Overview of electroconvulsive therapy

Electroconvulsive therapy (ECT) delivers an electric current to the brain and induces a seizure, resulting in rapid relief of symptoms of severe psychiatric disorders. ECT is administered under general anaesthesia and patients are also given a short-acting muscle relaxant before the procedure.

ECT can be used for severe psychiatric disorders, including in patients who have:

• had a previous good response to ECT or who prefer this method of treatment
• major depression with any of the following features:
  • depressive stupor or severe psychomotor disturbance leading to severe self-neglect
  • life-threatening refusal to accept fluid and food intake
  • melancholic features unresponsive to antidepressants
  • psychotic depression
  • severe postnatal depression
  • severe treatment-resistant major depression
  • strong suicidal thoughts
• schizoaffective disorder
• severe postpartum psychosis
• treatment-resistant bipolar depression
• treatment-resistant mania
• treatment-resistant schizophrenia.

Most Australian states and territories have ECT legislation that details:

• who can perform ECT
• where ECT can be performed and the minimum facilities required
• the minimum age that ECT can be administered
• consent and withdrawal of consent to treatment with ECT.

The stigma and anxiety associated with ECT can be a barrier to both clinicians and patients choosing this therapy. However, advances in technique and administration provide an improved balance between the benefits and harms of ECT.

Treatment approach is individualised to the patient, their disorder and their response to ECT. Individualisation can be achieved through adjustment of ECT parameters, such as current delivered, electrode placement, frequency of treatment. A course of ECT typically consists of multiple sessions, usually administered 2 to 3 times a week. Relapse rates after ECT are high and recovery should be maintained with pharmacotherapy. Occasionally, maintenance ECT is used for patients who do not respond to maintenance pharmacotherapy.

For advice on ECT during pregnancy, see here.