J Korean Neuropsychiatr Assoc.  2016 Feb;55(1):12-24. 10.4306/jknpa.2016.55.1.12.

Recent Trends for Optimization of Electroconvulsive Therapy

• Youn T
• Kang UG
• Kim YS
• Chung IW

• KMID: 2192904
• DOI: http://doi.org/10.4306/jknpa.2016.55.1.12

Abstract

Electroconvulsive therapy (ECT) is a safe and effective treatment not only for various mental disorders including depression, mania, and schizophrenia, but also for inadequacy and resistance to pharmacotherapy and the psychiatric emergences. The historical ups and downs of ECT treatment since its first introduction in 1938 were ended by the validation impacts of evidence-based medicine in the 1980s and by other clinical issues. Clinical research for the optimization of ECT to maximize therapeutic effects and to minimize adverse effects is ongoing to establish standardized procedures and educational programs through the ECT center. In addition, guidelines for ECT practices are also being developed for the clinical excellence of ECT practices in accordance with the recommendations of international organizations such as World Psychiatric Association and American Psychiatric Association. This article was prepared by reviews of the literature, direct observations of ECT practices abroad, and interviews with ECT experts around the world in order to enhance therapeutic effects with recently updated ECT practices under the belief that the most appropriate treatments should be provided to the patients in need.

Keyword

Electroconvulsive therapy; Optimization; Biological treatment

MeSH Terms

Bipolar Disorder
Depression
Drug Therapy
Electroconvulsive Therapy*
Evidence-Based Medicine
Humans
Mental Disorders
Schizophrenia

Reference

1. American Psychiatric Association. The practice of electroconvulsive therapy: recommendations for treatment, training, and privileging (a task force report of the American Psychiatric Association). 2nd ed. Washington, DC: American Psychiatric Association;2001.

2. Kim KT, Yoon DJ, Shin YH, Bahn GH, Yum TH. A view of Korean psychiatrists about electroconvulsive therapy. J Korean Neuropsychiatr Assoc. 2001; 40:1072–1089.

3. Xiang YT, Ungvari GS, Correll CU, Chiu HF, Lai KY, Wang CY, et al. Use of electroconvulsive therapy for Asian patients with schizophrenia (2001-2009): trends and correlates. Psychiatry Clin Neurosci. 2015; 69:489–496.

4. UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet. 2003; 361:799–808.

5. Pippard J. Audit of electroconvulsive treatment in two national health service regions. Br J Psychiatry. 1992; 160:621–637.

6. Chanpattana W, Sackeim HA. Electroconvulsive therapy in treatment-resistant schizophrenia: prediction of response and the nature of symptomatic improvement. J ECT. 2010; 26:289–298.

7. Fink M. Electroconvulsive therapy resurrected: its successes and promises after 75 years. Can J Psychiatry. 2011; 56:3–4.

8. Lee HY, Kang RH, Lee MS. Electroconvulsive therapy in major depressive disorder. Korean J Biol Psychiatry. 2008; 15:75–82.

9. National Institutes of Health. Electroconvulsive therapy. NIH Consens Statement. 1985; 5:1–23.

10. Pippard J, Ellam L. Electroconvulsive treatment in Great Britain. Br J Psychiatry. 1981; 139:563–568.

11. Holmberg G, Thesleff S. Succinyl-choline-iodide as a muscular relaxant in electroshock therapy. Am J Psychiatry. 1952; 108:842–846.

12. Dinwiddie SH, Spitz D. Resident education in electroconvulsive therapy. J ECT. 2010; 26:310–316.

13. Kellner CH. The FDA advisory panel on the reclassification of ECT devices. Psychiatric times [serial online] 2011 July 05. cited 2016 Feb 19. Available from: http://www.psychiatrictimes.com/electroconvulsive-therapy/fda-advisory-panel-reclassification-ect-devices.

14. Ottosson JO, Odeberg H. Evidence-based electroconvulsive therapy. Acta Psychiatr Scand. 2012; 125:177–184.

15. National Institute for Health and Clinical Excellence. Guidance on the use of electroconvulsive therapy. NICE technology appraisal guidance 59. London: NICE;2009.

