Editing Electroconvulsive therapy (section)

===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>