Indications

Usually indicated in the following conditions for refractory cases, cases in which a fast antidepressant effect is needed, when there are life-threatening symptoms (e.g., severe suicidality, malnutrition due to food refusal, severe psychosis), or if medication is contraindicated (e.g., pregnancy):

• Depression (most common)
• MDD with psychotic features
• Schizoaffective disorder
• Schizophrenia with catatonia
• Bipolar mood disorder (e.g., manic episodes)
• Highly suicidal or pregnant depressed patients (not usually first-line)

Tip

ECT is the most effective treatment for severe major depressive disorder.

Side effects

• Reversible memory loss: retrograde more often than anterograde amnesia (typically resolves within 6 months of last treatment)
• Tension-type headache
• Nausea
• Transient muscle pain
• Disorientation