In ECT, a seizure is electrically induced after the patient has been given a short-acting anesthetic 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. It is also used as a first line treatment in depression where an urgent response is required as it works more quickly than medications. ECT’s efficacy and safety are affected by a number of factors such as where electrodes are placed, the frequency of treatment, the degree to which the stimulus dose exceeds the seizure threshold and the dose and duration of concurrent medication.

What is the evidence for ECT for people with bipolar disorder?

High quality evidence suggests a small effect of greater response to ECT treatment in people with bipolar depression compared to people with major depression (77% vs. 74% responded). Moderate to high quality evidence suggests fewer number of sessions are required for bipolar depression than for major depression. There were no differences in remission rates between these groups.

High quality evidence suggests longer duration of depressive episode and non-response to medication are associated with medium-sized effects of poorer response to ECT treatment. Moderate quality evidence suggests comorbid psychotic features may be associated with a small effect of poorer response to ECT treatment, and increasing age may be associated with a small effect of better response to ECT treatment.

November 2021

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