Charting the course of electroconvulsive therapy: Where have we been and where are we headed?

Electroconvulsive therapy (ECT) is one of the oldest and best treatments for severe mental illness. A safe and highly effective option for treatment-resistant mood disorders, ECT can be a lifesaving treatment for people suffering from catatonia and acute suicidality. Less recognized are the benefits of ECT in the treatment of primary psychotic disorders, Parkinson’s disease, and status epilepticus. Evidence from multisite clinical trials in the past decade shows an evolving standard for the delivery of ECT to achieve and maintain remission and quality of life. Today, the optimal practice of ECT is defined by evidence-based treatment planning, including patient selection, choice of electrode placement and stimulus parameters, augmentation with pharmacotherapy, and the use of continuation/maintenance treatment. Research into biomarkers and neuroplasticity related to ECT response, as well as new investigational methods of delivering ECT, provide a glimpse into the future of this time-tested treatment.