Electroconvulsive therapy: current status

Electroconvulsive therapy (ECT) can differ in its application in three ways: electrode placement, frequency of treatments and electrical waveform of the stimulus. Seizure threshold and dosing affects efficacy, speed of clinical response and cognitive deficits. Proposed mechanisms are psychological theories, structural theories, electrophysiology and neurophysiology, biochemical theories and molecular theories. In animal models, there is synaptic plasticity in hippocampus, mossy fibre sprouting, alterations in cytoskeletal structure, promotion of neurogenesis and suppression of apoptosis. Biochemical theories include the monoamine hypothesis, beyond monoamines, vascular endothelial growth factor and brain derived neurotrophic factor. It has generally low risk and one of the safest procedures performed under general anaesthesia. ECT can be given safely to patient with epilepsy; can be given in healed skull and brain trauma, neurologically stable patient after a cerebrovascular accident. Primary use is in rapid definitive response required on medical or psychiatric grounds, risks of alternative treatments outweigh benefits, past history of poor response to psychotropics or good response to ECT and patient preference. ECT is the most effective treatment in depression. Scizopohrenia is the second most common diagnostic indication. Some individuals consider ECT to have been a beneficial and lifesaving treatment, while others reported feelings of terror, shame and distress. Written, informed consent of the patient is important before ECT is administered. With the development of new techniques for application of ECT its public perception regarding its use has improved in a positive sense.