16. National Institute for Health and Clinical Excellence. Depression in adults. NICE clinical guideline 90. London: NICE;2009.

17. New South Wales, Mental Health and Drug and Alcohol Office, NSW Department of Health. Guidelines: ECT minimum standards of practice in NSW. North Sydney: Mental Health and Drug and Alcohol Office, NSW Department of Health;2010.

18. O'Reardon JP, Cristancho MA, Cristancho P, Fontecha JF, Weiss D. Electroconvulsive therapy in a 96-year-old patient with severe aortic stenosis: a case report and review of the literature. J ECT. 2008; 24:96–98.

19. Leiknes KA, Jarosh-von Schweder L, Høie B. Contemporary use and practice of electroconvulsive therapy worldwide. Brain Behav. 2012; 2:283–344.

20. Sienaert P. What we have learned about electroconvulsive therapy and its relevance for the practising psychiatrist. Can J Psychiatry. 2011; 56:5–12.

21. Scott AIF. The ECT handbook: the third report of the Royal College of Psychiatrists' Special Committee on ECT. 2nd ed. London, UK: Royal College of Psychiatrists;2005.

22. Schweder LJ, Lydersen S, Wahlund B, Bergsholm P, Linaker OM. Electroconvulsive therapy in Norway: rates of use, clinical characteristics, diagnoses, and attitude. J ECT. 2011; 27:292–295.

23. Dombrovski AY, Mulsant BH, Haskett RF, Prudic J, Begley AE, Sackeim HA. Predictors of remission after electroconvulsive therapy in unipolar major depression. J Clin Psychiatry. 2005; 66:1043–1049.

24. Kalinowsky LB. Present status of electric shock therapy. Bull N Y Acad Med. 1949; 25:541–553.

25. Pawełczyk T, Kołodziej-Kowalska E, Pawełczyk A, Rabe-Jabłońska J. Augmentation of antipsychotics with electroconvulsive therapy in treatment-resistant schizophrenia patients with dominant negative symptoms: a pilot study of effectiveness. Neuropsychobiology. 2014; 70:158–164.

26. Payne NA, Prudic J. Electroconvulsive therapy: part I. A perspective on the evolution and current practice of ECT. J Psychiatr Pract. 2009; 15:346–368.

27. Casey DA. Electroconvulsive therapy in the neuroleptic malignant syndrome. Convuls Ther. 1987; 3:278–283.

28. Cline JS, Roos K. Treatment of status epilepticus with electroconvulsive therapy. J ECT. 2007; 23:30–32.

29. Girish K, Gill NS. Electroconvulsive therapy in lorazepam non-responsive catatonia. Indian J Psychiatry. 2003; 45:21–25.

30. Griesemer DA, Kellner CH, Beale MD, Smith GM. Electroconvulsive therapy for treatment of intractable seizures. Initial findings in two children. Neurology. 1997; 49:1389–1392.

31. Ozer F, Meral H, Aydin B, Hanoglu L, Aydemir T, Oral T. Electroconvulsive therapy in drug-induced psychiatric states and neuroleptic malignant syndrome. J ECT. 2005; 21:125–127.

32. Trollor JN, Sachdev PS. Electroconvulsive treatment of neuroleptic malignant syndrome: a review and report of cases. Aust N Z J Psychiatry. 1999; 33:650–659.

33. Usui C, Hatta K, Doi N, Kubo S, Kamigaichi R, Nakanishi A, et al. Improvements in both psychosis and motor signs in Parkinson's disease, and changes in regional cerebral blood flow after electroconvulsive therapy. Prog Neuropsychopharmacol Biol Psychiatry. 2011; 35:1704–1708.

34. van Waarde JA, Tuerlings JH, Verwey B, van der Mast RC. Electroconvulsive therapy for catatonia: treatment characteristics and outcomes in 27 patients. J ECT. 2010; 26:248–252.

