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Electroconvulsive therapy

What is electroconvulsive therapy (ECT)?

In ECT, a seizure is electrically induced after the patient has been given a short-acting anaesthetic and is asleep. Although viewed as controversial, ECT is a well established psychiatric treatment with good evidence to support its effective and safe use. ECT is most often used as a treatment for severe depression that has not responded adequately to other treatments as it has been shown to be more effective than antidepressant medication. It is also used as a first line treatment in depression where an urgent response is required as it works more quickly than medications. While most people with schizophrenia respond adequately to antipsychotic medication, some find it is not completely effective for all of their symptoms. ECT is currently used and is being further evaluated as an additional or alternative treatment for these people and is likely to be most effective for those who have depressive symptoms or have abrupt or recent onset of psychotic symptoms.

What is the evidence for ECT for people with schizophrenia?

Moderate to high quality evidence suggests a small, short-term benefit of ECT compared to sham ECT (placebo) for symptom improvement in people with schizophrenia who are or who are not being treated with antipsychotics. However, there was more memory impairment, headache, and EEG abnormalities with ECT.

Antipsychotics have been found to be more effective than ECT for global improvement, but not mental state, in people who are not necessarily resistant to antipsychotics. In people who are antipsychotic-resistant, moderate to high quality evidence finds a small effect of better mental state with ECT compared to standard care. Lower quality evidence also finds better functioning with ECT.

Moderate to low quality evidence suggests small to medium-sized benefits of ECT alone over psychoanalytic psychotherapy alone for mental state, behaviour, and social functioning six months after treatment, and for global improvement for two years after treatment.

September 2020

Last updated at: 3:26 am, 9th September 2020
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