Electroconvulsive therapy

Electroconvulsive therapy
Electroconvulsive therapy
	MECTA spECTrum 5000Q with electroencephalography (EEG) in a modern ECT suite
Other names	Electroshock therapy
ICD-10-PCS	GZB
ICD-9-CM	94.27
MeSH	D004565
OPS-301 code	8-630
MedlinePlus	007474
	[edit on Wikidata]

Electroconvulsive therapy (ECT) or electroshock therapy (EST) is a psychiatric treatment where a generalized seizure (without muscular convulsions) is electrically induced to manage refractory mental disorders.^[1] Typically, 70 to 120 volts are applied externally to the patient's head, resulting in approximately 800 milliamperes of direct current passing between the electrodes, for a duration of 100 milliseconds to 6 seconds, either from temple to temple (bilateral ECT) or from front to back of one side of the head (unilateral ECT). However, only about 1% of the electrical current crosses the bony skull into the brain because skull impedance is about 100 times higher than skin impedance.^[2]

Aside from effects on the brain, the general physical risks of ECT are similar to those of brief general anesthesia.^[3]^: 259 Immediately following treatment, the most common adverse effects are confusion and transient memory loss.^[4]^[5] Among treatments for severely depressed pregnant women, ECT is one of the least harmful to the fetus.^[6]

ECT is often used as an intervention for major depressive disorder, mania, and catatonia.^[4] The usual course of ECT involves multiple administrations, typically given two or three times per week until the patient no longer has symptoms. ECT is administered under anesthesia with a muscle relaxant.^[7] ECT can differ in its application in three ways: electrode placement, treatment frequency, and the electrical waveform of the stimulus. These treatment parameters can pose significant differences in both adverse side effects and symptom remission in the treated patient.

Placement can be bilateral, where the electric current is passed from one side of the brain to the other, or unilateral, in which the current is solely passed across one hemisphere of the brain. High-dose unilateral ECT has some cognitive advantages compared to moderate-dose bilateral ECT while showing no difference in antidepressant efficacy.^[8]

^ Rudorfer MV, Henry ME, Sackeim HA (2003). "Electroconvulsive therapy" (PDF). In Tasman A, Kay J, Lieberman JA (eds.). Psychiatry (Second ed.). Chichester: John Wiley & Sons Ltd. pp. 1865–1901. Archived (PDF) from the original on 2007-08-10.
^ Solano J (2009-04-20). "Electroconvulsive Therapy" (PDF). p. 4. Archived (PDF) from the original on 2022-02-18. Retrieved 2022-05-17.
^ Surgeon General (1999). Mental Health: A Report of the Surgeon General, chapter 4.
^ ^a ^b FDA. 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). Quote, p. 38: "Three major practice guidelines have been published on ECT. These guidelines include: APA Task Force on ECT (2001); Third report of the Royal College of Psychiatrists' Special Committee on ECT (2004); National Institute for Health and Clinical Excellence (NICE 2003; NICE 2009). There is significant agreement between the three sets of recommendations."
^ American Psychiatric Association, Committee on Electroconvulsive Therapy, Richard D. Weiner (chairperson), et al. (2001). The practice of electroconvulsive therapy: recommendations for treatment, training, and privileging (2nd ed.). Washington, DC: American Psychiatric Publishing. ISBN 978-0-89042-206-9.
^ Pompili M, Dominici G, Giordano G, Longo L, Serafini G, Lester D, et al. (December 2014). "Electroconvulsive treatment during pregnancy: a systematic review". Expert Review of Neurotherapeutics. 14 (12): 1377–1390. doi:10.1586/14737175.2014.972373. PMID 25346216. S2CID 31209001.
^ Margarita Tartakovsky (2012) Psych Central. 5 Outdated Beliefs About ECT Archived 2013-08-08 at the Wayback Machine
^ Kolshus E, Jelovac A, McLoughlin DM (February 2017). "Bitemporal v. high-dose right unilateral electroconvulsive therapy for depression: a systematic review and meta-analysis of randomized controlled trials" (PDF). Psychological Medicine. 47 (3): 518–530. doi:10.1017/S0033291716002737. PMID 27780482. S2CID 10711085. Archived (PDF) from the original on 2021-06-16.

[Rudorfer-1] Rudorfer MV, Henry ME, Sackeim HA (2003). "Electroconvulsive therapy" (PDF). In Tasman A, Kay J, Lieberman JA (eds.). Psychiatry (Second ed.). Chichester: John Wiley & Sons Ltd. pp. 1865–1901. Archived (PDF) from the original on 2007-08-10.

[2] Solano J (2009-04-20). "Electroconvulsive Therapy" (PDF). p. 4. Archived (PDF) from the original on 2022-02-18. Retrieved 2022-05-17.

[SG-3] Surgeon General (1999). Mental Health: A Report of the Surgeon General, chapter 4.

[FDA2011rev-4] FDA. 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). Quote, p. 38: "Three major practice guidelines have been published on ECT. These guidelines include: APA Task Force on ECT (2001); Third report of the Royal College of Psychiatrists' Special Committee on ECT (2004); National Institute for Health and Clinical Excellence (NICE 2003; NICE 2009). There is significant agreement between the three sets of recommendations."

[APA2001guideline-5] American Psychiatric Association, Committee on Electroconvulsive Therapy, Richard D. Weiner (chairperson), et al. (2001). The practice of electroconvulsive therapy: recommendations for treatment, training, and privileging (2nd ed.). Washington, DC: American Psychiatric Publishing. ISBN 978-0-89042-206-9.

[Pompili2014Rev-6] Pompili M, Dominici G, Giordano G, Longo L, Serafini G, Lester D, et al. (December 2014). "Electroconvulsive treatment during pregnancy: a systematic review". Expert Review of Neurotherapeutics. 14 (12): 1377–1390. doi:10.1586/14737175.2014.972373. PMID 25346216. S2CID 31209001.

[7] Margarita Tartakovsky (2012) Psych Central. 5 Outdated Beliefs About ECT Archived 2013-08-08 at the Wayback Machine

[pmid27780482-8] Kolshus E, Jelovac A, McLoughlin DM (February 2017). "Bitemporal v. high-dose right unilateral electroconvulsive therapy for depression: a systematic review and meta-analysis of randomized controlled trials" (PDF). Psychological Medicine. 47 (3): 518–530. doi:10.1017/S0033291716002737. PMID 27780482. S2CID 10711085. Archived (PDF) from the original on 2021-06-16.

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