Which is better SRM or Graphic Era

Brain stimulation procedures, electroconvulsive therapy

Psychiatry, psychosomatics, psychotherapy pp 1-23 | Cite as

  • Thomas. C. Baghai
  • Siegfried Kasper
Living reference work entry

Later version available View entry history

First Online:
Part of the Springer Reference Medicine book series (SRM)


Electroconvulsive Therapy (ECT) is a non-pharmacological biological treatment method that is extremely effective. a. in depressive disorders, but also in diseases from the schizophrenic group of forms, could be well documented in a large number of controlled studies. This applies to both acute treatment and maintenance therapy to prevent relapse. The safety and tolerability of ECT have been steadily improved through extensive modifications to the stimulation technique and extensive advances in anesthesiology. Thus, v. a. In recent years, many contraindications have largely been put into perspective, so that safe treatment can now also be offered to patients with increased somatic risks. This chapter describes the historical development of ECT, investigations into mechanisms of action, the indication, contraindications and risks as well as the clinical implementation of treatment in the context of acute treatment and prevention of recurrences. ECT is therefore still an important therapy option that v. a. seriously ill patients who are affected by other forms of treatment such as For example, if intensive combined pharmacotherapy and psychotherapy have not experienced sufficient improvement, this should not be withheld.

This is a preview of subscription content, log in to check access.


  1. Aarre TF, Bugge P (2002) ECT for patients taking lamotrigine. Eur Psychiat 17 (Suppl 1): 135CrossRefGoogle Scholar
  2. Abbasinazari M, Adib-Eshgh L, Rostami A, Beyraghi N, Dabir S, Jafari R (2015) Memantine in the prevention or alleviation of electroconvulsive therapy induces cognitive disorders: a placebo controlled trial. Asian J Psychiat 15: 5-9 CrossRefGoogle Scholar
  3. Abbott CC, Jones T, Lemke NT, Gallegos P, McClintock SM, Mayer AR, Bustillo J, Calhoun VD (2014) Hippocampal structural and functional changes associated with electroconvulsive therapy response. Transl Psychiatry 4, e483PubMedPubMedCentralCrossRefGoogle Scholar
  4. Abrams R (1982) ECT and tricyclic antidepressants in the treatment of endogenous depression. Psychopharmacol Bull 18: 73-75 PubMedGoogle Scholar
  5. Abrams R (1997a) Electroconvulsive therapy. Oxford University Press, New York / OxfordGoogle Scholar
  6. Abrams R (1997b) The mortality rate with ECT. Convuls Ther 13: 125-127PubMedGoogle Scholar
  7. Abrams R (2002) Electroconvulsive therapy. Oxford University Press, New York / OxfordGoogle Scholar
  8. Abrams R, Taylor MA (1974) Unipolar and bipolar depressive illness. Phenomenology and response to electroconvulsive therapy. Arch Gen Psychiatry 30: 320-321PubMedCrossRefGoogle Scholar
  9. Abrams R, Swartz CM, Vedak C (1991) Antidepressant effects of high-dose right unilateral electroconvulsive therapy. Arch Gen Psychiatry 48: 746-748 PubMedCrossRefGoogle Scholar
  10. Adams DA, Kellner CH, Aloysi AS, Majeske MF, Liebman LS, Ahle GM, Bryson EO (2014) Case report: transient left bundle branch block associated with ECT. Int J Psychiatry Med 48: 147-153 PubMedCrossRefGoogle Scholar
  11. Agarkar S, Hurt S, Lisanby S, Young RC (2012) ECT use in unipolar and bipolar depression. J ECT 28: e39 – e40PubMedPubMedCentralCrossRefGoogle Scholar
