Clinical Guidance: ECT in Treatment-Resistant Depression
Electroconvulsive therapy (ECT) is often effective for severely depressed patients who have not responded to multiple medication trials or who are at imminent risk of suicide or other acute clinical condition. Kellner et al. (CME, p. 1238) highlight the safety and efficacy of ECT while stressing the importance of the pre-ECT medical evaluation and consent process. A common strategy is to start with right unilateral ECT, which produces less retrograde amnesia, and if it is ineffective, switch to bilateral electrode placement. Antidepressants may be continued during ECT and may augment the response. Psychotic or other severe symptoms do not ordinarily affect the capacity to provide fully informed consent, but a family member can often corroborate the patient’s history, help the patient understand information about ECT, and care for the patient during treatment. ECT practitioners should know the local legal requirements, which vary by state and are more complex for children and adolescents.