Changing patterns of electroconvulsive therapy use: results of a five-year survey

Despite its proven efficacy and safety, electroconvulsive therapy (ECT) continues to be a controversial treatment. Ongoing scrutiny is therefore particularly important. We reviewed 315 patients who received 3903 ECT treatments over a five year period, and found a gradual decline in the use of ECT, due mainly to a reduction in ECT for schizophrenic patients. Eighty percent of treatments were given with bilateral electrode placement, although we did find the incidence of adverse effects to be greater with bilateral ECT. Most patients concurrently received medications which raise the seizure threshold. The administration of ECT to patients unable or unwilling to give informed consent raises ethical and medicolegal issues. We found that such difficulties had arisen with at least 16% of patients.