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

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


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 psychiatric and medical conditions [1].

ECT is practiced widely throughout the world [2]. A practice survey from 1988-89 estimated that at least 100,000 patients in the United States received ECT annually [3]. The typical ECT patient in the US is relatively affluent and receives ECT in a private sector psychiatric facility [4]. State hospitals rarely offer the treatment, even though many of the patients would meet indications for ECT.

The efficacy and safety of ECT is well established. Nevertheless, it remains controversial and stigmatized because of misinformation and outmoded perceptions about how the treatment is performed.

The indications for treating unipolar major depression with ECT and its efficacy are reviewed here. An overview of ECT, the technique for performing ECT, medical consultation for ECT, and the indications for and efficacy of ECT in bipolar disorder are discussed separately, as is choosing initial treatment for depression and treatment of resistant depression.

(See "Overview of electroconvulsive therapy (ECT) for adults".)

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Literature review current through: Nov 2017. | This topic last updated: May 16, 2017.
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