[The practice of electroconvulsive therapy at Department of Psychiatry and Psychotherapy, Semmelweis University]

Electroconvulsive therapy (ECT) is a highly effective biological treatment in psychiatry with a history of nearly one hundred years. In contemporary clinical practice, its primary indications include treatment-resistant affec tive disorders, catatonia, and selected psychotic conditions. Although the overall use of ECT has declined internationally, with appropriate infrastructure and organization it remains a safe and effective intervention and can be delivered in an outpatient setting. The aim of this paper is to present the organizational, technical, and clinical changes implemented at the Department of Psychiatry and Psychotherapy, Semmelweis University since 2018, and to describe the development of the local ECT service based on a retrospective analysis of clinical data. Key developments included the acquisition of a new ECT device, the establishment of a dedicated ECT treatment unit, the formation of a permanent multidisciplinary ECT team, expansion of anesthesiology support, and the introduction of outpatient, continuation, and maintenance ECT protocols. In parallel, a marked shift occurred in the diagnostic distribution of treated patients toward affective disorders. Results demonstrate a substantial increase in both the number of treated patients and the total number of ECT sessions, particularly following the COVID-19 pandemic. More than 80% of patients received ECT for affective disorders, consistent with current international trends. Severe catatonia emerged as a key indication, along with the provision of ECT for psychiatric patients treated in intensive care settings, where rapid symptom reduction is critical and pharmacological options may be limited or contraindicated. Authors' experience suggests that a structured ECT service incorporating outpatient care, continuation and maintenance treatment, and integrated practical education can improve the safety, effectiveness and accessibility of ECT, while also contributing to the reduction of stigma associated with this therapeutic modality in contemporary psychiatric practice. Keywords: electroconvulsive therapy; ECT; depression; catatonia.