Restrictive ECT use not warranted

[ectsurvivor]

Again - you may be surprised.
Guidelines for Canada, USA, UK, France and the Netherlands all recommend ECT as treatment of first choice in certain circumstances.
The Canadian Psychiatric Association position paper for example:

"Although ECT is frequently used as a second line treatment after psychotropic medications have failed, the use of ECT need not be restricted to this setting. Consideration of some of the factors noted above may lead the psychiatrist to offer ECT as a primary treatment modality."

This paper actually dates from 1992, but the same recommendations were made more recently in a 2001 editorial in the Canadian Journal of Psychiatry and in the recent AETIS guidelines: ECT as second-line treatment when drugs haven't worked, or as treatment of first choice for patients presenting with a high risk of suicide or psychic suffering/physical deterioration.

In practice, I imagine most people receive drugs before ECT. One recent survey in the UK, for example, found that only about 3 per cent of ECT patients had not been treated with drugs.

 

[David Baxter PhD]

Guidelines for Canada, USA, UK, France and the Netherlands all recommend ECT as treatment of first choice in certain circumstances.

The Canadian Psychiatric Association position paper for example:

"Although ECT is frequently used as a second line treatment after psychotropic medications have failed, the use of ECT need not be restricted to this setting. Consideration of some of the factors noted above may lead the psychiatrist to offer ECT as a primary treatment modality."

This paper actually dates from 1992, but the same recommendations were made more recently in a 2001 editorial in the Canadian Journal of Psychiatry and in the recent AETIS guidelines: ECT as second-line treatment when drugs haven't worked, or as treatment of first choice for patients presenting with a high risk of suicide or psychic suffering/physical deterioration.

In practice, I imagine most people receive drugs before ECT. One recent survey in the UK, for example, found that only about 3 per cent of ECT patients had not been treated with drugs.

Okay -- I concede that there may be certain specific circumstances in which one might go directly to ECT, especially in view of the fact that any medication will take some time to be beneficial -- with a severely depressed and actively suicidal patient, the doctor might well decide there isn't sufficient time to wait for an SSRI to "kick in".

I must say I'm surprised to see that the cited 3% rate is as high as it is -- I'm not disputing it, just surprised.