[Clinical value of electroconvulsive therapy in treatment of depression]

The electroconvulsive therapy (ECT), which provokes a generalized epileptic seizure by an electrical stimulus, was first administered in 1938 and performed without anesthesia during thirty years. Nowadays, ECT is carried out using brief anesthesia (preferably methohexital) and skeletal muscle relaxation (succinylcholine) to avoid fearful complications like bone and muscle fractures. ECT is a safe treatment without absolute contraindications; the treatment risk corresponds to the risk of general anesthesia. ECT is indicated in depression, mania and schizophrenia. It plays an important role in the treatment of therapy resistant, severely ill patients with affective disorders, suicidal drive, delusional symptoms, vegetative dysregulation, inanition and catatonic symptoms. The response rate (remission or marked improvement) is about 70%. Usually ECT is performed 3 times per week, resulting in an ECT course with a total number of 6 to 12 single treatments. Within 2 or 3 weeks a substantial improvement can be expected. Further controlled studies are required with regard to antidepressive and/or antipsychotic continuation therapy after successful ECT course. Brief pulse stimulation, unilateral nondominant electrode placement and individual stimulus titration with respect to seizure threshold (EEG monitoring is required!) can minimize cognitive side effects. The apprehension that ECT could cause prolonged amnesia and structural brain damage has not been confirmed by the available scientific data. Modern brain imaging methods could elicit the until now unknown mode of action of ECT.