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Objective: To review literature pertaining to the efficacy, safety, and tolerability of electroconvulsive therapy (ECT) in treating late-life depression. Method:We undertook a literature review with an emphasis on research studies published in the last 10 years.Results: There is a positive association between advancing age and ECT efficacy. Age per se does not necessarily increase the risk of cognitive side effects from ECT, but this risk is increased by age-associated neurological conditions such as Alzheimer's dementia and cerebrovascular disease. With appropriate evaluation and monitoring, ECT can be used safely in patients of very advanced age and in those with serious medical conditions. Several technical factors, including dose of electricity relative to a patient's seizure threshold, position of electrodes, frequency of administration, and total number of treatments, have an impact on the efficacy and cognitive side effects of ECT and need to be taken into account when administering ECT. Naturalistic studies have found that 50% or more of patients have a relapse of depression within 6 to 12 months of discontinuing acute ECT. Conclusions:In recent years, there has been substantial progress in our understanding of the effect of technical factors on the efficacy and cognitive side effects of ECT. When administered in an optimal manner, ECT is a safe, well-tolerated, and effective treatment in older patients. Relapse of depression after response to ECT remains a significant problem, and there is a need for further research into the prediction and prevention of post-ECT relapse. Clinical Implications · With appropriate evaluation and monitoring, electroconvulsive therapy (ECT) is a safe and effective treatment in elderly patients, including those of very advanced age and those with significant medical comorbidity. · Technical factors have a significant impact on the efficacy and side effects of ECT and need to be taken into account when administering the treatment. · Despite the use of continuation antidepressant medication, relapse of depression after ECT remains a significant problem. Limitations· Only 1 study, with a relatively small number of patients, has compared the efficacy and cognitive effects of high-dose right unilateral ECT with bilateral ECT. The findings of this study require replication in a larger group of patients recruited from more than 1 research centre. · The optimal electrical dose for right unilateral ECT remains to be established. · Data pertaining to the efficacy of continuation ECT are derived from uncontrolled or retrospective studies. However, data from the first controlled, prospective study of continuation ECT should soon be available.

The present results suggest cognitive deficits (mostly of executive functions) and vascular and neurodegenerative vulnerability in LOPS. Further studies with larger samples are needed to confirm the present findings.