Electroconvulsive therapy in the Nordic countries, 1977-1987

Area of Science:

• Psychiatry
• Neurology
• Clinical Research

Background:

• Electroconvulsive therapy (ECT) practices and indications have evolved.
• Understanding trends in ECT application is crucial for clinical practice and patient care.

Purpose of the Study:

• To compare the indications and methods of electroconvulsive therapy (ECT) in Nordic psychiatric departments between 1977 and 1987.
• To identify changes in the use of unilateral versus bilateral ECT over a decade.

Main Methods:

• A questionnaire survey was distributed to all psychiatric departments in Sweden, Norway, Denmark, Finland, and Iceland in 1977 and repeated in 1987.
• Data from the 1987 survey were compared with 1977 responses.
• Danish ECT data were further compared with historical inquiry results.

Main Results:

• A significant increase in the use of exclusively unilateral (U) and both unilateral and bilateral (UB) ECT was observed, with a drastic decrease in exclusively bilateral (B) treatment.
• ECT remained a primary treatment for endogenous depression in nearly all Nordic departments.
• Indications for mania and manic-depressive mixed states showed stability or increase, while use in schizophrenia and reactive psychosis generally decreased, though remaining in use in about half of departments.

Conclusions:

• The study highlights a clear shift towards unilateral ECT across Nordic countries.
• While core indications like endogenous depression persisted, ECT's role in other conditions like schizophrenia and reactive psychosis showed nuanced changes.
• ECT use in acute delirium increased during the study period.