<unk>  machine on display at Glenside Museum in Bristol, England<unk>  device produced by Siemens and used for example at the Asyl psychiatric hospital in Kristiansand, Norway from the 1960s to the 1980s The placement of electrodes, as well as the dose and duration of the stimulation is determined on a per-patient basis. In unilateral<unk> , both electrodes are placed on the same side of the patient's head. Unilateral<unk>  may be used first to minimize side effects such as memory loss. In bilateral<unk> , the two electrodes are placed on opposite sides of the head. Usually bitemporal placement is used, whereby the electrodes are placed on the temples. Uncommonly bifrontal placement is used; this involves positioning the electrodes on the patient's forehead, roughly above each eye. Unilateral<unk>  is thought to cause fewer cognitive effects than bilateral treatment, but is less effective unless administered at higher doses. Most patients in the US and almost all in the UK receive bilateral<unk> . The electrodes deliver an electrical stimulus. The stimulus levels recommended for<unk>  are in excess of an individual's seizure threshold: about one and a half times seizure threshold for bilateral<unk>  and up to 12 times for unilateral<unk> . Below these levels treatment may not be effective in spite of a seizure, while doses massively above threshold level, especially with bilateral<unk> , expose patients to the risk of more severe cognitive impairment without additional<unk> utic gains. Seizure threshold is determined by trial and error ("dose titration"). Some psychiatrists use dose titration, some still use "fixed dose" (that is, all patients are given the same dose) and others compromise by roughly estimating a patient's threshold according to age and sex. Older men tend to have higher thresholds than younger women, but it is not a hard and fast rule, and other factors, for example drugs, affect seizure threshold. Immediately prior to treatment, a patient is given a short-acting anesthetic such as methohexital, etomidate, or thiopental, a muscle relaxant such as suxamethonium (succinylcholine), and occasionally atropine to inhibit salivation. In a minority of countries such as Japan, India, and Nigeria,<unk>  may be used without anesthesia. The Union Health Ministry of India recommended a ban on<unk>  without anesthesia in India's Mental Health Care Bill of 2010 and the Mental Health Care Bill of 2013. The practice was abolished in Turkey's largest psychiatric hospital in 2008. The patient's EEG, ECG, and blood oxygen levels are monitored during treatment.<unk>  is usually administered three times a week, on alternate days, over a course of two to four weeks. An illustration depicting<unk>  Neuroimaging prior to<unk>  Neuroimaging prior to<unk>  may be useful for detecting intracranial pressure or mass given that patients respond less when one of these conditions exist. Nonetheless it is not indicated due to high cost and low prevalence of these conditions in patients needing<unk> . Concurrent pharmacotherapy Whether psychiatric medications are terminated prior to treatment or maintained, varies. However, drugs that are known to cause toxicity in combination with<unk> , such as lithium, are discontinued, and benzodiazepines, which increase the seizure threshold, are either discontinued, a benzodiazepine antagonist is administered at each<unk>  session, or the<unk>  treatment is adjusted accordingly. A 2009 RCT provides some evidence indicating that concurrent use of some antidepressant improves<unk>  efficacy. Course<unk>  is usually done from 6 to 12 times in 2 to 4 weeks but can sometimes exceed 12 rounds. It is also recommended to not do<unk>  more than 3 times per week. Treatment team In the US, the medical team performing the procedure typically consists of a psychiatrist, an anesthetist, an<unk>  treatment nurse or qualified assistant, and one or more recovery nurses. Medical trainees may assist, but only under the direct supervision of credentialed attending physicians and staff. Devices<unk>  machine from before 1960. Most modern<unk>  devices deliver a brief-pulse current, which is thought to cause fewer cognitive effects than the sine-wave currents which were originally used in<unk> . A small minority of psychiatrists in the US still use sine-wave stimuli. Sine-wave is no longer used in the UK or Ireland. Typically, the electrical stimulus used in<unk>  is about 800 milliamps and has up to several hundred watts, and the current flows for between one and six seconds. In the US,<unk>  devices are manufactured by two companies, Somatics, which is owned by psychiatrists Richard Abrams and Conrad Swartz, and Mecta. In the UK, the market for<unk>  devices was long monopolized by<unk> ron Ltd, which was set up by psychiatrist Robert Russell.
Electroconvulsive therapy
Brief psychotherapy
Psychotherapy
Cognitive therapy
Suicide intervention
Institutional psychotherapy
Insight-oriented psychotherapy
MDMA-assisted psychotherapy