Electroconvulsive therapy consultation: an update

In the past, a pre-electroconvulsive therapy (ECT) psychiatric evaluation focused on the question, "Does the patient have an ECT-responsive condition?" Technological advances, a broadening experience base with psychiatric patients with concomitant severe medical illness, and advances in ECT technique have led to the need for a more extensive pre-ECT assessment of the patient's psychiatric and medical status, including concomitant medications. A specific "ECT consultation" has evolved that builds on the basic components of the standard psychiatric consultation and extends to recommendations designed to maximize the safety and efficacy of ECT for each individual patient. This article briefly reviews the key components of the ECT consultation and provides an extensive update on important considerations in the use of combined ECT and psychotropic medications.