  12. Agelink MW, Andrich J, Postert T, Wurzinger U, Zeit T, Klotz P, Przuntek H (2001) Relation between electroconvulsive therapy, cognitive side effects, neuron specific enolase, and protein S-100. J Neurol Neurosurg Psychiatry 71: 394-396PubMedPubMedCentralCrossRefGoogle Scholar
  13. Alpak G, Ercan S, Alici H, Bulbul F, Altunbas G, Alici D, Saricicek V, Davutoglu V (2014) Influence of recurrent electroconvulsive therapy on cardiac function. Med Princ Pract 23: 225-228PubMedCrossRefGoogle Scholar
  14. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (DSM-5). Washington, DCGoogle Scholar
  15. American Psychiatric Association Committee on Electroconvulsive Therapy, Weiner RD, Coffey CE, Folk J, Fochtmann LJ, Greenberg RM, Isenberg KE, Kellner CH, Sackeim HA, Moench LM (2001) The practice of electroconvulsive therapy. American Psychiatric Association, Washington, DCGoogle Scholar
  16. Anastasian ZH, Khan N, Heyer EJ, Berman MF, Ornstein E, Prudic J, Brady JE, Berman JA (2014) Effect of atropine dose on heart rate during electroconvulsive therapy. J ECT 30: 298-302PubMedCrossRefGoogle Scholar
  17. Andrade C, Gangadhar BN, Channabasavanna SM (1987) Mania associated with electroconvulsive therapy. J Clin Psychiatry 48: 303-304 PubMedGoogle Scholar
  18. Angst J, Angst K, Baruffol I, Meinherz-Surbeck R (1992) ECT-induced and drug-induced hypomania. Convuls Ther 8: 179-185 PubMedGoogle Scholar
  19. Aten JJ, Oudega M, van EE, Stek ML, van Waarde JA (2015) Repeated dose titration versus age-based method in electroconvulsive therapy: a pilot study. Eur Arch Psychiatry Clin Neurosci 265: 351-356Google Scholar
  20. Atiku L, Gorst-Unsworth C, Khan BU, Huq F, Gordon J (2015) Improving relapse prevention after successful electroconvulsive therapy for patients with severe depression: completed audit cycle involving 102 full electroconvulsive therapy courses in West Sussex, United Kingdom. J ECT 31: 34-36 PubMedCrossRefGoogle Scholar
  21. Avery D, Lubrano A (1979) Depression treated with imipramine and ECT: the DeCarolis study reconsidered. Am J Psychiatry 136: 559-562 PubMedGoogle Scholar
  22. Ayhan Y, Akbulut BB, Karahan S, Gecmez G, Oz G, Gurel SC, Basar K (2015) Etomidate is associated with longer seizure duration, lower stimulus intensity, and lower number of failed trials in electroconvulsive therapy compared with thiopental. J ECT 31: 26-30 PublicMedCrossRefGoogle Scholar
  23. Baghai TC, Möller HJ (2008) Electroconvulsive therapy and its different indications. Dialogues Clin Neurosci 10: 105-117PubMedPubMedCentralGoogle Scholar
  24. Baghai TC, Frey R, Kasper S, Möller H-J (2004a) ElektrokonvulsstherapieWien. Springer, New YorkCrossRefGoogle Scholar
  25. Baghai TC, Frey R, Kasper S, Möller H-J (2004b) Electroconvulsion Therapy - Clinical and Scientific Aspects. Springer, ViennaGoogle Scholar
  26. Baghai TC, Marcuse A, Moller HJ, Rupprecht R (2004c) Electroconvulsive therapy at the Department of Psychiatry and Psychotherapy, University of Munich Development during the years 1995–2002. NeurologistGoogle Scholar
  27. Baghai TC, Eser D, Schüle C, Nothdurfter C, Möller H-J, Rupprecht R (2005) Electroconvulsion therapy for depressive disorders. J Neurol Neurosurgery Psychiatr 4 (2005): 20–28Google Scholar
