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Despite Being Effective Electroconvulsive Therapy is Underused for Severe Depression

ow ECT works. Effects on brain neurotransmitters, such as serotonin, dopamine, and norepinephrine may be involved.

Several treatments are often needed to achieve a response to ECTalthough improvement may occur after the first session, patients typically receive six to twelve treatments. Dr. Taylor emphasizes, "For all patientsit should be stressed that ECT represents a treatment that will bring remission, not a cure." Many patients will need "maintenance" treatments over time, because the effects of ECT are temporary. Treatment can be repeated if the patient's depression relapses.

The article also updates key technical issues related to the performance of ECT, including different approaches to "dosing," electrode placement, medications, anesthesia, and patient evaluation and follow-up. "Although current wisdom has relegated ECT to a last treatment option in many cases, experience and emerging research have made it clear that ECT should be offered to patients as a viable option at all stages of their illness process," Dr. Taylor concludes.

An accompanying editorial by Dr. James N. Kimball of Wake Forest University Baptist Medical Center, Winston-Salem, N.C., echoes the call for physicians and patients to be open to the possibility of pursuing ECT for persistent depression and other disorders. "It is not right for everyone, but it is a treatment health professionals should consider in their therapeutic arsenal," Dr. Kimball writes. "[ECT] is one of the oldest treatments currently in modern psychiatry, but also one whose time has come."


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