Use and misuse of electroconvulsive treatment.

For the continued availability of electroconvulsive therapy (ECT) in clinical practice on equal footing with other treatments, and without judicial interference, the following points are essential: ECT should be used or not used on the basis of scientific evidence and not because of public opinion or antipsychiatric propaganda. There should be no hesitation to use ECT in conditions where its omission would mean prolonged suffering, risk of suicide, or death from other causes (deep melancholic syndromes, acute lethal catatonia, psychogenic confusion). ECT should not be used where the effect is short-lived or must be paid at the price of an organic syndrome (schizophrenia, paranoid states, organic confusions). Efficiency should be optimal (oxygen, superficial narcosis, absence of benzodiazepines, generalized tonic-clonic seizures of at least 30-sec duration, maintenance treatment with antidepressive drugs). Safety should be optimal, not only for life but also for cerebral functioning (anesthesiological management, unilateral nondominant stimulation, pulse wave stimuli, appropriate number of treatments, not too closely spaced). The mechanism of action should be the object of further investigation. Such research will open possibilities for finding drugs that can compete with ECT.