Editing Electroconvulsive therapy (section)

== Modern use ==
ECT is used, where possible, with [[informed consent]]<ref name =Beloucif>{{cite journal | vauthors = Beloucif S | title = Informed consent for special procedures: electroconvulsive therapy and psychosurgery | journal = Current Opinion in Anesthesiology| volume = 26 | issue = 2 | pages = 182–185 | date = April 2013 | pmid = 23385317 | doi = 10.1097/ACO.0b013e32835e7380 | s2cid = 36643014 }}</ref> in treatment-resistant [[major depressive disorder]], [[bipolar depression]], treatment-resistant [[catatonia]], prolonged or severe [[mania]], and in conditions where "there is a need for rapid, definitive response because of the severity of a psychiatric or medical condition (e.g., when illness is characterized by [[suicidality]], [[psychosis]], [[stupor]], marked [[psychomotor retardation]], depressive [[delusion]]s or [[hallucination]]s, or life-threatening physical exhaustion associated with mania)."<ref name=FDA2011rev/><ref name="who.int">{{Cite web |title=WHO RESOURCE BOOK ON MENTAL HEALTH |url=https://www.who.int/mental_health/policy/resource_book_MHLeg.pdf |archive-url=https://web.archive.org/web/20130313054552/https://www.who.int/mental_health/policy/resource_book_MHLeg.pdf |archive-date=March 13, 2013}}</ref><ref name="Espinoza 2022" /> It has also been used to treat [[autism]] in adults with an intellectual disability, yet findings from a systematic review found this an unestablished intervention.<ref>{{cite journal | vauthors = Benevides TW, Shore SM, Andresen ML, Caplan R, Cook B, Gassner DL, Erves JM, Hazlewood TM, King MC, Morgan L, Murphy LE, Purkis Y, Rankowski B, Rutledge SM, Welch SP, Wittig K | title = Interventions to address health outcomes among autistic adults: A systematic review | journal = Autism | volume = 24 | issue = 6 | pages = 1345–1359 | date = August 2020 | pmid = 32390461 | pmc = 7787674 | doi = 10.1177/1362361320913664 | s2cid = 218586379 | doi-access = free }}</ref>

===Major depressive disorder===
For [[major depressive disorder]], despite a Canadian guideline and some experts arguing for using ECT as a first line treatment,<ref>{{cite journal | vauthors = Lipsman N, Sankar T, Downar J, Kennedy SH, Lozano AM, Giacobbe P | title = Neuromodulation for treatment-refractory major depressive disorder | journal = CMAJ | volume = 186 | issue = 1 | pages = 33–39 | date = January 2014 | pmid = 23897945 | pmc = 3883821 | doi = 10.1503/cmaj.121317 }}</ref><ref name="Psychiatry p.">{{cite book | veditors = Tasman A, Kay J, Lieberman JA, First MB, Riba MB | title=Psychiatry | publisher=John Wiley & Sons, Ltd | publication-place=Chichester, UK | year=2015 | isbn=978-1-118-75337-8 | doi=10.1002/9781118753378 | page=}}</ref><ref name="Bolwig 2005 p=51">{{cite journal | vauthors = Bolwig TG | title = First-line use of ECT | journal = The Journal of ECT | volume = 21 | issue = 1 | pages = 51 | date = March 2005 | pmid = 15791182 | doi = 10.1097/01.yct.0000158271.45828.76 | publisher = Ovid Technologies (Wolters Kluwer Health) }}</ref> ECT is generally used only when one or other treatments have failed, or in emergencies, such as imminent suicide.<ref name=FDA2011rev/><ref>{{cite journal | vauthors = Fitzgerald PB | title = Non-pharmacological biological treatment approaches to difficult-to-treat depression | journal = The Medical Journal of Australia | volume = 199 | issue = S6 | pages = S48–S51 | date = September 2013 | pmid = 25370288 | doi = 10.5694/mja12.10509 | s2cid = 204073048 }}</ref><ref name=NICE2009>{{cite web |url=https://www.nice.org.uk/guidance/cg90 |title=Depression in adults: The treatment and management of depression in adults. NICE guidelines CG90 |publisher=[[National Institute for Clinical Excellence]] |year=2009}}</ref> ECT has also been used in selected cases of depression occurring in the setting of [[multiple sclerosis]], [[Parkinson's disease]], [[Huntington's chorea]], [[Intellectual disability|developmental delay]], brain [[arteriovenous malformations]], and [[hydrocephalus]].<ref>{{cite book|title=Bradley's Neurology in Clinical Practice: Expert Consult|year=2012|publisher=Elsevier/Saunders|location=Philadelphia|isbn=978-1-4377-0434-1|vauthors=Murray ED, Buttner N, Price BH |volume=1|edition=6th|pages=114–115|veditors=Bradley WG, Daroff RB, Fenichel GM, Jankovic J |chapter=Depression and Psychosis in Neurological Practice}}</ref>

