Electroconvulsive therapy can be effective for patients with severe, treatment-refractory depression and its use should be considered more often in the earlier stages of the disease, according to an article in the May issue of the Southern Medical Journal.

"Electroconvulsive therapy has been shown to be a highly effective, safe, and even life-saving treatment for persistent and severe depression, bipolar disorder, and schizophrenia," wrote Stephen Taylor, MD, of the University of Louisville, Kentucky.

In his review of the history of therapy, especially in the USA, Taylor noted that "Electroconvulsive therapy has shown a strong comeback in the last decade, which is a testament to its continued efficacy and safety."

For patients with depression that does not improve with other drugs or treatments, electroconvulsive therapy produces a response rate of up to 55 percent. Recent studies have reported even higher response rates?80 to 90 percent?when it is used as initial treatment for severe depression.

The procedure is safe, with risks comparable with those of childbirth or minor surgery. Although concerns have been raised regarding memory loss as a side effect of electroconvulsive therapy, such loss often resolves within a few weeks.

Several treatments are often needed to achieve a response. Although improvement may occur after the first session, patients typically receive 6 to 12 treatments. Taylor emphasized that "For all patients…it should be stressed that electroconvulsive therapy represents a treatment that will bring remission, not a cure."

Many patients who respond to the therapy will need "maintenance" treatments over time, because its effects are temporary. Treatment can be repeated if the patient's depression relapses.

The article also updated key technical issues related to performance of therapy, including different approaches to "dosing," electrode placement, medications, anesthesia, and patient evaluation and follow-up.

An accompanying editorial by James N. Kimball, MD, of Wake Forest University Baptist Medical Center, Winston-Salem, NC, echoed the call for physicians and patients to be open to the possibility of pursuing electroconvulsive therapy for persistent depression and other disorders.

"It is not right for everyone, but it is a treatment health professionals should consider in their therapeutic arsenal," Kimball wrote. "[Electroconvulsive therapy] is one of the oldest treatments currently in modern psychiatry, but also one whose time has come."