NICE guidance - the use of electroconvulsive therapy (ECT)

Summary points of guidance:

• consider ECT for severe, life-threatening depression and when a rapid response is required, or when other treatments have failed
• do not use ECT routinely for people with moderate depression but consider it if their depression has not responded to multiple treatments
• ensure the person is fully informed of the risks and benefits associated with having ECT20. Document the assessment and consider:
  • the risks associated with a general anaesthetic
  • medical comorbidities
  • potential adverse events, notably cognitive impairment
  • the risks associated with not receiving ECT
• make the decision to use ECT jointly with the person if possible, taking into account the Mental Health Act 2007. Also:
  • obtain valid informed consent without pressure or coercion
  • remind the person of their right to withdraw consent at any point
  • adhere to recognised guidelines about consent and involve advocates or carers
  • if informed consent is not possible, give ECT only if it does not conflict with a valid advance directive, and consult the person’s advocate or carer.

Notes:

• previous NICE guidance (2) also suggested that:
  • ECT used only to achieve rapid and short-term improvement of severe symptoms after an adequate trial of other treatment options has proven ineffective and/ or when the condition is considered to be potentially life-threatening, in individuals with:
    ° severe depressive illness
    ° catatonia
    ° a prolonged or severe manic episode
  • risks associated with ECT may be enhanced during pregnancy, in older people, and in children and young people, and therefore clinicians should exercise particular caution when considering ECT treatment in these groups
  • clinical status should be assessed following each ECT session and treatment should be stopped when a response has been achieved, or sooner if there is evidence of adverse effects. Cognitive function should be monitored on an ongoing basis, and at a minimum at the end of each course of treatment
  • a repeat course of ECT should be considered only for individuals who have severe depressive illness, catatonia or mania and who have previously responded well to ECT. In patients who are experiencing an acute episode but have not previously responded, a repeat trial of ECT should be undertaken only after all other options have been considered and following discussion of the risks and benefits with the individual and/ or where appropriate their carer/ advocate

For detailed information then consult the full guidelines (1,2).

Reference:

• 1) NICE (October 2009). Depression.
• 2)NICE (2003). Guidance - on the use of electroconvulsive therapy