35. Kim IG, Kim KH, Park JM, Lee SJ. A case of complete recovery of visual loss associated with electroconvulsive therapy. J Korean Ophthalmol Soc. 2010; 51:1543–1547.

36. Rabheru K. The use of electroconvulsive therapy in special patient populations. Can J Psychiatry. 2001; 46:710–719.

37. Peterchev AV, Rosa MA, Deng ZD, Prudic J, Lisanby SH. Electroconvulsive therapy stimulus parameters: rethinking dosage. J ECT. 2010; 26:159–174.

38. Näätänen R, Lehtokoski A, Lennes M, Cheour M, Huotilainen M, Iivonen A, et al. Language-specific phoneme representations revealed by electric and magnetic brain responses. Nature. 1997; 385:432–434.

39. Fleminger JJ, Bunce L. Investigation of cerebral dominance in 'left-handers' and 'right-handers' using unilateral electroconvulsive therapy. J Neurol Neurosurg Psychiatry. 1975; 38:541–545.

40. Dragovic M, Allet L, Janca A. Electroconvulsive therapy and determination of cerebral dominance. Ann Gen Hosp Psychiatry. 2004; 3:14.

41. Strachan JA. Electroconvulsive therapy - attitudes and practice in New Zealand. Psychiatr Bull. 2001; 25:467–470.

42. Trevino K, McClintock SM, Husain MM. A review of continuation electroconvulsive therapy: application, safety, and efficacy. J ECT. 2010; 26:186–195.

43. Swartz CM, Nelson AI. Rational electroconvulsive therapy electrode placement. Psychiatry (Edgmont). 2005; 2:37–43.

44. Andre L. Doctors of deception: what they don't want you to know about shock treatment. New Brunswick, NJ: Rutgers University Press;2009.

45. Breggin PR. Electroshock: its brain-disabling effects. New York: Springer Publishing Company;1979.

46. Remington G, Saha A, Chong SA, Shammi C. Augmentation strategies in clozapine-resistant schizophrenia. CNS Drugs. 2005; 19:843–872.

47. Williams L, Newton G, Roberts K, Finlayson S, Brabbins C. Clozapine-resistant schizophrenia: a positive approach. Br J Psychiatry. 2002; 181:184–187.

48. Schoeyen HK, Kessler U, Andreassen OA, Auestad BH, Bergsholm P, Malt UF, et al. Treatment-resistant bipolar depression: a randomized controlled trial of electroconvulsive therapy versus algorithm-based pharmacological treatment. Am J Psychiatry. 2015; 172:41–51.

49. Petrides G, Malur C, Braga RJ, Bailine SH, Schooler NR, Malhotra AK, et al. Electroconvulsive therapy augmentation in clozapine-resistant schizophrenia: a prospective, randomized study. Am J Psychiatry. 2015; 172:52–58.

50. Kim HS, Kim SH, Lee NY, Youn T, Kim YS, Chung IW. Effectiveness of electroconvulsive therapy qugmentation on clozapine-resistant schizophrenia. Psychiatry Investig. 2016; In press.

51. Sackeim HA, Prudic J, Fuller R, Keilp J, Lavori PW, Olfson M. The cognitive effects of electroconvulsive therapy in community settings. Neuropsychopharmacology. 2007; 32:244–254.

52. Kellner CH, Knapp R, Husain MM, Rasmussen K, Sampson S, Cullum M, et al. Bifrontal, bitemporal and right unilateral electrode placement in ECT: randomised trial. Br J Psychiatry. 2010; 196:226–234.

53. Sackeim HA, Prudic J, Devanand DP, Kiersky JE, Fitzsimons L, Moody BJ, et al. Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. N Engl J Med. 1993; 328:839–846.

54. Prudic J, Olfson M, Marcus SC, Fuller RB, Sackeim HA. Effectiveness of electroconvulsive therapy in community settings. Biol Psychiatry. 2004; 55:301–312.

