Electroconvulsive Therapy Practice Changes in Older Individuals Due to COVID-19: Expert Consensus Statement

Am J Geriatr Psychiatry. 2020 Nov;28(11):1133-1145. doi: 10.1016/j.jagp.2020.08.001. Epub 2020 Aug 7.


The ubiquitous coronavirus 2019 (COVID-19) pandemic has required healthcare providers across all disciplines to rapidly adapt to public health guidelines to reduce risk while maintaining quality of care. Electroconvulsive therapy (ECT), which involves an aerosol-generating procedure from manual ventilation with a bag mask valve while under anesthesia, has undergone drastic practice changes in order to minimize disruption of treatment in the midst of COVID-19. In this paper, we provide a consensus statement on the clinical practice changes in ECT specific to older adults based on expert group discussions of ECT practitioners across the country and a systematic review of the literature. There is a universal consensus that ECT is an essential treatment of severe mental illness. In addition, there is a clear consensus on what modifications are imperative to ensure continued delivery of ECT in a manner that is safe for patients and staff, while maintaining the viability of ECT services. Approaches to modifications in ECT to address infection control, altered ECT procedures, and adjusting ECT operations are almost uniform across the globe. With modified ECT procedures, it is possible to continue to meet the needs of older patients while mitigating risk of transmission to this vulnerable population.

Keywords: ECT; aerosol-generating; coronavirus.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Betacoronavirus
  • COVID-19
  • Consensus
  • Coronavirus Infections* / epidemiology
  • Coronavirus Infections* / prevention & control
  • Electroconvulsive Therapy* / adverse effects
  • Electroconvulsive Therapy* / methods
  • Electroconvulsive Therapy* / standards
  • Expert Testimony
  • Humans
  • Infection Control / methods*
  • Infection Control / organization & administration
  • Mental Disorders* / epidemiology
  • Mental Disorders* / therapy
  • Organizational Innovation*
  • Pandemics* / prevention & control
  • Pneumonia, Viral* / epidemiology
  • Pneumonia, Viral* / prevention & control
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / organization & administration*
  • SARS-CoV-2
  • Systematic Reviews as Topic