Evolution of Electroconvulsive Therapy Practice During the COVID-19 Pandemic: A Systematic Review.

Abstract: The COVID-19 pandemic disrupted the provision of electroconvulsive therapy (ECT) across the globe, challenging ECT services to develop protocols that preserve access to this life-saving treatment. This systematic review maps the literature on global ECT practice during the COVID-19 pandemic. The English-language literature was searched through OVID (MEDLINE, PsycINFO, and Embase) on August 7, 2024. Included articles described ECT practice at ECT-providing centers anywhere in the world during the COVID-19 pandemic. Studies were critically appraised, and descriptive synthesis focused on ECT capacity, decision making, hospital resources, procedural modifications, and patient outcomes. Of the 297 identified articles, 61 met the inclusion criteria. In the published articles, 90.7% of articles reported a reduced treatment volume. ECT services were also shifted to prioritize inpatient treatments. Decision making was balanced between administrators and ECT unit staff, although only 2 articles (3.2%) reported the involvement of clinical ethicists in decision making. Other common challenges included staff shortages or redeployment (39.3%), personal protective equipment shortages (18.0%), and limited space availability (11.5%). Among studies that reported on it, relapse occurred in 85.0% articles due to ECT service disruptions. Significant variation in procedural modifications and mitigation strategies were observed, with limited consensus on best practices. To better understand these variations, we developed a decision matrix categorizing ECT service based on the transmission risks and resource availability. This review highlights the importance of evaluating long-term ECT disruptions and developing policies ensuring service continuity in future public health emergencies.