Standardized Electroconvulsive Therapy Protocol

Electroconvulsive therapy was performed according to the Dutch treatment guidelines (14 ), using a Thymatron System IV (Somatics Incorporation, Lake Bluff, IL, USA). A constant current (900 mA), brief pulse (0.25–1.0 ms) was used. Electrode position [i.e., right unilateral according to D’Elia (RUL), bifrontotemporal (BL) or left unilateral (LUL)] was chosen by the treating psychiatrist depending on the patients’ clinical condition. The initial dose was determined by titration (i.e., 2.5 seizure threshold in BL and six times seizure threshold in RUL/LUL ECT) or by age-based methods. The standard sedative agent was etomidate (0.2–0.3 mg/kg body mass) and succinylcholine (0.5–1.0 mg/kg body mass) was used as a muscle relaxant.