Clinical applications of recent research on electroconvulsive therapy.

Electroconvulsive therapy (ECT) has been in use since the late 1930s to treat a variety of severe mental illnesses, most notably major depression. Current research efforts focus on patient selection, memory impairment, and high posttreatment relapse rates. Psychopathological factors such as psychosis and severe psychomotor retardation predict favorable response to ECT in depression. Technical variables that affect memory include electrode placement, stimulus intensity, and treatment frequency. Strategies to reduce posttreatment relapse rates include maintenance ECT and aggressive medication combinations. In this article, I review recent research that bears on these aspects of ECT practice. Additionally, I review some findings on the neurobiological effects of ECT.