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October 18, 1985

Electroconvulsive Therapy

JAMA. 1985;254(15):2103-2108. doi:10.1001/jama.1985.03360150079028

Electroconvulsive therapy (ECT) is a treatment for severe mental illness in which a brief application of electric stimulus is used to produce a generalized seizure. In the United States in the 1940s and 1950s, the treatment was often administered to the most severely disturbed patients residing in large mental institutions. As often occurs with new therapies, ECT was used for a variety of disorders, frequently in high doses and for long periods. Many of these efforts proved ineffective, and some even harmful. Moreover, its use as a means of managing unruly patients, for whom other treatments were not then available, contributed to the perception of ECT as an abusive instrument of behavioral control for patients in mental institutions for the chronically ill. With the introduction of effective psychopharmacologic medications and the development of judicial and regulatory restrictions, the use of ECT has waned.

The treatment is now used primarily in general hospital psychiatric units and in psychiatric hospitals. A National Institute of Mental Health hospital survey estimated that 33,384 patients admitted to hospital psychiatric services during 1980 were treated with ECT, representing approximately 2.4% of all psychiatric admissions.

Although ECT has been in use for more than 45 years, there is continuing controversy concerning the mental disorders for which ECT is indicated, its efficacy in their treatment, the optimal methods of administration, possible complications, and the extent of its usage in various settings. These issues have contributed to concerns about the potential for misuse and abuse of ECT and to desires to ensure the protection of patients' rights. At the same time, there is concern that the curtailment of ECT use in response to public opinion and regulation may deprive certain patients of a potentially effective treatment.

In recent decades, researchers intensified efforts to establish the effectiveness of ECT and its indications, understand its mechanism of action, clarify the extent of adverse effects, and determine optimum treatment technique. Despite recent research effort yielding substantial information, permitting professional and public evaluation of the safety and efficacy of ECT, the investigation of ECT has not generally been in the mainstream of mental health research.

To help resolve questions surrounding these issues, the National Institutes of Health in conjunction with the National Institute of Mental Health convened a Consensus Development Conference on Electroconvulsive Therapy from June 10 to 12, 1985. For 1 1/2 days, experts in the field presented their findings, and an audience, including health professionals, former patients, and other interested persons, discussed the issues. A consensus panel representing psychiatry, psychology, neurology, psychopharmacology, epidemiology, law, and the general public considered the scientific evidence and agreed on answers to the following questions:

  1. What is the evidence that ECT is effective for patients with specific mental disorders?

  2. What are the risks and adverse effects of ECT?

  3. What factors should be considered by the physician and patient in determining if and when ECT would be an appropriate treatment?

  4. How should ECT be administered to maximize benefits and minimize risks?

  5. What are the directions for future research?