====Efficacy====
A [[meta-analysis]] on the effectiveness of ECT in unipolar and bipolar depression indicated that although patients with [[unipolar depression]] and [[bipolar depression]] responded to other medical treatments very differently, both groups responded equally well to ECT. Overall [[Remission (medicine)|remission]] rate for patients given a round of ECT treatment was 50.9% for those with unipolar depression and 53.2% for those with bipolar depression. Most severely depressed patients respond to ECT.<ref name="Dierckx Heijnen van den Broek Birkenhäger 2012 pp. 146–150">{{cite journal | vauthors = Dierckx B, Heijnen WT, van den Broek WW, Birkenhäger TK | title = Efficacy of electroconvulsive therapy in bipolar versus unipolar major depression: a meta-analysis | journal = Bipolar Disorders | volume = 14 | issue = 2 | pages = 146–150 | date = March 2012 | pmid = 22420590 | doi = 10.1111/j.1399-5618.2012.00997.x | publisher = Wiley | s2cid = 44280002 }}</ref>

In 2004, a meta-analysis found in terms of efficacy, "a significant superiority of ECT in all comparisons: ECT versus simulated ECT, ECT versus [[placebo]], ECT versus antidepressants in general, ECT versus tricyclics and ECT versus [[monoamine oxidase inhibitor]]s."<ref name="pmid15087991">{{cite journal | vauthors = Pagnin D, de Queiroz V, Pini S, Cassano GB | title = Efficacy of ECT in depression: a meta-analytic review | journal = The Journal of ECT | volume = 20 | issue = 1 | pages = 13–20 | date = March 2004 | pmid = 15087991 | doi = 10.1097/00124509-200403000-00004 | s2cid = 25843283 }}</ref>

In 2003, the UK ECT Review Group published a [[systematic review]] and meta-analysis comparing ECT to [[placebo]] and antidepressant drugs. This meta-analysis demonstrated a large effect size (high efficacy relative to the mean in terms of the [[standard deviation]]) for ECT versus placebo, and versus antidepressant drugs.<ref name=":0">{{cite journal | vauthors = ((UK ECT Review Group)) | title = Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis | journal = Lancet | volume = 361 | issue = 9360 | pages = 799–808 | date = March 2003 | pmid = 12642045 | doi = 10.1016/S0140-6736(03)12705-5 | s2cid = 28964580 }}</ref>

Compared with [[repetitive transcranial magnetic stimulation]] (rTMS) for people with treatment-resistant major depressive disorder, ECT relieves depression as shown by reducing the score on the [[Hamilton Rating Scale for Depression]] by about 15 points, while rTMS reduced it by 9 points.<ref>{{cite journal | vauthors = Micallef-Trigona B | title = Comparing the effects of repetitive transcranial magnetic stimulation and electroconvulsive therapy in the treatment of depression: a systematic review and meta-analysis | journal = Depression Research and Treatment | volume = 2014 | pages = 135049 | year = 2014 | pmid = 25143831 | pmc = 4131106 | doi = 10.1155/2014/135049 | doi-access = free }}</ref>

