Advances in the Application of Electroconvulsive Therapy

Electroconvulsive therapy (ECT) is one of the oldest and most effective treatments in psychiatry. Despite modifications in technique, memory loss remains the major side effect of ECT causing many patients who might benefit from the treatment to avoid it. In this review, we present updates on three ECT-related topics. In December 2015, the FDA issued draft guidelines for ECT device classification and administration which propose special controls over what patients should be told about cognitive side effects and how they should be monitored. In this review, we update readers on the topic of ECT-triggered cognitive side effects and efforts to reduce them. We then turn to the topic of stimulus dosing and consider the evidence favoring seizure threshold titration versus formula-based methods. Finally, we update readers on an emerging indication for ECT, namely suppression of severe, intractable self-injurious behavior associated with autism spectrum disorder.