  28. Baghai TC, Marcuse A, Brosch M, Schule C, Eser D, Nothdurfter C, Steng Y, Noack I, Pietschmann K, Moller HJ, Rupprecht R (2006) The influence of concomitant antidepressant medication on safety, tolerability and clinical effectiveness of electroconvulsive therapy. World J Biol Psychiatry 7: 82-90PubMedCrossRefGoogle Scholar
  29. Bailine SH, Rifkin A, Kayne E, Selzer JA, Vital-Herne J, Blieka M, Pollack S (2000) Comparison of bifrontal and bitemporal ECT for major depression. Am J Psychiatry 157: 121-123PubMedCrossRefGoogle Scholar
  30. Bailine S, Fink M, Knapp R, Petrides G, Husain MM, Rasmussen K, Sampson S, Mueller M, McClintock SM, Tobias KG, Kellner CH (2010) Electroconvulsive therapy is equally effective in unipolar and bipolar depression. Acta Psychiatr Scand 121: 431-436PubMedCrossRefGoogle Scholar
  31. Bannour S, Bouhlel S, Krir MW, Amamou B, Ben NS, El KY, Ben Hadj AB (2014) Combination of maintenance electroconvulsive therapy and clozapine in treating a patient with refractory schizophrenia. J ECT 30: e29 – e30PubMedCrossRefGoogle Scholar
  32. Bica BE, Moro AL, Hax V, Nicol NA, Campos GS, Rivera LM, da Costa AF, Xavier RM, Monticielo OA (2015) Electroconvulsive therapy as a treatment for refractory neuropsychiatric lupus with catatonia: three case studies and literature review. Lupus 12: 1327-31Google Scholar
  33. Birkenhager TK, Pluijms EM, Lucius SA (2003) ECT response in delusional versus non-delusional depressed inpatients. J Affect Disord 74: 191-195 PubMedCrossRefGoogle Scholar
  34. Bjolseth TM, Engedal K, Benth JS, Dybedal GS, Gaarden TL, Tanum L (2015a) Baseline cognitive function does not predict the treatment outcome of electroconvulsive therapy (ECT) in late-life depression. J Affect Disord 185: 67-75 PubMedCrossRefGoogle Scholar
  35. Bjolseth TM, Engedal K, Benth JS, Dybedal GS, Gaarden TL, Tanum L (2015b) Clinical efficacy of formula-based bifrontal versus right unilateral electroconvulsive therapy (ECT) in the treatment of major depression among elderly patients: a pragmatic, randomized, assessor-blinded, controlled trial. J Affect Disord 175: 8-17 PubMedCrossRefGoogle Scholar
  36. Black DW, Winokur G, Nasrallah A (1986) ECT in unipolar and bipolar disorders: a naturalistic evaluation of 460 patients. Convuls Ther 2: 231-237PubMedGoogle Scholar
  37. Bolwig TG, Povlsen UJ (2004) Status epilepticus and ECT: a reply to Dr. Finch. J ECT 20: 274-275PubMedCrossRefGoogle Scholar
  38. Brodaty H, Berle D, Hickie I, Mason C (2001) "Side effects" of ECT are mainly depressive phenomena and are independent of age. J Affect Disord 66: 237-245 PubMedCrossRefGoogle Scholar
  39. Brown ED, Lee H, Scott D, Cummings GG (2014) Efficacy of continuation / maintenance electroconvulsive therapy for the prevention of recurrence of a major depressive episode in adults with unipolar depression: a systematic review. J ECT 30: 195-202 PubMedCrossRefGoogle Scholar
  40. Bryson EO, Kellner CH, Ahle GM, Liebman LS (2014) Asystole during electroconvulsive therapy. J ECT 30: 259-260PubMedCrossRefGoogle Scholar
  41. Bryson EO, Popeo DM, Briggs MC, Pasculli RM, Kellner CH (2015) Automatic implantable cardioverter defibrillator in electroconvulsive therapy. J ECT 31, e22PubMedCrossRefGoogle Scholar
  42. Bulbul F, Copoglu US, Alpak G, Unal A, Demir B, Tastan MF, Savas HA (2013) Electroconvulsive therapy in pregnant patients. Gen Hosp Psychiatry 35: 636-639PubMedCrossRefGoogle Scholar
  43. Bumb JM, Aksay SS, Janke C, Kranaster L, Geisel O, Gass P, Hellweg R, Sartorius A (2015) Focus on ECT seizure quality: serum BDNF as a peripheral biomarker in depressed patients. Eur Arch Psychiatry Clin Neurosci 265: 227–232PubMedCrossRefGoogle Scholar