Other estimates regarding the response rate in treatment resistant depression vary between 60–80%, with a remission rate of 50–60%.<ref name="Espinoza 2022">{{cite journal |last1=Espinoza |first1=Randall T. |last2=Kellner |first2=Charles H. |title=Electroconvulsive Therapy |journal=New England Journal of Medicine |date=17 February 2022 |volume=386 |issue=7 |pages=667–672 |doi=10.1056/NEJMra2034954|pmid=35172057 }}</ref> In addition to reducing symptoms of depression and inducing relapse, ECT has also been shown to reduce the risk of suicide, improve functional outcomes and quality of life as well as reduce the risk of re-hospitalization.<ref name="Espinoza 2022" /> Efficacy does not depend on depression subtype.<ref name="Psychiatry p."/> With regards to treatment resistant schizophrenia, the response rate is 40–70%.<ref name="Espinoza 2022" />

====Follow-up====
There is little agreement on the most appropriate follow-up to ECT for people with major depressive disorder.<ref name="Jelovac2013Rev">{{cite journal | vauthors = Jelovac A, Kolshus E, McLoughlin DM | title = Relapse following successful electroconvulsive therapy for major depression: a meta-analysis | journal = Neuropsychopharmacology | volume = 38 | issue = 12 | pages = 2467–2474 | date = November 2013 | pmid = 23774532 | pmc = 3799066 | doi = 10.1038/npp.2013.149 }}</ref> The initial course of ECT is then transitioned to maintenance ECT, pharmacotherapy or both. When ECT is stopped abruptly, without a bridge to maintenance ECT or medications (usually antidepressants and [[Lithium (medication)|Lithium]]), it is associated with a relapse rate of 84%.<ref name="Espinoza 2022" /> There is no defined schedule for maintenance ECT, however it is usually started weekly with intervals extended permissibly with the goal of maintaining remission.<ref name="Espinoza 2022" /> When ECT is followed by treatment with [[antidepressants]], about 50% of people relapsed by 12 months following successful initial treatment with ECT, with about 37% relapsing within the first 6 months. About twice as many relapsed with no antidepressants. Most of the evidence for continuation therapy is with [[tricyclic antidepressants]]; evidence for relapse prevention with newer antidepressants is lacking.<ref name=Jelovac2013Rev/>{{update after|2025|3|26}} Adjunct maintenance ECT paired with [[cognitive behavioral therapy]] has also been shown to reduce relapse rates.<ref name="Espinoza 2022" /> Maintenance ECT may safely continue indefinitely, with no set maximum treatment interval established.<ref name="Espinoza 2022" />

[[Lithium (medication)|Lithium]] has also been found to reduce the risk of relapse, especially in younger patients.<ref name="Lambrichts Detraux Vansteelandt Nordenskjöld 2021 pp. 294–306">{{cite journal | vauthors = Lambrichts S, Detraux J, Vansteelandt K, Nordenskjöld A, Obbels J, Schrijvers D, Sienaert P | title = Does lithium prevent relapse following successful electroconvulsive therapy for major depression? A systematic review and meta-analysis | journal = Acta Psychiatrica Scandinavica | volume = 143 | issue = 4 | pages = 294–306 | date = April 2021 | pmid = 33506961 | doi = 10.1111/acps.13277 | s2cid = 231759831 | hdl = 10067/1751810151162165141 | url = https://lirias.kuleuven.be/handle/123456789/669413 | hdl-access = free }}</ref>

