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Overview of electroconvulsive therapy (ECT) for adults

Author
Charles Kellner, MD
Section Editor
Peter P Roy-Byrne, MD
Deputy Editor
David Solomon, MD

INTRODUCTION

Electroconvulsive therapy (ECT) uses a small electric current to produce a generalized cerebral seizure under general anesthesia. ECT is used mainly to treat severe depression, but is also indicated for patients with other conditions, including bipolar disorder, schizophrenia, schizoaffective disorder, catatonia, and neuroleptic malignant syndrome.

There is no question about the efficacy and safety of ECT, which is practiced widely in the United States and the rest of the world [1]. Nevertheless, it remains controversial and stigmatized because of misinformation and outmoded perceptions about how the treatment is performed [2].

This topic provides an overview of ECT. The indications for and efficacy of ECT in unipolar major depression, technique for performing ECT, medical consultation for ECT, and indications for and efficacy of ECT in bipolar disorder are discussed separately.

(See "Unipolar major depression in adults: Indications for and efficacy of electroconvulsive therapy (ECT)".)

(See "Technique for performing electroconvulsive therapy (ECT) in adults".)

                          

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Literature review current through: Nov 2016. | This topic last updated: Wed Aug 24 00:00:00 GMT+00:00 2016.
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References
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  1. Lisanby SH. Electroconvulsive therapy for depression. N Engl J Med 2007; 357:1939.
  2. Kellner CH, Greenberg RM, Murrough JW, et al. ECT in treatment-resistant depression. Am J Psychiatry 2012; 169:1238.
  3. Shorter, E, Healy, D. Shock Therapy: A History of Electroconvulsive Treatment in Mental Illness, Rutgers University Press, New Brunswick 2007.
  4. Kalinowsky LB. History of convulsive therapy. Ann N Y Acad Sci 1986; 462:1.
  5. Endler NS. The Origins of Electroconvulsive Therapy (ECT). Convuls Ther 1988; 4:5.
  6. Bini, L. Experimental researches on epileptic attacks induced by the electric current. Am J Psychiatry 1938; 94:172.
  7. Thompson JW, Weiner RD, Myers CP. Use of ECT in the United States in 1975, 1980, and 1986. Am J Psychiatry 1994; 151:1657.
  8. Hermann RC, Dorwart RA, Hoover CW, Brody J. Variation in ECT use in the United States. Am J Psychiatry 1995; 152:869.
  9. Rudorfer MV, Risby ED, Hsiao JK, et al. Disparate Biochemical Actions of Electroconvulsive Therapy and Antidepressant Drugs. Convuls Ther 1988; 4:133.
  10. Nikisch G, Mathé AA. CSF monoamine metabolites and neuropeptides in depressed patients before and after electroconvulsive therapy. Eur Psychiatry 2008; 23:356.
  11. Lapierre YD. Neurotransmitter functions in depression. Prog Neuropsychopharmacol Biol Psychiatry 1982; 6:639.
  12. Sackeim HA, Decina P, Prohovnik I, et al. Anticonvulsant and antidepressant properties of electroconvulsive therapy: a proposed mechanism of action. Biol Psychiatry 1983; 18:1301.
  13. Piccinni A, Del Debbio A, Medda P, et al. Plasma Brain-Derived Neurotrophic Factor in treatment-resistant depressed patients receiving electroconvulsive therapy. Eur Neuropsychopharmacol 2009; 19:349.
  14. Okamoto T, Yoshimura R, Ikenouchi-Sugita A, et al. Efficacy of electroconvulsive therapy is associated with changing blood levels of homovanillic acid and brain-derived neurotrophic factor (BDNF) in refractory depressed patients: a pilot study. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32:1185.
