Guidance on the use of electroconvulsive therapy

  • Technology appraisal guidance
  • TA59
  • Published: 
  • Last updated: 

Scope: Electroconvulsive therapy (ECT) for depressive illness, schizophrenia, and mania

Objective: to establish the clinical and cost effectiveness of ECT for depressive illness, schizophrenia, catatonia and mania, and to provide guidance to the NHS in England and Wales.1

Background and Technology: ECT has been available for use since the 1930s. The therapy involves the passage of an electric current through a person's brain while they are under a general anaesthetic and have been given a muscle relaxant. This normally produces a convulsion.

A course of ECT usually consists of six to twelve treatments given twice a week. ECT is indicated for severely depressed patients, but is also has a role in the management of those with schizophrenia, mania and catatonia, often when drug therapy has proved ineffective or is not suitable.

In the period January to March 1999, there were approximately 16 500 administrations of ECT in England, given to 2 800 people, of whom approximately 68% were female.2 There are wide variations in its use between regions, hospitals and psychiatrists 3.

Intervention

Electroconvulsive therapy

Population
  • Individuals with depressive illness, schizophrenia, catatonia and mania
  • To include use of ECT in older people, young people and children
Current standard treatments (comparators)

ECT is currently the standard treatment for a specific group of people. The appraisal will consider its use alongside or in comparison to any appropriate pharmacological or psychological treatment for that same group.
Other considerations

The scope of this appraisal will include consideration of the:

  • ECT stimulus parameters (e.g. dosage, frequency, number of treatments, electrode placement)
  • general medical fitness of the person to undergo ECT treatment.
  • associated risks and side-effects to include suicide
  • duration of effect
  • use of maintenance ECT
  • impact of concomitant therapy on outcomes
  • patient acceptability and choice and how these may effect outcomes
  • additional infrastructure and training required for the optimal delivery of ECT therapy.
  • use as emergency therapy
  • setting in which therapy is administered
  • impact of technique on effectiveness

Although issues around consent to treatment fall outside the remit of this appraisal, if the evidence allows, the impact of compulsory treatment on effectiveness will be considered.

Again, if the evidence allows, the appraisal will attempt to identify people for whom the treatment is particularly effective or suitable and those for whom it is not, or for whom there are particular contraindications. This will include consideration of clinical features, age, sex and ethnicity and its use in pregnant women.

1 The Department of Health remit to the Institute is "To advise on the clinical and cost-effectiveness of ECT in comparison with other conventional treatments in depression, schizophrenia, mania and catatonia, taking particular account of safety and patient acceptability; and to advise on patient groups for whom it may be particularly suitable or unsuitable."

2 Source: Electro Convulsive Therapy: survey covering the period January 1999 to March 1999, England. Statistical Bulletin 1999/22, Dept. of Health

3 Salford Community Health Council. The Salford Report. Electro-convulsive Therapy, its use and effects. April 1998.

This page was last updated: 30 March 2010