Electroconvulsive Therapy Across Nations: A 2022 Survey of Practice

Paul Rohde; Rachel Noorani; Elyssa Feuer; Sarah H Lisanby; William T Regenold

doi:10.1097/YCT.0000000000000980

Electroconvulsive Therapy Across Nations: A 2022 Survey of Practice

J ECT. 2023 Dec 8. doi: 10.1097/YCT.0000000000000980. Online ahead of print.

Authors

Paul Rohde¹, Rachel Noorani², Elyssa Feuer³, Sarah H Lisanby¹, William T Regenold¹

Affiliations

¹ From the Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda.
² University of Maryland, College Park, College of Behavioral and Social Sciences, College Park, MD.
³ University of Toledo College of Medicine and Life Sciences, Toledo, OH.

PMID: 38109328
DOI: 10.1097/YCT.0000000000000980

Abstract

Objectives: We aimed to characterize worldwide electroconvulsive therapy (ECT) practice and compare practice across nations and global regions.

Method: Our anonymous survey was open on SurveyMonkey.com from January to June 2022. We sent invitations to providers identified using a Medicare provider database, an advanced PubMed search function, and professional group listservs. Participants were instructed to submit one survey per ECT site. Response frequencies were pooled by global region and compared using nonparametric methods.

Results: Responses came from 126 sites, mostly in the United States (59%, n = 74), Europe (18%, n = 23), Canada (10%, n = 12), and South/East Asia (6%, n = 8). With some exceptions, sites were broadly consistent in practice as indicated by: a likely shift internationally from bitemporal to right unilateral electrode placement; predominant use of pulse widths <1 ms; preference for seizure threshold titration over age-based dosing methods; widespread availability of continuation/maintenance ECT (97%); and frequent use of quantitative outcome measures for depressive symptoms (88%) and cognitive adverse effects (80%).

Conclusions: This is the first, published survey that aimed to characterize worldwide ECT practice. With some exceptions, responses suggest a concordance in practice. However, responses were primarily from the Global North. To obtain a truly worldwide characterization of practice, future surveys should include more responses from the Global South.