1. Overview

 

The prescribing and discontinuation of ECT are the decision of the patients Consultant/RMO.  However, the decision to discontinue ECT may also take place in the context of discussion with the ECT Consultant and/or Anaesthetist in the light of adverse reactions to ECT such as cognitive problems or anaesthetic problems.

 

Discontinuation may also take place because of poor efficacy or, most importantly, because the patient has withdrawn consent.

 

The clinical status of a patient should always be assessed between each ECT session and treatment should be stopped when a response has been achieved.

 

A patient should not receive more treatments than is required to achieve an adequate response, even if more have been prescribed, hence the patient must be reviewed after each treatment during the treatment course.

 

    2.   Recommendations (from ECT Handbook, 2005)

 

A set course of treatments should not be prescribed – the need for further treatments should be assessed after each individual treatment.

 

 

Bilateral ECT

If no clinical improvement at all is seen after six properly-given bilateral treatments, then the course should be abandoned.

 

It may be worth continuing up to 12 bilateral treatments before abandoning ECT in patients who have shown definite but slight or temporary improvement with early treatments.

 

Unilateral ECT

For patients who do not respond to unilateral ECT, consideration should be given to switching to bilateral treatment.  It will be necessary to retitrate seizure threshold in this case.