Electroconvulsive therapy research in India: A scoping review

Area of Science:

• Psychiatry
• Neurology
• Clinical Research

Background:

• Electroconvulsive therapy (ECT) is a highly effective psychiatric treatment.
• India has a significant body of research on ECT's clinical, technical, ethical, and sociocultural aspects.
• Existing evidence on ECT in India is scattered, necessitating a comprehensive synthesis.

Purpose of the Study:

• To systematically review and synthesize the scope of electroconvulsive therapy (ECT) research conducted in India.
• To provide a unified overview of ECT research findings from India.

Main Methods:

• Systematic literature search following PRISMA-ScR guidelines.
• Inclusion of studies from major databases and Indian psychiatric journals.
• Narrative synthesis of eligible research articles.

Main Results:

• 270 articles were synthesized, demonstrating ECT's efficacy in schizophrenia, depression, mania, and catatonia.
• Research has refined ECT parameters (dosing, pulse width, electrode placement) for safer, individualized treatment.
• Studies on adverse effects show transient cognitive/noncognitive effects, manageable with structured tools.
• Anesthesia research highlights agents like propofol, etomidate, and ketamine for seizure quality and stability.
• Knowledge-attitude-practice studies indicate persistent gaps and stigma, but educational interventions show promise.
• Legal/ethical discussions focus on challenges post-Mental Healthcare Act 2017; other research covers neurobiology, biomarkers, devices, and service delivery.

Conclusions:

• Indian ECT research is extensive and diverse, covering multiple dimensions of the treatment.
• Key research gaps persist, including long-term outcomes, cost-effectiveness, qualitative insights, and ultrabrief pulse ECT.
• Addressing these gaps, increasing awareness, and enhancing service capacity are crucial for advancing ECT in India.