  15. Ota M, Noda T, Sato N, et al. Effect of electroconvulsive therapy on gray matter volume in major depressive disorder. J Affect Disord 2015; 186:186.
  16. Joshi SH, Espinoza RT, Pirnia T, et al. Structural Plasticity of the Hippocampus and Amygdala Induced by Electroconvulsive Therapy in Major Depression. Biol Psychiatry 2016; 79:282.
  17. Dukart J, Regen F, Kherif F, et al. Electroconvulsive therapy-induced brain plasticity determines therapeutic outcome in mood disorders. Proc Natl Acad Sci U S A 2014; 111:1156.
  18. Tendolkar I, van Beek M, van Oostrom I, et al. Electroconvulsive therapy increases hippocampal and amygdala volume in therapy refractory depression: a longitudinal pilot study. Psychiatry Res 2013; 214:197.
  19. Nobler MS, Oquendo MA, Kegeles LS, et al. Decreased regional brain metabolism after ect. Am J Psychiatry 2001; 158:305.
  20. Perrin JS, Merz S, Bennett DM, et al. Electroconvulsive therapy reduces frontal cortical connectivity in severe depressive disorder. Proc Natl Acad Sci U S A 2012; 109:5464.
  21. Abbott CC, Jones T, Lemke NT, et al. Hippocampal structural and functional changes associated with electroconvulsive therapy response. Transl Psychiatry 2014; 4:e483.
  22. Lyden H, Espinoza RT, Pirnia T, et al. Electroconvulsive therapy mediates neuroplasticity of white matter microstructure in major depression. Transl Psychiatry 2014; 4:e380.
  23. Sackeim HA, Luber B, Katzman GP, et al. The effects of electroconvulsive therapy on quantitative electroencephalograms. Relationship to clinical outcome. Arch Gen Psychiatry 1996; 53:814.
  24. Rasmussen KG, Rummans TA, Richardson JW. Electroconvulsive therapy in the medically ill. Psychiatr Clin North Am 2002; 25:177.
  25. Hızlı Sayar G, Eryılmaz G, Semieoğlu S, et al. Influence of valproate on the required dose of propofol for anesthesia during electroconvulsive therapy of bipolar affective disorder patients. Neuropsychiatr Dis Treat 2014; 10:433.
  26. FDA Executive Summary: Prepared for the January 27-28, 2011 meeting of the Neurological Devices Panel. Meeting to Discuss the Classification of Electroconvulsive Therapy Devices (ECT). http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/MedicalDevices/MedicalDevicesAdvisoryCommittee/NeurologicalDevicesPanel/UCM240933.pdf (Accessed on May 25, 2011).
  27. Sackeim HA, Dillingham EM, Prudic J, et al. Effect of concomitant pharmacotherapy on electroconvulsive therapy outcomes: short-term efficacy and adverse effects. Arch Gen Psychiatry 2009; 66:729.
  28. American Psychiatric Association Task Force on Electroconvulsive Therapy. The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging. American Psychiatric Association, Washington, DC 2001.
  29. Baghai TC, Marcuse A, Brosch M, et al. The influence of concomitant antidepressant medication on safety, tolerability and clinical effectiveness of electroconvulsive therapy. World J Biol Psychiatry 2006; 7:82.
  30. Nothdurfter C, Eser D, Schüle C, et al. The influence of concomitant neuroleptic medication on safety, tolerability and clinical effectiveness of electroconvulsive therapy. World J Biol Psychiatry 2006; 7:162.
  31. Klapheke MM. Combining ECT and Antipsychotic Agents: Benefits and Risks. Convuls Ther 1993; 9:241.
  32. Dolenc TJ, Rasmussen KG. The safety of electroconvulsive therapy and lithium in combination: a case series and review of the literature. J ECT 2005; 21:165.
  33. Greenberg RM, Pettinati HM. Benzodiazepines and Electroconvulsive Therapy. Convuls Ther 1993; 9:262.