  44. Burakgazi E, Dalkilic A, Moghal U, Shah U, Carran M (2013) A case of atypical absence seizures after electroconvulsive treatment in a patient with treatment-resistant depression. Clin EEG Neurosci 44: 62-69PubMedCrossRefGoogle Scholar
  45. Calev A, Nigal D, Shapira B, Tubi N, Chazan S, Ben Yehuda Y, Kugelmass S, Lerer B (1991) Early and long-term effects of electroconvulsive therapy and depression on memory and other cognitive functions. J Nerv Ment Dis 179: 526-533 PubMedCrossRefGoogle Scholar
  46. Calev A, Gaudino EA, Squires NK, Zervas IM, Fink M (1995) ECT and non-memory cognition: a review. Br J Clin Psychol 34 (Pt 4): 505-515 PubMedCrossRefGoogle Scholar
  47. Canbek O, Ipekcioglu D, Menges OO, Atagun MI, Karamustafalioglu N, Cetinkaya OZ, Ilnem MC (2015) Comparison of propofol, etomidate, and thiopental in anesthesia for electroconvulsive therapy: a randomized, double-blind clinical trial. J ECT 31: 91-97 PubMedCrossRefGoogle Scholar
  48. Carney S, Sami MB, Clark V, Kuruvilla KK (2015) Electroconvulsive therapy: a life course approach for recurrent depressive disorder. BMJ Case reports 2015, published online 24.05.15Google Scholar
  49. Caudill GB, Rosenquist P, McCall WV (2011) Could monoamine oxidase inhibitors promote asystole in electroconvulsive therapy patients? J ECT 27: 264-265PubMedCrossRefGoogle Scholar
  50. Cerletti U, Bini L (2015) Un nuovo metodo di shock therapy “L'elettroshock”. Boll Acad Med Roma 64: 136-138Google Scholar
  51. Chanpattana W, Kramer BA (2003) Acute and maintenance ECT with flupenthixol in refractory schizophrenia: sustained improvements in psychopathology, quality of life, and social outcomes. Schizophr Res 63: 189-193 PubMedCrossRefGoogle Scholar
  52. Chater SN, Simpson KH (1988) Effect of passive hyperventilation on seizure duration in patients undergoing electroconvulsive therapy. Br J Anaesth 60: 70-73 PubMedCrossRefGoogle Scholar
  53. Cheng YC, Liang CM, Liu HC (2015) Serotonin syndrome after electroconvulsive therapy in a patient on trazodone, bupropion, and quetiapine: a case report. Clin Neuropharmacol 38: 112-113 PubMedGoogle Scholar
  54. Cline JS, Roos K (2007) Treatment of status epilepticus with electroconvulsive therapy. J ECT 23: 30-32 PublicMedCrossRefGoogle Scholar
  55. Cohen D, Taieb O, Flament M, Benoit N, Chevret S, Corcos M, Fossati P, Jeammet P, Allilaire JF, Basquin M (2000) Absence of cognitive impairment at long-term follow-up in adolescents treated with ECT for severe mood disorder. Am J Psychiatry 157: 460-462PubMedCrossRefGoogle Scholar
  56. Conca A, Hinterhuber H, Prapotnik M, Geretsegger C, Frey R, Hausmann A, Hofmann P, Kasper S, Lahousen T, König P, DiPauli J, Pramsohler B, Rittmannsberger H, Wagner W, Pycha R (2004) The electroconvulsive therapy: Theory and Practice (Official EKT Consensus Paper of the ÖGPP). Neuropsychiatrist 18: 1-17Google Scholar
  57. Coughlin JM, Rodenbach K, Lee PH, Hayat MJ, Griffin MM, Mirski MA, Reti IM (2012) Asystole in ultrabrief pulse electroconvulsive therapy. J ECT 28: 165-169 PubMedCrossRefGoogle Scholar
  58. d’Elia G, Raotma H (1975) Is unilateral ECT less effective than bilateral ECT? Br J Psychiatry 126: 83-89 PubMedCrossRefGoogle Scholar
  59. Daly JJ, Prudic J, Devanand DP, Nobler MS, Lisanby SH, Peyser S, Roose SP, Sackeim HA (2001) ECT in bipolar and unipolar depression: differences in speed of response. Bipolar Disord 3: 95-104PubMedCrossRefGoogle Scholar
