Electroconvulsive Therapy in Germany: Development Over 8 Years With a Background of 4 Decades

The use of electroconvulsive therapy (ECT) in Europe varies broadly between the extremes of Sweden on one side and Italy on the other. Here, we document the frequency, practice and standards of ECT in Germany in 2016, compare it with a survey of 2008, and describe the historical background.

A questionnaire was sent electronically to the 396 psychiatric institutions in Germany. Repeated follow-up calls yielded a complete list of hospitals performing ECT and a high rate of detailed responses.

Forty-five percent (178/396) of the psychiatric hospitals performed ECT. Of those, 73.6% (131/178) completed the questionnaire. Based on 2 procedures, we estimated an incidence of 60,000 single treatments and 5700 patients treated, with a rate of 6.9 patients per 105 inhabitants. As in 2008, regional differences proved to be significant. The rate at which patients are referred to ECT hospitals from other clinics for the special purpose of ECT has increased since 2008. Maintenance treatments and the use of ketamine for anesthesia have gone up considerably while fewer hospitals offered outpatient treatments.

The application of ECT has increased markedly in the last 8 years, showing an exponential growth over the last 4 decades in Germany. The accessibility to the treatment seems to have improved and some global trends have been well received. Electroconvulsive therapy has become a modern, increasingly used medical intervention.