Electroconvulsive Therapy and Depression

Abstract

After 25 years there is still considerable disagreement surrounding the indications for electro-convulsive therapy (E.C.T.). This is a particular problem in the treatment of depression, both because of the controversy over the division of depression into endogenous and reactive illnesses and because of the increasing use of the antidepressant drugs. These drugs will induce a remission in many patients, and will alter the clinical picture in others. As their use becomes still more widespread (Freyhan (1) has recommended that intensive imipramine treatment should be tried routinely before E.C.T. in all depressed patients) there may be further difficulties in the selection of depressed patients likely to respond well to E.C.T. Furthermore several recent reviews draw attention to a reduction in the use of E.C.T., and the lack of a consistent rationale for its use (2–4).