Current status of electroconvulsive therapy for mood disorders: a clinical review

Abstract

Electroconvulsive therapy (ECT) is an effective treatment for mood disorders and a viable treatment option especially when urgency of clinical situation requires a prompt treatment response. After acute series of ECT, the ECT long-term treatment may be considered, although this practice may vary significantly between countries or even within the same country, because there is no universal consensus about its indications, duration and frequency of administration. Continuation or maintenance ECT is common in routine clinical practice and clinicians should be aware of the risks of using ECT long term. Neuropsychological assessment should be an essential part of a good clinical practice in ECT services. Cognitive side effects of ECT are sometimes underestimated and may last much longer after completed treatment than it is usually expected. These cognitive impairments associated with ECT may cause significant functional difficulties and prevent patients to return to work. Cognitive assessment during ECT treatment is usually not comprehensive enough and is limited to bedside assessment. A more proactive approach to careful neuropsychological assessment and consideration of combined maintenance medication treatment after ECT are essential.

Depression, memory and electroconvulsive therapy

“…To conclude, several recent papers illustrate the essence of some of these questions. Although the Montreal Cognitive Assessment 12 is considered to be useful in monitoring cognitive function after ECT, 13 on the other hand, cognitive assessment after ECT is also presently thought to not be comprehensive enough, especially if limited to bedside testing only 9 . As with many of the questions surrounding the clinical practice and neuroscience of ECT, this is not an easy one to provide a definitive answer to.…”

“…Cognitive domains assessed generally include information processing, language functions, new learning and retention, construction, visual–spatial abilities and executive control functions, among several others. Kolar suggests that neuropsychological testing should be an integral part of ECT service provision 9 . In ECT services, testing will most likely focus on cognitive domains such as new learning and retention, as well as information processing.…”

Is stigma preventing knowledge translation and utilization of electroconvulsive therapy for depression?

“…Our meta-analysis was a review on the acute efficacy of ECT for depression. However, studies have supported the use of ECT as a potential maintenance treatment (5). Additionally, this same statement could be applied to any other treatment in our field (antidepressants, antipsychotics, mood stabilizers, among other medications).…”

Finding treatment-resistant depression in real-world data: How a data-driven approach compares with expert-based heuristics

“…Although the therapies included as proxies are recognized treatments for TRD,(Health Quality Kolar, 2017; Ontario, 2004) these therapies can also be used for the treatment of patients with severe depression and imminent risk of suicide, who may not have TRD. Furthermore, in clinical practice not all patients who have TRD receive these therapies.…”