===Catatonia===
ECT is generally a second-line treatment for people with [[catatonia]] who do not respond to other treatments, but is a first-line treatment for severe or life-threatening catatonia.<ref name=FDA2011rev/><ref name=catatoniaRev>{{cite journal | vauthors = Sienaert P, Dhossche DM, Vancampfort D, De Hert M, Gazdag G | title = A clinical review of the treatment of catatonia | journal = Frontiers in Psychiatry | volume = 5 | pages = 181 | date = Dec 2014 | pmid = 25538636 | pmc = 4260674 | doi = 10.3389/fpsyt.2014.00181 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Leroy A, Naudet F, Vaiva G, Francis A, Thomas P, Amad A | title = Is electroconvulsive therapy an evidence-based treatment for catatonia? A systematic review and meta-analysis | journal = European Archives of Psychiatry and Clinical Neuroscience | volume = 268 | issue = 7 | pages = 675–687 | date = October 2018 | pmid = 28639007 | doi = 10.1007/s00406-017-0819-5 | s2cid = 4013882 }}</ref> There is a plethora of evidence for its efficacy, notwithstanding a lack of randomised controlled trials, such that "the excellent efficacy of ECT in catatonia is generally acknowledged".<ref name=catatoniaRev/> For people with [[Autism Spectrum Disorders|autism spectrum disorders]] who have catatonia, there is little published evidence about the efficacy of ECT.<ref>{{cite journal | vauthors = DeJong H, Bunton P, Hare DJ | title = A systematic review of interventions used to treat catatonic symptoms in people with autistic spectrum disorders | journal = Journal of Autism and Developmental Disorders | volume = 44 | issue = 9 | pages = 2127–2136 | date = September 2014 | pmid = 24643578 | doi = 10.1007/s10803-014-2085-y | s2cid = 22002956 }}</ref>

===Mania===
ECT is used to treat people who have severe or prolonged [[mania]];<ref name=FDA2011rev/> [[NICE]] recommends it only in life-threatening situations or when other treatments have failed<ref name=NICEtech2003>NICE [https://www.nice.org.uk/guidance/ta59 Guidance on the use of electroconvulsive therapy. NICE technology appraisals TA59].  Published date: April 2003</ref> and as a second-line treatment for [[bipolar disorder|bipolar mania]].<ref>{{cite journal | vauthors = Kanba S, Kato T, Terao T, Yamada K | title = Guideline for treatment of bipolar disorder by the Japanese Society of Mood Disorders, 2012 | journal = Psychiatry and Clinical Neurosciences | volume = 67 | issue = 5 | pages = 285–300 | date = July 2013 | pmid = 23773266 | doi = 10.1111/pcn.12060 | s2cid = 2058163 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Malhi GS, Tanious M, Berk M | title = Mania: diagnosis and treatment recommendations | journal = Current Psychiatry Reports | volume = 14 | issue = 6 | pages = 676–686 | date = December 2012 | pmid = 22986995 | doi = 10.1007/s11920-012-0324-5 | s2cid = 37771648 }}</ref>

===Schizophrenia===
ECT is widely used worldwide in the treatment of [[schizophrenia]]. However, in North America and Western Europe it is invariably used only in [[treatment resistant schizophrenia]] when symptoms show little response to [[antipsychotic]]s; there is comprehensive research evidence for such practice.<ref>{{cite journal | vauthors = Tharyan P, Adams CE | title = Electroconvulsive therapy for schizophrenia | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD000076 | date = April 2005 | pmid = 15846598 | doi = 10.1002/14651858.CD000076.pub2 | veditors = Tharyan P }}</ref> It is useful in the case of severe exacerbations of [[catatonic schizophrenia]], whether excited or stuporous.<ref name=FDA2011rev/><ref name=NICEtech2003/> There are also case reports of ECT improving persistent psychotic symptoms associated with [[Stimulant psychosis|stimulant-induced psychosis]].<ref>{{cite journal | vauthors = Penders TM, Gestring RE, Vilensky DA | title = Intoxication delirium following use of synthetic cathinone derivatives | journal = The American Journal of Drug and Alcohol Abuse | volume = 38 | issue = 6 | pages = 616–617 | date = November 2012 | pmid = 22783894 | doi = 10.3109/00952990.2012.694535 | s2cid = 207428569 }}</ref><ref>{{cite journal | vauthors = Penders TM, Lang MC, Pagano JJ, Gooding ZS | title = Electroconvulsive therapy improves persistent psychosis after repeated use of methylenedioxypyrovalerone ("bath salts") | journal = The Journal of ECT | volume = 29 | issue = 4 | pages = e59–e60 | date = December 2013 | pmid = 23609518 | doi = 10.1097/YCT.0b013e3182887bc2 | s2cid = 45842375 }}</ref>