I remember when we used to treat schizophrenia with haloperidol or clozapine (there were no new drugs like risperidone or olanzapine back then), and when we really couldn’t solve it, we did 6 to 8 electrotherapy sessions, which often solved the problem. At that time, the only concern was whether the convulsions would cause fractures. So, later on, I abandoned electroconvulsive therapy, which was only $11 per session, and switched to convulsion-free electrotherapy with an instrument imported from the United States for $700 per session (nowadays it has increased to $1000). However, both patients and clinicians felt that MECT was not effective enough and mostly did not solve the problem; money was spent for nothing and there were many side effects (e.g. memory loss, etc.). Why? What is the problem? Is it the absence of twitching? Or does it lie in the operation of the electrotherapist? Our previous years of ECT treatment experience tells us that the first electrotherapy treatment often requires only a small amount of power and duration to exceed the “threshold” and cause a “convulsive attack”, at which point the effect can be produced. If the power used is too small or not enough time, the patient will only lose consciousness for a moment, and there is no convulsive seizure, which can only be called a “small seizure”. At this point, no effect can be produced, but side effects such as headache, dizziness and memory loss will occur. After the first electrotherapy, the body’s threshold must be increased. Therefore, if the second electrotherapy is still using the same power and duration of the first, it will not necessarily cause a “convulsive seizure”. At this time, the operating doctor must judge the situation and increase the power or energizing time appropriately in order to achieve the effect of “seizure”. Thereafter, with the number of electrotherapy sessions, the threshold will be increased step by step. Therefore, the third or fourth session of electrotherapy has to be done only one day apart to allow the threshold to fall on its own in order to ensure the “attack”. However, the interval should not be too long, otherwise the effect of electrotherapy will not accumulate and achieve the elimination of symptoms. Is it possible to achieve “the degree of attack with each electrotherapy session, but the interval between electrotherapy sessions is not too long”? That is, can we achieve the maximum effect? That is the “art” level of the operating doctor. Finally, once clinical improvement was seen, the interval could be extended to allow the threshold to return to the original level as much as possible, so that the “attack” level could be achieved successfully with each treatment. At that time, we customarily set the number of electrotherapy sessions at 12, after which we could consolidate once a week, and after two weeks, once every two weeks. In short, our electrotherapy operation had only one goal: to achieve the level of “seizure” in each electrotherapy session within the shortest possible period of time, so that the effect of electrotherapy could be accumulated to eliminate the mental symptoms. The basic principle of non-convulsive electrotherapy is the same. Does it achieve “seizure”? It can only be judged by the presence of spikes lasting more than 30 seconds on the electroencephalogram (EEG). Now let’s look at the record of a very successful MECT by a doctor in Shanghai Mental Health Center: once he started, he gave the patient three days of continuous electrotherapy, then every one to two days, and after the 10th time, the interval was changed to five to six days. Finally, after consolidating every two weeks for three times, it is not shown on this graph. The line of power and time shows that he adjusted the “EEG seizure time” according to whether it exceeded 30 seconds, in order to ensure that the seizure could still reach more than 30 seconds this time. In the past, when we did ECT with convulsions, the patient would have generalized convulsions, and the doctor was worried that the high dose of antipsychotics might aggravate the patient’s burden, so the hospital director stipulated that the dose of antipsychotics should be reduced appropriately when doing ECT. Later, when MECT was switched to, the patient would not convulse at all, and the dose size of the antipsychotics would have nothing to do with ECT, so there was no need to reduce the dose at all. Otherwise, the reduced dose may affect the efficacy of the treatment. Therefore, I would like to remind parents: 1. You must not give up the right of the patient’s family to understand the treatment process and to request a printout of the medical history, as stipulated by the Ministry of Health. It is recommended that after each electrotherapy session, you ask the doctor to provide in writing whether the electrotherapy session reached the level of seizure (that is, whether it exceeded 30 seconds). 2. Do not reduce the original dosage of medication. As I said in the analogy: the drug dragged the patient from the third floor to the front door, the patient still refused to come out of the door of the disease. At this point, use electrotherapy to kick him in the butt and make him rush out of the disease gate. If you reduce the medication or the amount of medication, the patient will retreat to the second or third floor, and the electrotherapy “kick” will not work as it should.