ECT instrumentation

BIOL PSYCHIATRY

Correspondence

361

1988;24:360-369

Safety and Performance Standards for Electroconvulsive Therapy Devices since its inception in 1982; it was this group that proposed the minimum standards for this generation of instruments. It is my understanding that Weaver was an active participant in defining the standards for the “second generation” instruments, which each new instrument and each manufacturer of U.S. instruments clearly meets. It is unfortunate, therefore, with a record of useful contributions, that Weaver and Williams give the readers of Biological Psychiatry unsubstantiated ad-

vice as to the characteristics of modem ECT instruments and the importance of parametric studies for our understanding of the ECI process. Their advice should be cautiously regarded until direct comparisons of the efficiency of instruments are published, following the promising example of Nilsen, Willis and Pettinati . Max Fink, M.D. Editor Convulsive Therapy PO Box 457

St. James, NY 11780

fects of various stimulus parameter types, we also believe that other contemporary pulse ECT devices (MECTA-SR and JR series, Medcmft B25, and Somatics Thymatron) offer rational choices for the clinical practice of ECT, as well as for most types of ECT research activities. In each of these devices, reasonable parameter choices have been made on the basis of empirical data. In addition, all such devices display a rough equivalency among themselves with regard to both minimum and maximum charge and energy outputs. Although much work clearly remains to be done in the determination of optimum stimulus parameter settings with ECT, this fact does not constitute sufficient reason to consider any particular instrument as inferior to its counterparts. Each presently marketed ECT device has it’s own intrinsic “selling points,” only one of which is the number of user-modifiable parameters. Unfortunately, until recently (Nilsen et al. 1986) objective comprehensive reviews of ECT devices were not available to users. It is our hope that the apparent growing focus on ECT stimuli and the equipment that generates them, as manifested in part by the editorial that prompted this letter, will serve to generate further discussions of these issues in the years to come. C.E. Coffey R.D. Weiner

References Fink M (1979): Convulsive Therapy: Theory and Practice. New York: Raven Press. Nilsen SM, Willis KW, Pettinati HM (1986): Instrument review: Initial impression of two new brief-pulse electroconvulsive therapy machines. Convuls Ther 2: 43-54. Weaver LA, Williams RW (1987): ECT: Second generation instruments. Bid Psychiatry 22: 1181-l 182. Weaver L, Ives J, Williams R (1985): Total energy and rate of application as measures of the electroconvnlsive therapy stimulus. Convuls Ther 1:22-3 1.

Department of Psychiatry Duke University Medical Center Box 3920 Durham NC 27710

Reference Nilsen SM, Willis KW, Pettinati HM (1986): Instrument review: Initial impression of two new brief-pulse electroconvnlsive therapy machines. Con&s Ther 2: 43-54.

To the Editor: The recent editorial in this journal by Weaver and Williams focused on the advantages of user-modifiable parameters in contemporary pulse ECT devices. As the newly announced Elcot MF-1000 has an extremely wide range of adjustable stimulus parameters, it was recommended as the device of choice, particularly for those in a research setting. Although we are in agreement that the MF-1000 provides the user with an unparalleled opportunity to contrast the ef-

To the Editor: The editorial ECT: Second Generation Instruments by Weaver and Williams (1987) discusses refined instruments for new research opportunities. Whereas their considerations are interesting, my 50 years of experience with ECT make me question their statement that the clinician must “choose the proper