Electroconvulsive therapy in general hospital psychiatry: a focus on new indications and technologies

This paper documents the recent dramatic shift towards the delivery of psychiatric services in the general hospital setting and outlines the increasing number of special indications for electroconvulsive therapy (ECT). These include: delusional depression; depressions which are not responsive to antidepressants; affective illness in geriatric populations, depression, mania or schizophrenia in patients who cannot tolerate medication side effects, and drug-refractory Parkinson's disease. Such technological advances as nondominant unilateral placement of electrodes, brief pulse electrical stimulation, and simultaneous ictal monitoring of EEG and EKG have increased the safety while reducing the side effects of the procedure. In that comparative studies show ECT to have safety and efficacy superior to antidepressant agents in the treatment of severe depressive illness, the author encourages physicians to consider this treatment which is becoming increasingly available through our general hospital services.