  34. Krystal AD, Watts BV, Weiner RD, et al. The use of flumazenil in the anxious and benzodiazepine-dependent ECT patient. J ECT 1998; 14:5.
  35. Sienaert P, Peuskens J. Anticonvulsants during electroconvulsive therapy: review and recommendations. J ECT 2007; 23:120.
  36. Rasmussen KG, Zorumski CF. Electroconvulsive therapy in patients taking theophylline. J Clin Psychiatry 1993; 54:427.
  37. Kellner, CH, Pritchett, JT, Beale, MD, Coffey, CE. Handbook of ECT, American Psychiatric Press, Inc., Washington, DC 1997.
  38. Kellner CH, Knapp RG, Petrides G, et al. Continuation electroconvulsive therapy vs pharmacotherapy for relapse prevention in major depression: a multisite study from the Consortium for Research in Electroconvulsive Therapy (CORE). Arch Gen Psychiatry 2006; 63:1337.
  39. Kellner CH, Knapp R, Husain MM, et al. Bifrontal, bitemporal and right unilateral electrode placement in ECT: randomised trial. Br J Psychiatry 2010; 196:226.
  40. Charlson F, Siskind D, Doi SA, et al. ECT efficacy and treatment course: a systematic review and meta-analysis of twice vs thrice weekly schedules. J Affect Disord 2012; 138:1.
  41. Lerer B, Shapira B, Calev A, et al. Antidepressant and cognitive effects of twice- versus three-times-weekly ECT. Am J Psychiatry 1995; 152:564.
  42. Shapira B, Tubi N, Drexler H, et al. Cost and benefit in the choice of ECT schedule. Twice versus three times weekly ECT. Br J Psychiatry 1998; 172:44.
  43. HAMILTON M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23:56.
  44. Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry 1979; 134:382.
  45. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12:189.
  46. Porter R, Heenan H, Reeves J. Early effects of electroconvulsive therapy on cognitive function. J ECT 2008; 24:35.
  47. Kramer BA. Use of ECT in California, revisited: 1984-1994. J ECT 1999; 15:245.
  48. Abrams R. The mortality rate with ECT. Convuls Ther 1997; 13:125.
  49. Shiwach RS, Reid WH, Carmody TJ. An analysis of reported deaths following electroconvulsive therapy in Texas, 1993-1998. Psychiatr Serv 2001; 52:1095.
  50. Watts BV, Groft A, Bagian JP, Mills PD. An examination of mortality and other adverse events related to electroconvulsive therapy using a national adverse event report system. J ECT 2011; 27:105.
  51. Baker NJ. Electroconvulsive Therapy and Severe Osteoporosis: Use of a Nerve Stimulator to Assess Paralysis. Convuls Ther 1986; 2:285.
  52. Minneman SA. A history of oral protection for the ECT patient: past, present, and future. Convuls Ther 1995; 11:94.
  53. Datto CJ. Side effects of electroconvulsive therapy. Depress Anxiety 2000; 12:130.
  54. Devanand DP, Polanco P, Cruz R, et al. The efficacy of ECT in mixed affective states. J ECT 2000; 16:32.
  55. Weiner SJ, Ward TN, Ravaris CL. Headache and electroconvulsive therapy. Headache 1994; 34:155.
  56. Rasmussen KG, Petersen KN, Sticka JL, et al. Correlates of myalgia in electroconvulsive therapy. J ECT 2008; 24:84.
  57. Kellner CH. Brain stimulation in psychiatry: ECT, DBS, TMS, and other modalities, Cambridge University Press, Cambridge, United Kingdom 2012.
  58. Devanand DP, Fitzsimons L, Prudic J, Sackeim HA. Subjective side effects during electroconvulsive therapy. Convuls Ther 1995; 11:232.
  59. Rose D, Fleischmann P, Wykes T, et al. Patients' perspectives on electroconvulsive therapy: systematic review. BMJ 2003; 326:1363.
  60. Semkovska M, McLoughlin DM. Objective cognitive performance associated with electroconvulsive therapy for depression: a systematic review and meta-analysis. Biol Psychiatry 2010; 68:568.