55. Gálvez V, Hadzi-Pavlovic D, Smith D, Loo CK. Predictors of seizure threshold in right unilateral ultrabrief electroconvulsive therapy: role of concomitant medications and anaesthesia used. Brain Stimul. 2015; 8:486–492.

56. Sartorius A, Muñoz-Canales EM, Krumm B, Krier A, Andres FJ, Bender HJ, et al. ECT anesthesia: the lighter the better? Pharmacopsychiatry. 2006; 39:201–204.

57. Jelovac A, Kolshus E, McLoughlin DM. Relapse following successful electroconvulsive therapy for major depression: a meta-analysis. Neuropsychopharmacology. 2013; 38:2467–2474.

58. Shibasaki C, Takebayashi M, Fujita Y, Yamawaki S. Factors associated with the risk of relapse in schizophrenic patients after a response to electroconvulsive therapy: a retrospective study. Neuropsychiatr Dis Treat. 2015; 11:67–73.

59. Bourgon LN, Kellner CH. Relapse of depression after ECT: a review. J ECT. 2000; 16:19–31.

60. Sackeim HA, Haskett RF, Mulsant BH, Thase ME, Mann JJ, Pettinati HM, et al. Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial. JAMA. 2001; 285:1299–1307.

61. Martínez-Amorós E, Cardoner N, Gálvez V, Urretavizcaya M. Effectiveness and pattern of use of continuation and maintenance electroconvulsive therapy. Rev Psiquiatr Salud Ment. 2012; 5:241–253.

62. Elias A, Chathanchirayil SJ, Bhat R, Prudic J. Maintenance electroconvulsive therapy up to 12 years. J Affect Disord. 2014; 156:228–231.

63. Gangadhar BN, Thirthalli J. Frequency of electroconvulsive therapy sessions in a course. J ECT. 2010; 26:181–185.

64. Kerner N, Prudic J. Current electroconvulsive therapy practice and research in the geriatric population. Neuropsychiatry (London). 2014; 4:33–54.

65. Croarkin PE, McCaffrey P, McClintock SM, Rodez C, Husain MM. Electroconvulsive therapy in child and adolescent psychiatry. Curr Psychiatr Rev. 2009; 5:298–305.

66. Cohen D, Taieb O, Flament M, Benoit N, Chevret S, Corcos M, et al. Absence of cognitive impairment at long-term follow-up in adolescents treated with ECT for severe mood disorder. Am J Psychiatry. 2000; 157:460–462.

67. Ghaziuddin N, Walter G. Electroconvulsive therapy in children and adolescents. New York: Oxford University Press;2014.

68. Koo JW, Lee MS, Kim SH. Electroconvulsive therapy in one female with very early onset schizophrenia: a case report. Korean J Psychopharmacol. 2005; 16:416–420.

69. Miller LJ. Use of electroconvulsive therapy during pregnancy. Hosp Community Psychiatry. 1994; 45:444–450.

70. Leiknes KA, Cooke MJ, Jarosch-von Schweder L, Harboe I, Høie B. Electroconvulsive therapy during pregnancy: a systematic review of case studies. Health. 2015; 18:1–39.

71. Babu GN, Thippeswamy H, Chandra PS. Use of electroconvulsive therapy (ECT) in postpartum psychosis--a naturalistic prospective study. Arch Womens Ment Health. 2013; 16:247–251.

72. Avramov MN, Husain MM, White PF. The comparative effects of methohexital, propofol, and etomidate for electroconvulsive therapy. Anesth Analg. 1995; 81:596–602.

73. Song HI, Min KJ, Choi IG, Yoo TH. A clinical study on softening E.C.T. & comparison of propofol and pentothal as anaesthetic agents on seizure duration. J Korean Soc Biol Psychiatry. 1997; 4:259–264.

74. Jun GW, Yang HS, Lee YK, Seo HJ. Anesthetic efficacy of etomidate, propofol and thiopental sodium during electroconvulsive therapy. Anesth Pain Med. 2011; 6:32–36.