  60. Davidson J, McLeod M, Law-Yone B, Linnoila M (1978) A comparison of electroconvulsive therapy and combined phenelzine-amitriptyline in refractory depression. Arch Gen Psychiatry 35: 639-642 PubMedCrossRefGoogle Scholar
  61. de Wolf MM, Olde Bijvank EG (2015) Takotsubo cardiomyopathy as a complication of electroconvulsive therapy. Tijdschr Psychiatr 57: 361-366PubMedGoogle Scholar
  62. DeCarolis V, Giberti F, Roccatagliata G, Rossi R (1964a) Catamnestic findings in imipramine and electro-convulsive therapy of depressions. Sist Nerv 16: 43-52 PubMedGoogle Scholar
  63. DeCarolis V, Giberti F, Roccatagliata G, Rossi R, Venuti G (1964b) Imipramine and electroshok in the therapy of depressions: clinico-statistical analysis of the results in 437 cases. Sist Nerv 16: 29-42 PubMedGoogle Scholar
  64. Dehning S, Feddersen B, Mehrkens JH, Muller N (2011) Long-term results of electroconvulsive therapy in severe Gilles de la Tourette syndrome. J ECT 27: 145-147 PubMedCrossRefGoogle Scholar
  65. Delva NJ, Brunet D, Hawken ER, Kesteven RM, Lawson JS, Lywood DW, Rodenburg M, Waldron JJ (2000) Electrical dose and seizure threshold: relations to clinical outcome and cognitive effects in bifrontal, bitemporal, and right unilateral ECT. J ECT 16: 361-369 PubMedCrossRefGoogle Scholar
  66. Dequardo JR, Tandon R (1988) Concurrent lithium therapy prevents ECT-induced switch to mania. J Clin Psychiatry 49: 167-168 PubMedGoogle Scholar
  67. Dersch R, Zwernemann S, Voderholzer U (2011) Partial status epilepticus after electroconvulsive therapy and medical treatment with bupropion. Pharmacopsychiat 44: 344-346 CrossRefGoogle Scholar
  68. Devanand DP, Decina P, Sackeim HA, Prudic J (1988a) Status epilepticus following ECT in a patient receiving theophylline. J Clin Psychopharmacol 8: 153PubMedCrossRefGoogle Scholar
  69. Devanand DP, Sackeim HA, Decina P, Prudic J (1988b) The development of mania and organic euphoria during ECT. J Clin Psychiatry 49: 69-71 PubMedGoogle Scholar
  70. Devanand DP, Verma AK, Tirumalasetti F, Sackeim HA (1991) Absence of cognitive impairment after more than 100 lifetime ECT treatments. Am J Psychiatry 148: 929-932 PubMedCrossRefGoogle Scholar
  71. Devanand DP, Dwork AJ, Hutchinson ER, Bolwig TG, Sackeim HA (1994) Does ECT alter brain structure? Am J Psychiatry 151: 957-970 PubMedCrossRefGoogle Scholar
  72. Devanand DP, Fitzsimons L, Prudic J, Sackeim HA (1995) Subjective side effects during electroconvulsive therapy. Convuls Ther 11: 232-240PubMedGoogle Scholar
  73. Dierckx B, Heijnen WT, van den Broek WW, Birkenhager TK (2012) Efficacy of electroconvulsive therapy in bipolar versus unipolar major depression: a meta-analysis. Bipolar Disord 14: 146-150PubMedCrossRefGoogle Scholar
  74. Dietzfelbinger T, Möller HJ, Steinmeier EM, Fimmers R (1990) In: Möller HJ (Ed) Therapy resistance under antidepressant treatment. Springer, Berlin / Heidelberg / New York, pp. 176–185Google Scholar
  75. Dinan TG, Barry S (1989) A comparison of electroconvulsive therapy with a combined lithium and tricyclic combination among depressed tricyclic nonresponders. Acta Psychiatr Scand 80: 97-100PubMedCrossRefGoogle Scholar
  76. Duthie AC, Perrin JS, Bennett DM, Currie J, Reid IC (2015) Anticonvulsant mechanisms of electroconvulsive therapy and relation to therapeutic efficacy. J ECT 31 (3): 173-8