Electroconvulsive therapy in patients with trauma and personality disorders: what is the evidence?

Introduction: Electroconvulsive therapy (ECT) is one the most effective interventions for treatment-resistant depression. There is a link between trauma history and the development of depression, and frequent comorbidity with post-traumatic stress disorder (PTSD) and personality disorders. The impact of comorbid trauma and personality disorders on the efficacy of ECT has attracted research interest, with the possibility raised for using ECT to target other core symptoms of these disorders.

Areas covered: In this scoping review, the authors describe the available evidence on the use of ECT in personality disorders, PTSD, and individuals with a trauma history. The article is based on literature derived from Embase, APA PsycInfo, Web of Science, CINAHL, and Cochrane CENTRAL databases on relevant studies published up until 9 December 2024.

Expert opinion: Preliminary evidence supports the efficacy of ECT to treat depressive symptoms in patients with comorbid PTSD while there is more conflicting evidence for its use in patients with comorbid personality disorders, particularly borderline personality disorder. A careful exploration of trauma history, baseline mood symptoms, and previous treatment trials should be undertaken prior to the recommendation of ECT. Randomized controlled trials are needed to verify the therapeutic benefits of ECT for core symptom domains in other disorders.