NICE releases new guidelines for ECT

May 3, 2003

NICE has issued new guidelines for clinicians as to when and to whom it considers ECT should be administered.

Below is a summary of the NICE guidance. For the guidelines in full click here

To read what psychiatrists plan to do, click here
To read what mental health groups think, click here

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Guidance

1.1 It is recommended that electroconvulsive therapy (ECT) is
used only to achieve rapid and short-term improvement of
severe symptoms after an adequate trial of other treatment
options has proven ineffective and/or when the condition is
considered to be potentially life-threatening, in individuals
with:
• severe depressive illness
• catatonia
• a prolonged or severe manic episode.

1.2 The decision as to whether ECT is clinically indicated should be based on a documented assessment of the risks and potential benefits to the individual, including: the risks
associated with the anaesthetic; current co-morbidities;
anticipated adverse events, particularly cognitive impairment; and the risks of not having treatment.

1.3 The risks associated with ECT may be enhanced during
pregnancy, in older people, and in children and young
people, and therefore clinicians should exercise particular
caution when considering ECT treatment in these groups.

1.4 Valid consent should be obtained in all cases where the
individual has the ability to grant or refuse consent. The
decision to use ECT should be made jointly by the individual
and the clinician(s) responsible for treatment, on the basis of
an informed discussion. This discussion should be enabled by the provision of full and appropriate information about the
general risks associated with ECT (see Section 1.9) and about the risks and potential benefits specific to that individual.

Consent should be obtained without pressure or coercion,
which may occur as a result of the circumstances and clinical
setting, and the individual should be reminded of their right
to withdraw consent at any point. There should be strict
adherence to recognised guidelines about consent and the
involvement of patient advocates and/or carers to facilitate
informed discussion is strongly encouraged.

1.5 In all situations where informed discussion and consent is not possible advance directives should be taken fully into
account and the individual’s advocate and/or carer should be
consulted.

1.6 Clinical status should be assessed following each ECT session and treatment should be stopped when a response has been achieved, or sooner if there is evidence of adverse effects.

Cognitive function should be monitored on an ongoing basis,
and at a minimum at the end of each course of treatment.

1.7 It is recommended that a repeat course of ECT should be
considered under the circumstances indicated in 1.1 only for
individuals who have severe depressive illness, catatonia or
mania and who have previously responded well to ECT. In
patients who are experiencing an acute episode but have not
previously responded, a repeat trial of ECT should be undertaken only after all other options have been considered and following discussion of the risks and benefits with the individual and/or where appropriate their carer/advocate.

1.8 As the longer-term benefits and risks of ECT have not been clearly established, it is not recommended as a maintenance therapy in depressive illness.

1.9 The current state of the evidence does not allow the general use of ECT in the management of schizophrenia to be
recommended.

1.10 National information leaflets should be developed through
consultation with appropriate professional and user
organisations to enable individuals and their carers/advocates to make an informed decision regarding the appropriateness of ECT for their circumstances.

The leaflets should be evidence based, include information about the risks of ECT and availability of alternative treatments, and be produced in formats and languages that make them accessible to a wide range of service users.

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