Contemporary use and practice of electroconvulsive therapy worldwide

Abstract

To explore contemporary (from 1990) utilization and practice of electroconvulsive therapy (ECT) worldwide. Systematic search (limited to studies published 1990 and after) was undertaken in the databases Medline, Embase, PsycINFO, SveMed, and EBSCO/Cinahl. Primary data‐based studies/surveys with reported ECT utilization and practice in psychiatric institutions internationally, nationally, and regionally; city were included. Two reviewers independently checked study titles and abstracts according to inclusion criteria, and extracted ECT utilization and practice data from those retrieved in full text. Seventy studies were included, seven from Australia and New Zealand, three Africa, 12 North and Latin America, 33 Europe, and 15 Asia. Worldwide ECT differences and trends were evident, average number ECTs administered per patient were eight; unmodified (without anesthesia) was used in Asia (over 90%), Africa, Latin America, Russia, Turkey, Spain. Worldwide preferred electrode placement was bilateral, except unilateral at some places (Europe and Australia/New Zealand). Although mainstream was brief‐pulse wave, sine‐wave devices were still used. Majority ECT treated were older women with depression in Western countries, versus younger men with schizophrenia in Asian countries. ECT under involuntary conditions (admissions), use of ambulatory‐ECT, acute first line of treatment, as well as administered by other professions (geriatricians, nurses) were noted by some sites. General trends were only some institutions within the same country providing ECT, training inadequate, and guidelines not followed. Mandatory reporting and overall country ECT register data were sparse. Many patients are still treated with unmodified ECT today. Large global variation in ECT utilization, administration, and practice advocates a need for worldwide sharing of knowledge about ECT, reflection, and learning from each other's experiences.

On electroconvulsive therapy in depression : Clinical, cognitive and neurobiological aspects

“…Our findings of the characteristics of the Swedish ECT population (paper I) are in accordance to data from other western countries (Leiknes et al 2012), in the aspects that we find a predominance of women receiving ECT, with a median age above middle-age, and depression being the most common indications for ECT. This is in contrast to Asian countries, were the most common ECT patient is a young man with schizophrenia.…”

“…In a global perspective, Sweden has a relatively high availability of ECT (Leiknes et al 2012), similar to that in Belgium (41 per 100 000 inhabitants) (Sienaert et al 2006) and Australia (40-44 per 100 000) (Wood andBurgess 2003, Chanpattana 2007). In contrast lower rates of use have recently been reported in Norway (24 per 100 000) (Schweder et al 2011), Slovakia (29 per 100 000) (Dragasek 2012) and Canada (23-25 per 100 000) (Martin et al 2014).…”

“…However, the most common indication for receiving ECT in the western world today is for depression (Leiknes et al 2012).…”

“…In a recent systematic overview, Leiknes et al (Leiknes et al 2012) showed a large global variation in the indications, treatment technique and availability of ECT. The availability in terms of treated person rate (TPR) varied from 1.1 to 54 per 100 000 in various countries throughout the world.…”

Bitemporal Versus High-Dose Unilateral Twice-Weekly Electroconvulsive Therapy for Depression (EFFECT-Dep): A Pragmatic, Randomized, Non-Inferiority Trial

“…ECT is used to treat severe mental disorders in 1.4 million people annually worldwide, depression being the most common indication in Western countries (1). ECT is the most acutely effective treatment for treatment-resistant, sometimes life-threatening, depression (2,3).…”