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National Institute for
Clinical Excellence

Guidance on the use of
electroconvulsive therapy

Technology Appraisal 59
April 2003

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Technology Appraisal Guidance 59
Guidance on the use of electroconvulsive therapy

Issue date: April 2003
Review date: November 2005

To order copies
Copies of this guidance can be obtained from the NHS Response Line by telephoning 0870 1555
455 and quoting ref: N0205. A patient version of this document can…

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1 Guidance 5
2 Clinical need and practice 7
3 The technology 9
4 Evidence and interpretation 11
5 Recommendations for further research 18
6 Implications for the NHS 19
7 Implementation and audit 19
8 Related Guidance 21
9 Review of Guidance 22

Appendix A: Appraisal Committee

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1 Guidance
1.1 It is recommended that electroconvulsive therapy (ECT) is
used only to achieve rapid and short-term improvement of
severe symptoms after an adequate trial of other treatment
options has proven ineffective and/or when the condition is
considered to be potentially life-threatening, in individuals

· severe depressive illness…

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1.6 Clinical status should be assessed following each ECT 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…

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2 Clinical need and practice
2.1 This appraisal considers electroconvulsive therapy (ECT) in
the treatment of: depressive illness, schizophrenia, catatonia
and mania.

2.2 Depressive illness is associated with discrete episodes that are
characterised by feelings of sadness, despair, loss of interest
in daily life and discouragement. The severity of depressive…

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2.7 Depressive illness, schizophrenia and mania are frequently
chronic, relapsing conditions and are associated with
considerable suicide risk. Diagnosable depressive disorders
are implicated in between 40% and 60% of suicide attempts.
The 2000 ONS Psychiatric Morbidity Survey found that in
individuals with a current depressive episode, 5% reported a

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3 The technology
3.1 During ECT, an electric current is passed briefly through the
brain, via electrodes applied to the scalp, to induce
generalised seizure activity. The individual receiving
treatment is placed under general anaesthetic and muscle
relaxants are given to prevent body spasms. The ECT
electrodes can be placed…

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loss. However, this should not detract from the fact that a
number of individuals find their memory loss extremely
damaging and for them this negates any benefit from ECT.

3.6 Advance directives are statements made by an individual
that express decisions about the healthcare they wish to
receive, in anticipation…


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