What is Electroconvulsive Therapy (ECT)?

From the Guidelines

Electroconvulsive Therapy (ECT) is a principal treatment approach for severe mental health conditions, including major depressive disorder, mania, and catatonia, involving the use of electrical impulses to induce seizures for therapeutic purposes.

Key Points

• ECT is used to treat severe, persistent mental health conditions, including major depression, mania, and catatonia, particularly when other treatments have failed 1.
• The treatment involves the use of electrical impulses to induce seizures, which can lead to improvements in mood and cognitive function 1.
• Common adverse effects of ECT include impairment of memory and new learning, headache, nausea, vomiting, muscle aches, confusion, and agitation 1.
• The primary diagnostic consideration for ECT in adolescents is a severe mood disorder, and psychiatric comorbidity should not be considered a contraindication for ECT 1.
• Before an adolescent is considered for ECT, they must meet specific criteria, including a diagnosis of severe, persistent major depression or mania, severity of symptoms, and lack of treatment response to at least two adequate trials of psychopharmacological agents 1.

Indications and Contraindications

• ECT may be used to treat catatonia and neuroleptic malignant syndrome, and may be considered for adolescents with schizophrenia, especially when affective symptoms are prominent 1.
• There are insufficient data to allow firm conclusions to be drawn regarding absolute contraindications to ECT use in adolescents, but active chest infection and recent myocardial infarction are no longer considered absolute contraindications 1.
• Mental retardation is not a contraindication for ECT, and ECT may be used in patients with a history of craniotomy or cerebral lesions, but cautious use is recommended 1.

From the Research

Definition and Overview of Electroconvulsive Therapy (ECT)

• Electroconvulsive therapy (ECT) is a procedure that has been used in the treatment of mental illness for over 60 years 2.
• It is a medical and psychiatric procedure whereby electrical current is delivered to the brain under general anesthesia to induce a generalized seizure 3.
• ECT is considered one of the most effective therapeutic interventions for a wide variety of psychiatric disorders, including treatment-resistant depression, bipolar depression, mania, catatonia, and clozapine-resistant schizophrenia 4, 5, 3.

Efficacy and Safety of ECT

• ECT has been proven to be a highly effective treatment option, predominantly for depression, but also for schizophrenia and other indications 6.
• The safety and tolerability of electroconvulsive treatment have been enhanced by the use of modified stimulation techniques and by progress in modern anesthesia 6.
• Despite its efficacy, ECT remains a controversial treatment, with questions concerning its efficacy and safety being raised by mental health professionals and service users themselves 2.
• Neurocognitive side effects remain one of the major drawbacks to its use and contribute to the negative stigma of this highly effective treatment 4.

Mechanisms of Action and Future Directions

• There is a need to understand fundamental physiologic, cellular, and molecular mechanisms of ECT to devise strategies to optimize therapeutic outcomes 3.
• Clinical trials that set out to adjust parameters, electrode placement, adjunctive medications, and patient selection are critical steps towards the goal of improving outcomes with ECT 3.
• Researchers continue to explore different ways of using ECT by modifying the treatment parameters to maintain efficacy and decrease side effects 4.