Electroconvulsive therapy for depression in general psychiatric practice.

Abstract

This paper identifies areas of consensus about the use of electroconvulsive therapy (ECT) for depression and some of the important points of disagreement which have implications for clinical practice and research. The clinical indications for ECT as a primary treatment of choice, a secondary treatment, and a maintenance or prophylactic treatment for depression are described. The commonly accepted outcome findings that ECT is highly effective are contrasted with more recent data indicating it may be quite ineffective when administered with a low-dose electric stimulus. The constituents of the treatment dosage are presented in the context of controversy surrounding the respective contributions of the electrical energy of the stimulus and the convulsions themselves to the overall therapeutic effectiveness. The points of consensus within the limited knowledge in this area are identified as the basis for the most appropriate approach to the design of clinical dosage protocols. It is concluded that ECT is an effective treatment for some of the severe presentations of depression. Its therapeutic effectiveness should not be compromised by efforts to minimize the side effects through excessive dosage reduction.