Electroconvulsive therapy research in India: A scoping review

Electroconvulsive therapy (ECT), since its introduction, remains one of psychiatry's most effective treatments. India has contributed substantially to research across its clinical, technical, ethical, and sociocultural dimensions. Despite this extensive body of work, the evidence has remained scattered and heterogeneous, without a single comprehensive synthesis.

The present review sought to systematically summarize the scope of ECT research conducted in India.

Following PRISMA-ScR guidelines, a systematic search of major databases and Indian psychiatric journals was undertaken, and eligible studies were narratively synthesized.

A total of 270 articles were included. The findings demonstrate effectiveness of ECT in schizophrenia, depression, mania, and catatonia. Research on ECT parameters has refined understanding of stimulus dosing, seizure thresholds, pulse widths, and electrode placements, contributing to safer and more individualized treatment delivery. Literature on adverse effects indicates that most cognitive and noncognitive effects are transient and can be systematically monitored using structured tools. Anesthesia-related studies highlight agents that optimize seizure quality and cardiovascular stability, with propofol, etomidate, and ketamine offering distinct advantages. Adjuvants such as dexmedetomidine and esmolol effectively moderate sympathetic responses. Knowledge-attitude-practice studies reveal persistent knowledge gaps and media-driven stigma, although educational interventions improve perceptions. Legal and ethical discussions predominantly address challenges following the Mental Healthcare Act 2017. Additional literature addresses neurobiology, biomarkers, device development, service delivery trends, including COVID-19-related disruptions.

Overall, Indian ECT research is broad and methodologically diverse, yet important gaps remain, particularly regarding long-term outcomes, cost-effectiveness, qualitative perspectives, and ultrabrief pulse ECT. Addressing these gaps, enhancing awareness, and strengthening service capacity remain paramount.