ECT on a world map - a narrative review of the use of electroconvulsive therapy and its frequency in the world

Abstract

Introduction: Since implementation, electroconvulsive therapy has remained very effective treatment in psychiatry. The aim of this study is to present the differences in its use in medical practice around the world. The range of diseases in which ECT is most commonly used and the frequency of its use in different countries were compared with special attention to the differences between highly and poorly developed countries. Material and method: Review of literature by searching PubMed and Google Scholar databases using the keywords: indications of ECT, frequency of ECT use for papers published from 1991 to 2021. Results: Among the diseases for which electroconvulsive therapy is used worldwide, major depression dominates, while in Asia and Africa this therapy is used in schizophrenia. In Latin America it is used primarily for schizophrenia and bipolar disorder. In Poland, it is used for depression, bipolar disorder, and fewer for schizophrenia. The highest rate of people treated with therapy per 100,000 population is found in countries such as the USA (51), Canada (23.2-25.6), Australia (37.85), Sweden (41), Finland (23), Slovakia (29.2), Estonia (27.8) and Belgium (47). Conclusions: There is a relationship between the range of diseases most frequently treated with ECT, the frequency of use and the level of country development. In the high developed countries, ECT is used mainly in major depression, in less developed countries more frequent treatment of schizophrenia may be determined by the high cost of medications and limited availability of hospital beds. The highest rates of use of this therapy are found in more developed countries.

Availability of Electroconvulsive Therapy in Public Health Services in the Last Decade in Brazil

“…Australia (37.85), Estonia (27.8), and Western European countries such as Belgium (47) and the United Kingdom (37) are among the countries with the highest indices. 13 In the present study, we estimated a rate of 1.92 patients treated with ECT per 100,000 inhabitants in Brazil, which is lower than that in Thailand (11.15), 12 Singapore (10.9), 12 Spain (6.1), 13 France (6), 16 Switzerland (4.8), 13 South Africa (2.2), 17 and Ukraine (2.0). 10 It surpasses only Poland (1.3) 18 and Latvia (0.45).…”

“…In the rest of the country, the number of sessions ranged from 1000 to 2000 sessions. 13 By 2022, the country's population was 3.4 million. In Brazil, in 2022, we estimated 13,386 ECT sessions annually, with a population of approximately 203 million people.…”

“…It is mandatory to promote national mental health policies that encourage ECT as a treatment option for patients with serious mental disorders and to develop a national database on ECT services to better understand the application of treatment throughout the national territory. Rate of people treated with ECT per 100,000 population in different countries, 13 including Brazil.…”

“…Although there is variation in the use of ECT on a global scale, it is possible to highlight data on the use of ECT in the countries of North America and the Nordics. The United States leads the frequency of ECT use with 51 people per 100,000 individuals, followed by Canada (23.2–25.6) 13 . Countries such as Sweden (41), 14 Denmark (36), 13 Norway (24), 13 and Finland (23) 15 also have a significantly high frequency of treatment.…”

“…FIGURE 2. Rate of people treated with ECT per 100,000 population in different countries,13 including Brazil.…”