• ECT has the highest rates of response and remission of any form of antidepressant treatment, with 70%–90% of patients treated showing improvement.

  • Evaluation for ECT should identify potential indications for caution or modifications in ECT technique or anesthesia, such as recent myocardial infarction, cardiac arrhythmias, or intracranial space-occupying lesions.

  • ECT may have cardiovascular side effects, which can be managed by optimizing blood pressure control prior to ECT and administering antihypertensive agents (e.g., short-acting beta-blockers or calcium channel blockers) at the time of ECT. Arrhythmias, which are usually transient, can also occur in conjunction with ECT and can be managed with usual antiarrhythmic therapies if they do not resolve spontaneously.

  • Patients may experience cognitive effects after ECT. The most common of these effects is confusion that generally lasts 30–60 minutes after treatment. Retrograde amnesia may also occur but typically resolves.

  • Treatments are usually administered two or three times per week. An acute course of ECT typically consists of 6–12 treatments, until symptoms have remitted or clearly reached a plateau.


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