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Electroconvulsive Therapy

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Electroconvulsive therapy (ECT), or shock therapy, remains a critical biomedical intervention for severe, treatment-resistant depression. While its origins can be traced back to Hippocrates' observations that malaria-induced convulsions alleviated mental illness, modern ECT has evolved significantly from its earlier, more primitive applications. First introduced in 1938 by Ugo Cerletti and his colleagues, ECT involves inducing controlled seizures using electrical currents. In its early...
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  11. Electroconvulsive Therapy In The United States: A 2022 Survey Of Practice.

Electroconvulsive Therapy in the United States: A 2022 Survey of Practice.

Rachel Noorani1, Paul Rohde2, Elyssa Feuer3

  • 1From the University of Maryland, College Park, College of Behavioral and Social Sciences, College Park, MD.

The Journal of ECT
|February 5, 2024

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View abstract on PubMed

Summary
This summary is machine-generated.

This survey of US electroconvulsive therapy (ECT) practice reveals changes over time, with a need for more female and Black or African American providers. Current practices favor right unilateral placement and seizure threshold titration.

Area of Science:

  • Neuroscience
  • Psychiatry
  • Health Services Research

Background:

  • Electroconvulsive therapy (ECT) remains a vital treatment for severe mental illness.
  • Understanding current ECT practice patterns in the US is crucial for quality improvement and future research.
  • Previous nationwide surveys of ECT practice are scarce, with the last one conducted nearly 40 years ago.

Purpose of the Study:

  • To describe the current landscape of electroconvulsive therapy (ECT) practice across the United States.
  • To identify shifts and trends in ECT procedures and provider demographics over time.
  • To provide data that can inform ongoing discussions and policy regarding ECT practice.

Main Methods:

  • An anonymous online survey was distributed to ECT providers nationwide via SurveyMonkey from January to June 2022.

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  • Provider invitations were sourced from Medicare databases, PubMed searches, and professional listservs.
  • Data were collected from 74 US practice sites, with responses aggregated for analysis of frequency, comments, and comparative data.

    • Main Results:

    • Responses came from 74 US practice sites, representing 283 providers, primarily from academic medical centers.
    • Significant disparities were noted in provider demographics, with lower proportions of female (29%) and Black or African American (1%) providers compared to patient populations.
    • Common practices included a median of 10 treatments for major depressive episodes, right unilateral (66%) electrode placement, and seizure threshold titration for dosing. Quantitative outcome measures for depressive symptoms (89%) and cognitive effects (84%) were widely utilized.

    Conclusions:

    • This study represents the first comprehensive national survey of ECT practice in almost four decades.
    • Findings highlight significant changes in practice and underscore the urgent need to enhance diversity, particularly increasing the representation of female and Black or African American ECT providers.
    • Establishing a robust network of ECT sites is recommended to facilitate regular nationwide data collection and monitoring.