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. 2024 Jan 11;49(4):640–648. doi: 10.1038/s41386-023-01780-4

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© The Author(s) 2024

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 — A Subject flow and attrition based on pre- (V1), mid- (V2), and post-ECT (V3) time points. B Study protocol and hypotheses: The first treatment determined an amplitude seizure threshold (STa). Subsequent treatments were completed at 800 mA. The resultant amplitude ratio 800 mA/STa determines the relative dose of ECT. Low STa followed by 800 mA will result in a “high” dose and cognitive impairment. High STa followed by 800 mA will result in a “low” dose that is insufficient for antidepressant response.