ABSTRACT
Using electricity to elicit a seizure as a means of treating severe depressive illness must seem perplexing, if not frankly bizarre; to people who have no experience of electroconvulsive therapy (ECT), but ECT remains a treatment with a useful and important role in modern psychiatric practice. This chapter covers the following areas of importance to treating older adults with affective disorders with ECT: indications, concurrent physical illness, administration of treatment, side-effects, efficacy, and maintenance treatment. Flint and Gagnon, in their review of naturalistic studies of the use of ECT in late-life depressive illness, concluded that 50% of patients or more will relapse within 6 to 12 months post ECT. The clinical implication of these findings is that more prolonged antidepressive treatment will be needed following a course of ECT and, in practice, combination treatments should be considered, e.g. use of a mood stabiliser in combination with an antidepressive drug, or pharmacological and psychological treatment combinations.
