023-01677-2

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© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2023

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 1 — Conventional ECT techniques, with standard right unilateral (RUL), bifrontal (BF), and bitemporal (BT) electrode placements, and experimental technique such as focal electrically administered seizure therapy (FEAST), involve the use of high amplitude E-field for seizure induction. With conventional ECT, the E-field and seizure are always coupled, which does not allow for the study their relative contribution to clinical outcome and cognitive side effects. Techniques that use low amplitude currents for seizure induction include: low amplitude ECT (LAMP), frontomedial (FM) ECT, magnetic seizure therapy (MST), and individualized low amplitude seizure therapy (iLAST). The use of chemoconvulsant for seizure induction involves no use of electricity. These techniques allow us to test the hypothesis that the seizure drives efficacy while the E-field drives side effects. Transcranial electrical stimulation therapy (TEST) is a nonconvulsive modality that use high amplitude E-field. TEST allows us to evaluate the hypothesis that sufficiently high amplitude E-field drive efficacy while the seizure drives side effects. Finally, transcranial magnetic stimulation (TMS) is another nonconvulsive modality that use low amplitude E-field, which allows us to test the hypothesis that low amplitude stimulation, applied repetitively, have a cumulative effect on efficacy with minimal side effects.