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Over the past several decades, electroconvulsive therapy (ECT) has been proven to be perhaps the most effective somatic treatment for mood disorders (Kellner et al. 2012). The continued use of ECT spurred more systematic research on its indications, techniques to maximize efficacy and minimize side effects, and understanding ECT’s mechanism of action. In this chapter, we review the history of ECT, the preclinical and clinical data on the mechanism of action of ECT, and the relevant literature related to the efficacy and side-effect burden of ECT. We also offer practical guidelines for the administration of ECT in treating various psychiatric disorders, including appropriate patient selection, stimulus settings and electrode placement, pretreatment medical evaluation, and management of the patient during acute, continuation, and maintenance courses of ECT. Finally, we discuss recent developments with nonconvulsive therapies such as transcranial magnetic stimulation (TMS) in relation to their efficacy in depression treatment and their utility as part of the neuromodulatory treatments.
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