NICE recommends to use electroconvulsive therapy (ECT) only to attain quick and short-term improvement of severe symptoms if an adequate trial of other options has not been effective and/or when the condition is considered to be potentially life-threatening, in individuals with:
- a prolonged or severe manic episode.
Indication to an individual must be based a documented assessment of the risks and potential benefits to the individual.
Exercise caution when considering electroconvulsive therapy during pregnancy, in older people, and in children and young people.
Valid consent should be obtained in all cases where the individual can grant or refuse consent. The decision to use electroconvulsive therapy should be made jointly by the individual and the clinician(s) responsible for treatment, based on an informed discussion after full information about the risks and potential benefits, without pressure or coercion, the involvement of patient advocates and/or carers is strongly encouraged.
If informed consent is not possible advance directives should be taken fully into account.
Clinical status should be assessed following each electroconvulsive therapy 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.
Consider a repeat course under the circumstances indicated for patients who previously responded. In patients who have not previously responded, a repeat trial should be undertaken only after all options have been considered and following discussion with individual/carer/advocate.
Do not recommend to patients with schizophrenia.
For patients with depression, see use electroconvulsive therapy as recommended in the NICE guidance on the treatment of depression.