75. Geretsegger C, Nickel M, Judendorfer B, Rochowanski E, Novak E, Aichhorn W. Propofol and methohexital as anesthetic agents for electroconvulsive therapy: a randomized, double-blind comparison of electroconvulsive therapy seizure quality, therapeutic efficacy, and cognitive performance. J ECT. 2007; 23:239–243.

76. Rasmussen KG. Propofol for ECT anesthesia a review of the literature. J ECT. 2014; 30:210–215.

77. Bauer J, Hageman I, Dam H, Báez A, Bolwig T, Roed J, et al. Comparison of propofol and thiopental as anesthetic agents for electroconvulsive therapy: a randomized, blinded comparison of seizure duration, stimulus charge, clinical effect, and cognitive side effects. J ECT. 2009; 25:85–90.

78. Rasmussen KG, Kung S, Lapid MI, Oesterle TS, Geske JR, Nuttall GA, et al. A randomized comparison of ketamine versus methohexital anesthesia in electroconvulsive therapy. Psychiatry Res. 2014; 215:362–365.

79. Heo JS, Kim GH, Lee SM. Anesthesia for caffeine augmentation in electroconvulsive therapy: a case report. Korean J Anesthesiol. 2006; 50:236–239.

80. Sackeim HA, Prudic J, Devanand DP, Nobler MS, Lisanby SH, Peyser S, et al. A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities. Arch Gen Psychiatry. 2000; 57:425–434.

81. Choi YM, Jung SW, Kim YT, Kim HC. Clinical effectiveness of electroconvulsive therapy in a university hospital setting. J Korean Neuropsychiatr Assoc. 2015; 54:330–337.

82. Kellner CH, Tobias KG, Wiegand J. Electrode placement in electroconvulsive therapy (ECT): a review of the literature. J ECT. 2010; 26:175–180.

83. d'Elia G. Unilateral electroconvulsive therapy. Acta Psychiatr Scand Suppl. 1970; 215:1–98.

84. Bakewell CJ, Russo J, Tanner C, Avery DH, Neumaier JF. Comparison of clinical efficacy and side effects for bitemporal and bifrontal electrode placement in electroconvulsive therapy. J ECT. 2004; 20:145–153.

85. Devanand DP, Lisanby SH, Nobler MS, Sackeim HA. The relative efficiency of altering pulse frequency or train duration when determining seizure threshold. J ECT. 1998; 14:227–235.

86. Sackeim HA, Long J, Luber B, Moeller JR, Prohovnik I, Devanand DP, et al. Physical properties and quantification of the ECT stimulus: I. Basic principles. Convuls Ther. 1994; 10:93–123.

87. Boylan LS, Haskett RF, Mulsant BH, Greenberg RM, Prudic J, Spicknall K, et al. Determinants of seizure threshold in ECT: benzodiazepine use, anesthetic dosage, and other factors. J ECT. 2000; 16:3–18.

88. Seshadri M, Mazi-Kotwal NZ. Response predictors in ECT: a discussion about seizure threshold. BJMP. 2011; 4:a424.

89. Durand DM, Bikson M. Suppression and control of epileptiform activity by electrical stimulation: a review. Proc IEEE. 2001; 89:1065–1082.

90. Coffey CE, Lucke J, Weiner RD, Krystal AD, Aque M. Seizure threshold in electroconvulsive therapy: I. Initial seizure threshold. Biol Psychiatry. 1995; 37:713–720.

91. Abrams R. Electroconvulsive therapy. 4th ed. New York: Oxford University Press;2002.

92. Fink M. Electroconvulsive therapy: a guide for professionals and their patients. New York: Oxford University Press;2009.

93. Sackeim HA, Decina P, Kanzler M, Kerr B, Malitz S. Effects of electrode placement on the efficacy of titrated, low-dose ECT. Am J Psychiatry. 1987; 144:1449–1455.

94. Swartz CM. ECT dosing by the benchmark method. Ger J Psychiatry. 2002; 5:1–4.

95. Swartz CM, Michael N. Age-based seizure threshold determination. J ECT. 2013; 29:18–20.

96. Lee MB, Ahn JH, Lee C, Han OS, Kim CY. Guidelines for the adequate initial electric stimuli in bilateral ECT using MECTA device. Korean J Psychopharmacol. 1999; 10:138–142.

