An evidence-informed model for the modern practice of electroconvulsive therapy

After nearly a century of use and despite its many controversies, Electroconvulsive therapy (ECT) continues to be practiced and remains a viable treatment option in modern day psychiatry. Arriving on the scene in the 1930s when limited therapeutic options were available, ECT transformed psychiatry and created hope for the severely mentally ill. Unfortunately, it rapidly was seen as a panacea and was used for a wide variety of psychiatric disorders, many of which did not respond to it. The reputation of ECT suffered due to its inappropriate application and a negative public portrayal of the treatment by the anti-psychiatry movement and in Hollywood movies. The arrival of effective psychotropic medications created an exaggerated hope that ECT and other "invasive" procedures used to treat the severely mentally ill would be eliminated. However, ECT continues to be practiced - it stood the test of time because evidence suggests that there is no other treatment in psychiatry that approaches its efficacy in the management of certain psychiatric illnesses like severe depression. Modern day psychiatry is turning back to ECT when needing a quick response or faced with the history of medication resistance. However, ECT is not always practiced in accordance with available treatment guidelines and many health centers do not even have a policy for the safe and evidence-informed practice of ECT. In this chapter, we summarize the current evidence for the use of ECT in psychiatric illnesses, including benefits and risks, and outline a model of ECT service delivery informed by current published evidence and consensus guidelines.