Electroconvulsive therapy: old acquaintance for the youngster or new opportunity for the elder? Review of the literature and applications in the geriatric population

Abstract

Electroconvulsive therapy (ECT) is among the most controversial and mythicized therapies in the psychiatric and medical clinical context. Historically, this practice was used in some contexts as a torture or a coercive method and the lay public as well as the collective imaginary has always considered and represented this treatment as inhuman. Prejudices and limited knowledge of this therapeutic tool have contributed to consider this procedure as a violent act and an assault to human dignity, progressively reducing its employment in time. Despite these prejudices, in the international literature several studies have demonstrated a considerable evidence in support of the use of ECT for some psychiatric diseases, considering it among the safest and most effective treatments. Especially in case of life-risk diseases, such as major depression, ECT proved to be necessary in dealing with pharmaco-resistance and bringing to remission psychotic depression with high risk of suicide. Furthermore, to date ECT results to be the treatment of choice in depressed patients that cannot be treated with pharmacotherapy, e.g. in pregnant women, in which the use of antidepressant drugs exposes the fetus to a teratogenic risk, or in elder patients, in which multiple-drug treatments and interactions have to be carefully considered. The purpose of this paper is to provide a review of the literature regarding ECT and concise guidelines for this treatment and its clinical outcomes, with special reference to geriatric population.