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?11-12
  • What role does anesthesia play in ECT?13-15
  • How should anesthetics be chosen?16
  • What are significant drug-drug interactions with ECT and how should they be managed?17-20
  • How do psychotropic medications effect 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

Reviewer 1: Trisha McHugh, PharmD
Reviewer 2: Austin Smith, PharmD, BCPP
2023-2024 AAPP Resident and New Practitioner Committee


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  12. Rose S, Dotters-Katz S, Kuller J. Electroconvulsive therapy in pregnancy: safety, best practices, and barriers to care. Obstet Gynecol Surv. 2020;75(3):199-203. [PubMed]
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  14. Folk JW, Kellner CH, Beale MD, Conroy JM, Duc TA. Anesthesia for electroconvulsive therapy: a review. J Ect. 2000;16(2):157-70. DOI: 10.1097/00124509-200006000-00007. PubMed PMID: 10868325.
  15. Soehle M, Bochem J, Kayser S, Weyerhäuser J, Valero R. Challenges and pitfalls in anesthesia for electroconvulsive therapy. Best Pract Res Clin Anaesthesiol. 2021;35(2):181-189. [PubMed]
  16. Wagner KJ, Möllenberg O, Rentrop M, Werner C, Kochs EF. Guide to anaesthetic selection for electroconvulsive therapy. CNS Drugs. 2005;19(9):745-58. DOI: 10.2165/00023210-200519090-00002. PubMed PMID: 16142990.
  17. Mehta V, Mueller PS, Gonzalez-Arriaza HL, Pankratz VS, Rummans TA. Safety of electroconvulsive therapy in patients receiving long-term warfarin therapy. Mayo Clin Proc. 2004;79(11):1396-401. DOI: 10.4065/79.11.1396. PubMed PMID: 15544018.
  18. Naguib M, Koorn R. Interactions between psychotropics, anaesthetics and electroconvulsive therapy: implications for drug choice and patient management. CNS Drugs. 2002;16(4):229-47. DOI: 10.2165/00023210-200216040-00003. PubMed PMID: 11945107.
  19. Patel RS, Bachu A, Youssef NA. Combination of lithium and electroconvulsive therapy (ECT) is associated with higher odds of delirium and cognitive problems in a large national sample across the United States. Brain Stimul. 2020;13(1):14-19. [PubMed]
  20. Zolezzi, M. Medication management during electroconvulsant therapy. Neuropsychiatr Dis Treat. 2016;12:931-9. [PubMed]
  21. Pisani F, Oteri G, Costa C, Di Raimondo G, Di Perri R. Effects of Psychotropic Drugs on Seizure Threshold. Drug Saf. 2002;25(2):91- 110. DOI: 10.2165/00002018-200225020-00004.
  22. Tang VM, Pasricha AN, Blumberger DM, et al. Should benzodiazepines and anticonvulsants be used during electroconvulsive therapy?: A case study and literature review. J ECT. 2017;33(4):237-42. [PubMed]
  23. Loo C, Simpson B, MacPherson R. Augmentation strategies in electroconvulsive therapy. J ECT. 2010; 26(3):202-7. [PubMed]
  24. Datto C, Rai AK, Ilivicky HJ, et al. Augmentation of seizure induction in electroconvulsive therapy: a clinical reappraisal. J ECT. 2002; 18(3):118-25. [PubMed]
  25. Anderson IM, Blamire A, Branton T, et al. Ketamine augmentation of electroconvulsive therapy to improve neuropsychological and clinical outcomes in depression (Ketamine-ECT): a multicentre, double-blind, randomised, parallel-group, superiority trial. Lancet Psychiatry. 2017;4(5):365-377. [PubMed]
  26. Kellner CH, Husain MM, Knapp RG, et al. Right unilateral ultrabrief pulse ECT in geriatric depression: phase 1 of the PRIDE study. Am J Psychiatry. 2016;173(11):1101-1109. [PubMed]
  27. Lisanby SH, McClintock SM, Alexopoulos G, et al. Neurocognitive effects of combined electroconvulsive therapy (ECT) and venlafaxine in geriatric depression: phase 1 of the PRIDE study. Am J Geriatr Psychiatry. 2020;28(3):304-316. [PubMed]
  28. Lisanby SH, McClintock SM, McCall WV et al. Longitudinal neurocognitive effects of combined electroconvulsive therapy (ECT) and pharmacotherapy in major depressive disorder in older adults: phase 2 of the PRIDE study. Am J Geriatr Psychiatry. 2022;30(1):15-28. [PubMed]
  29. Luccarelli J, McCoy TH Jr, Seiner SJ, Henry ME. Maintenance ECT is associated with sustained improvement in depression symptoms without adverse cognitive effects in a retrospective cohort of 100 patients each receiving 50 or more ECT treatments. J Affect Disord. 2020;271:109-114. [PubMed]
  30. Mankad MV and Weiner RD (2010). Anesthetics and Other Medications. In Mankad MV, Beyer JL, Weiner JL, Krystal AD. Clinical Manual of Electroconvulsive Therapy (pp. 81-93).ISBN: 1585622699, 978-1585622696 [Amazon Smile]
  31. Anesthesia Management for Electroconvulsive Therapy: Practical Techniques and Physiological Background 1st ed. 2016 Edition. [Amazon Smile]
  32. Handbook of ECT: A Guide to Electroconvulsive Therapy for Practitioners 1st Edition by Charles H. Kellner. [Amazon Smile]
  33. The Practice Of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging 2nd Edition by American Psychiatric Association. [Amazon Smile]