Review Article

Electroconvulsive Therapy: A Review of History, Patient Selection, Technique, and Medication Management

Authors: Stephen Taylor, MD


Electroconvulsive therapy (ECT) is a safe and effective treatment for severe and persistent depression, bipolar disorder and schizophrenia. Though ECT is now over 60 years old, it remains an underutilized treatment today. History, patient selection, safety, and characteristics of the treatment stimulus, technique, and medications used in ECT are reviewed. Dosing strategies, as pertaining to seizure threshold, will be considered. Mechanisms of action, especially with regard to serotonin, norepinephrine, and dopamine receptor expression will be discussed.

Key Points

* Electroconvulsive therapy (ECT) has been shown to be a highly effective, safe, and even life-saving treatment for persistent and severe depression, bipolar disorder and schizophrenia.

* ECT is safe for patients with comorbid medical conditions, as modern anesthesia techniques and medications have greatly reduced the morbidity and mortality of ECT.

* Experience and emerging research have made it clear that ECT should be offered to patients as a viable treatment option at all stages of their illness process.

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