Psychiatric Pharmacy Essentials: Medications and Electroconvulsive Therapy (ECT)

Electroconvulsive therapy (ECT) is a psychiatric treatment for severe mental illness (emphasis on bipolar disorder, depression, suicidality, and catatonia) that involves passing small electric currents through the brain to induce a brief seizure or convulsion. This is often saved for patients who have not responded or have had insufficient response to medications.

• Where does ECT play a role in the treatment of mental illness?^1-7
• What do current psychiatric guidelines recommend?^8-9
• What is the recommended frequency and duration of ECT?¹⁰
• What recommendations are available for ECT use in pregnancy?^11-13 
• What role does anesthesia play in ECT?^14-16
• How should anesthetics be chosen?¹⁷
• What are significant drug-drug interactions with ECT and how should they be managed?^{3, 18-20}
• How do psychotropic medications affect seizure threshold and how will it affect ECT?^21-22
• What are suggested augmentation strategies with ECT?^23-25
• What evidence is there for efficacy and safety of using ECT in depressed older adults?^26-28
• What is the long-term safety of maintenance ECT?²⁹
• What are recommended textbooks that may serve as good references regarding ECT?^30-33
• What special safety considerations and risk mitigation strategies should be considered when using ECT in patients with significant medical comorbidities (e.g., cardiovascular disease, neurologic conditions, neuromuscular disorders, pregnancy, or risk for musculoskeletal/vascular complications)?³⁴
• How do methylxanthines affect seizure threshold and seizure duration during ECT, and when should their use be considered?^35-37

Reviewer 1: Brooke Bernu, PharmD, BCPS, BCPP
Reviewer 2: Angeleki Zecopoulos, PharmD
2026-2027 AAPP Resident and New Practitioner Committee