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Syllabi and Readings
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List of ECT Bibliography


Kellner, C. H., R. M. Greenberg, et al. (2012). "ECT in Treatment-Resistant Depression." Am J Psychiatry 169(12): 1238-1244.

American Psychiatric Association. Ethics Primer. Washington DC: APA Press, 2001.


Mankad, M. V., Beyer, J. L., et al.  (2010). Clinical Manual of Electroconvulsive Therapy.  Arlington, VA, American Psychiatric Publishing.  The core textbook for this rotation.

Other texts you might consult for different perspectives:
Fink, M.  (2008). Electroconvulsive Therapy (second edition).  New York, NY, Oxford University Press.  A more casual text explaining consent, procedures, and indications for ECT.  This book is accessible for patients as well.

Scott, A. I. F., Ed. (2005). The ECT Handbook (second edition). London, England, Royal College of Psychiatrists.  Widely available online in PDF format, this text reviews the evidence for most aspects of ECT.


Pagnin, D., V. de Queiroz, et al. (2004). "Efficacy of ECT in depression: a meta-analytic review." J ECT 20(1): 13-20.  A review of trial data, including sham trials, supporting the use of electroconvulsive therapy for depression.

Dombrovski, A. Y., Mulsant B. H., et al. (2005). “Predictors of remission after electroconvulsive therapy in unipolar major depression.”  J Clin Psychiatry 66(8): 1043-1049.  Patients with more chronic depression, dysthymia, or medication resistance appear less likely to respond to unilateral ECT.

Medical Screening for ECT

Tess, A. V. and G. W. Smetana (2009). "Medical evaluation of patients undergoing electroconvulsive therapy." N Engl J Med 360(14): 1437-1444.

Procedure & Practice

Swartz, C. M. and A. I. Nelson (2005). "Rational electroconvulsive therapy electrode placement." Psychiatry (Edgmont) 2(7): 37-43.  An illustrated review of common (and esoteric) ECT electrode placements.

Mayur, P. (2006). "Ictal electroencephalographic characteristics during electroconvulsive therapy: a review of determination and clinical relevance." J ECT 22(3): 213-217.  A review the clinical relevance of various EEG characteristics during ECT.

Sackeim, H. A., J. Prudic, et al. (2008). "Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy." Brain Stimul 1(2): 71-83.  This RCT demonstrates that the use of ultrabrief pulse (0.3ms) reduces adverse effects while preserving efficacy.

Tew, J. D., Jr., B. H. Mulsant, et al. (2002). "A randomized comparison of high-charge right unilateral electroconvulsive therapy and bilateral electroconvulsive therapy in older depressed patients who failed to respond to 5 to 8 moderate-charge right unilateral treatments." J Clin Psychiatry 63(12): 1102-1105.  Among patients without improvement with an initial course of unilateral ECT, switching to high-charge unilateral ECT (450% above seizure threshold) is as effective as bilateral ECT.  We typically optimize unilateral ECT before switching to bilateral ECT.


Reves, J. G., P. S. A. Glass, et al. (2010). Intravenous Anesthetics. Miller's anesthesia. R. D. Miller. Philadelphia, PA, Churchill Livingstone/Elsevier: 719-768.  From the seminal anesthesia text, this chapter describes the basics of induction agents used in ECT.

Hooten, W. M. and K. G. Rasmussen, Jr. (2008). "Effects of general anesthetic agents in adults receiving electroconvulsive therapy: a systematic review." J ECT 24(3): 208-223.  A review of the comparative evidence among the large variety of induction agents appropriate for use in ECT.

Naguib, M. and C. A. Lien (2010). Pharmacology of Muscle Relaxants and Their Antagonists. Miller's anesthesia. R. D. Miller. Philadelphia, PA, Churchill Livingstone/Elsevier: 859-911.  Further reading on the pharmacology and use of muscle relaxants including succinylcholine.

Augmentation Strategies

Loo, C., B. Simpson, et al. (2010). "Augmentation strategies in electroconvulsive therapy." J ECT 26(3): 202-207.  Some procedural techniques may enhance efficacy for treatment refractory patients or for those with poor seizure quality.

Loo, C. K., A. Kaill, et al. (2010). "The difficult-to-treat electroconvulsive therapy patient - Strategies for augmenting outcomes." J Affect Disord 124(3): 219-227.  A similar review to above with additional focus on treatment strategies, including antidepressants, studied to improve ECT outcomes.  There is not strong evidence underlying most augmentation strategies.

Cognitive Impairment

Hausner, L., M. Damian, et al. (2011). "Efficacy and cognitive side effects of electroconvulsive therapy (ECT) in depressed elderly inpatients with coexisting mild cognitive impairment or dementia." J Clin Psychiatry 72(1): 91-97.  Regardless of baseline cognition, elderly patients’ MMSE scores improve by 6 weeks after ECT – reflecting the significant cognitive symptoms of depression and the transient, reversible nature of ECT-induced cognitive side effects.

After the Index Series: Continuation & Maintenance

Frederikse, M., G. Petrides, et al. (2006). "Continuation and maintenance electroconvulsive therapy for the treatment of depressive illness: a response to the National Institute for Clinical Excellence report." J ECT 22(1): 13-17.  The authors review the administration of and evidence for maintenance ECT in response to a NICE report questioning the treatment’s utility.

Sackeim, H. A., Haskett, R. F., et al.  (2001). “Continuation Pharmacotherapy in the Prevention of Relapse Following Electroconvulsive Therapy: A Randomized Controlled Trial.”  JAMA 285(10): 1299-1307.  This RCT imparts the importance of aggressive pharmacotherapy after response to an index ECT series.

Application in Certain Populations

Feske, U., B. H. Mulsant, et al. (2004). "Clinical outcome of ECT in patients with major depression and comorbid borderline personality disorder." Am J Psychiatry 161(11): 2073-2080.  This cohort study suggests depressed patients with borderline personality disorder, even compared to those with other personality disorders, are not as treatment responsive to ECT.

Anderson, E. L. and I. M. Reti (2009). "ECT in pregnancy: a review of the literature from 1941 to 2007." Psychosom Med 71(2): 235-242.  This systemic review notes ECT to be highly efficacious and safe for pregnant women and fetuses.

Stoppe, A., M. Louza, et al. (2006). "Fixed high-dose electroconvulsive therapy in the elderly with depression: a double-blind, randomized comparison of efficacy and tolerability between unilateral and bilateral electrode placement." J ECT 22(2): 92-99.  This randomized trial suggests high-dose right unilateral and bilateral electroconvulsive therapy to be similarly effective for elderly patients with depression.

Regenold, W. T., D. Weintraub, et al. (1998). "Electroconvulsive therapy for epilepsy and major depression." Am J Geriatr Psychiatry 6(2): 180-183.  Patients often ask whether ECT can precipitate further seizures: in fact, the opposite may be true.  This case report and review describes ECT’s use for the treatment of complex-partial seizures.

Dolenc, T. J. and K. G. Rasmussen (2005). "The safety of electroconvulsive therapy and lithium in combination: a case series and review of the literature." J ECT 21(3): 165-170.  A case series questions the traditional teaching that lithium must be discontinued prior to ECT.


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