97. Yesavage JA, Berens ES. Multiple monitored electroconvulsive therapy in the elderly. J Am Geriatr Soc. 1980; 28:206–209.

98. Roemer RA, Dubin WR, Jaffe R, Lipschutz L, Sharon D. An efficacy study of single- versus double-seizure induction with ECT in major depression. J Clin Psychiatry. 1990; 51:473–478.

99. Mielke DH, Winstead DK, Goethe JW, Schwartz BD. Multiple-monitored electroconvulsive therapy: safety and efficacy in elderly depressed patients. J Am Geriatr Soc. 1984; 32:180–182.

100. Maletzky BM. Conventional and multiple-monitored electroconvulsive therapy. A comparison in major depressive episodes. J Nerv Ment Dis. 1986; 174:257–264.

101. Centers for Medicare and Medicaid Services. [homepage on the Internet]. Medicare national coverage determinations manual (chapter 1, part 2: sections 90-160.26). Baltimore: cited 2016 Feb 19. Available from: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/ncd103c1_part2.pdf.

102. Klysner R, Bjerg Bendsen B, Hansen MS. Transient serotonin toxicity evoked by combination of electroconvulsive therapy and fluoxetine. Case Rep Psychiatry. 2014; 2014:162502.

103. Okamoto N, Sakamoto K, Yamada M. Transient serotonin syndrome by concurrent use of electroconvulsive therapy and selective serotonin reuptake inhibitor: a case report and review of the literature. Case Rep Psychiatry. 2012; 2012:215214.

104. Conway CR, Nelson LA. The combined use of bupropion, lithium, and venlafaxine during ECT: a case of prolonged seizure activity. J ECT. 2001; 17:216–218.

105. Hill GE, Wong KC, Hodges MR. Potentiation of succinylcholine neuromuscular blockade by lithium carbonate. Anesthesiology. 1976; 44:439–442.

106. Sartorius A, Wolf J, Henn FA. Lithium and ECT--concurrent use still demands attention: three case reports. World J Biol Psychiatry. 2005; 6:121–124.

107. Weiner RD, Whanger AD, Erwin CW, Wilson WP. Prolonged confusional state and EEG seizure activity following concurrent ECT and lithium use. Am J Psychiatry. 1980; 137:1452–1453.

108. Small JG, Kellams JJ, Milstein V, Small IF. Complications with electroconvulsive treatment combined with lithium. Biol Psychiatry. 1980; 15:103–112.

109. Thirthalli J, Harish T, Gangadhar BN. A prospective comparative study of interaction between lithium and modified electroconvulsive therapy. World J Biol Psychiatry. 2011; 12:149–155.

110. Haskett RF, Loo C. Adjunctive psychotropic medications during electroconvulsive therapy in the treatment of depression, mania, and schizophrenia. J ECT. 2010; 26:196–201.

111. Song TH, Shim JC, Kong BG, Kang JW, Moon JJ, Kim SJ, et al. Electroconvulsive therapy for patients with treatment-resistant schizophrenia patients: a retrospective study. J Korean Neuropsychiatr Assoc. 2012; 51:271–276.

112. Tharyan P, Adams CE. Electroconvulsive therapy for schizophrenia. Cochrane Database Syst Rev. 2005; (2):CD000076.

113. Kupchik M, Spivak B, Mester R, Reznik I, Gonen N, Weizman A, et al. Combined electroconvulsive-clozapine therapy. Clin Neuropharmacol. 2000; 23:14–16.

114. Kim CE, Lee SY. The efficacy and safety of concurrent administration of clozapine and electroconvulsive therapy: a case report. Korean J Psychopharmacol. 2000; 11:73–77.

115. Naguib M, Koorn R. Interactions between psychotropics, anaesthetics and electroconvulsive therapy: implications for drug choice and patient management. CNS Drugs. 2002; 16:229–247.