  61. Fernie G, Bennett DM, Currie J, et al. Detecting objective and subjective cognitive effects of electroconvulsive therapy: intensity, duration and test utility in a large clinical sample. Psychol Med 2014; 44:2985.
  62. Stoudemire A, Hill CD, Morris R, Dalton ST. Improvement in depression-related cognitive dysfunction following ECT. J Neuropsychiatry Clin Neurosci 1995; 7:31.
  63. Tielkes CE, Comijs HC, Verwijk E, Stek ML. The effects of ECT on cognitive functioning in the elderly: a review. Int J Geriatr Psychiatry 2008; 23:789.
  64. Mattis, S. Mental status examination for organic mental syndrome in the elderly patient. In: Geriatric Psychiatry: A Handbook for Psychiatrists and Primary Care Physicians, Bellak, L, Karasu, TB (Ed), Grune & Stratton, New York 1976. pp.77.
  65. Liston EH, Sones DE. Postictal Hyperactive Delirium in ECT: Management with Midazolam. Convuls Ther 1990; 6:19.
  66. Tzabazis A, Schmitt HJ, Ihmsen H, et al. Postictal agitation after electroconvulsive therapy: incidence, severity, and propofol as a treatment option. J ECT 2013; 29:189.
  67. Fink M, Abrams R, Bailine S, Jaffe R. Ambulatory electroconvulsive therapy: report of a task force of the association for convulsive therapy. Association for Convulsive Therapy . Convuls Ther 1996; 12:42.
  68. Lisanby SH, Maddox JH, Prudic J, et al. The effects of electroconvulsive therapy on memory of autobiographical and public events. Arch Gen Psychiatry 2000; 57:581.
  69. Sobin C, Sackeim HA, Prudic J, et al. Predictors of retrograde amnesia following ECT. Am J Psychiatry 1995; 152:995.
  70. McElhiney, MG, Moody, B, Steif, B, et al. Autobiographical memory and mood: Effects of Electroconvulsive therapy. Neuropsychology 1995; 9:501.
  71. Sackeim HA. Memory and ECT: from polarization to reconciliation. J ECT 2000; 16:87.
  72. Kellner CH. Electroconvulsive therapy in a perfect world. J ECT 2007; 23:63.
  73. Prudic J, Olfson M, Marcus SC, et al. Effectiveness of electroconvulsive therapy in community settings. Biol Psychiatry 2004; 55:301.
  74. Navarro V, Gastó C, Torres X, et al. Continuation/maintenance treatment with nortriptyline versus combined nortriptyline and ECT in late-life psychotic depression: a two-year randomized study. Am J Geriatr Psychiatry 2008; 16:498.
  75. Nordenskjöld A, von Knorring L, Ljung T, et al. Continuation electroconvulsive therapy with pharmacotherapy versus pharmacotherapy alone for prevention of relapse of depression: a randomized controlled trial. J ECT 2013; 29:86.
  76. Kellner CH, Husain MM, Knapp RG, et al. A Novel Strategy for Continuation ECT in Geriatric Depression: Phase 2 of the PRIDE Study. Am J Psychiatry 2016; 173:1110.
  77. Smith GE, Rasmussen KG Jr, Cullum CM, et al. A randomized controlled trial comparing the memory effects of continuation electroconvulsive therapy versus continuation pharmacotherapy: results from the Consortium for Research in ECT (CORE) study. J Clin Psychiatry 2010; 71:185.
  78. Rami L, Bernardo M, Boget T, et al. Cognitive status of psychiatric patients under maintenance electroconvulsive therapy: a one-year longitudinal study. J Neuropsychiatry Clin Neurosci 2004; 16:465.
  79. McFarquhar TF, Thompson J. Knowledge and attitudes regarding electroconvulsive therapy among medical students and the general public. J ECT 2008; 24:244.
  80. Payne NA, Prudic J. Electroconvulsive therapy: Part II: a biopsychosocial perspective. J Psychiatr Pract 2009; 15:369.
  81. Olfson M, Marcus S, Sackeim HA, et al. Use of ECT for the inpatient treatment of recurrent major depression. Am J Psychiatry 1998; 155:22.