What we have learned about electroconvulsive therapy and its relevance for the practising psychiatrist

Can J Psychiatry. 2011 Jan;56(1):5-12. doi: 10.1177/070674371105600103.

Abstract

In this narrative review, the current knowledge base on the efficacy and the practice of electroconvulsive therapy (ECT) is reviewed, and its relevance for the practising psychiatrist is appreciated. In the past decade, several large-scale studies have confirmed the significant superiority of ECT in the treatment of severe and refractory psychiatric conditions, such as major depressive disorder and bipolar disorder. However, the efficacy of ECT is not reflected in current treatment algorithms, where ECT is often reserved as a last resort. However, clinical characteristics, such as the presence of psychotic symptoms, suicidality, or catatonic signs, should prompt the clinician to consider ECT earlier in the treatment course. ECT is a safe procedure, without absolute contraindications for its use. Nevertheless, patients' fears and complaints should be acknowledged, and patients should be adequately informed about expected benefits and possible risks, such as memory problems, that are generally transient. Research focusing on further minimizing memory problems, while maintaining a superior efficacy, is ongoing. Adequate continuation treatment, either pharmacotherapy or continuation ECT, after a successful ECT course is of vital importance to maintain the benefits achieved and should be the focus of future research.

Publication types

  • Review

MeSH terms

  • Adult
  • Aged
  • Bipolar Disorder / physiopathology
  • Bipolar Disorder / psychology
  • Bipolar Disorder / therapy
  • Brain / physiopathology
  • Combined Modality Therapy
  • Depressive Disorder, Major / physiopathology
  • Depressive Disorder, Major / psychology
  • Depressive Disorder, Major / therapy
  • Electroconvulsive Therapy / adverse effects
  • Electroconvulsive Therapy / methods*
  • Electroconvulsive Therapy / psychology
  • Humans
  • Mental Disorders / physiopathology
  • Mental Disorders / therapy*
  • Middle Aged
  • Patient Acceptance of Health Care / psychology
  • Patient Selection
  • Psychiatry*
  • Psychotic Disorders / physiopathology
  • Psychotic Disorders / psychology
  • Psychotic Disorders / therapy
  • Psychotropic Drugs / therapeutic use
  • Risk Factors
  • Schizophrenia / physiopathology
  • Schizophrenia / therapy
  • Schizophrenic Psychology
  • Treatment Outcome

Substances

  • Psychotropic Drugs