The importance of electroconvulsive therapy in the multimodal treatment of depressive disorders

Abstract

Electroconvulsive therapy (ECT) is part of the multimodal treatment concept in the treatment of depressive disorders in particular. Therapy-resistant depression is regarded as a major indication. After decades of experience, ECT continues to prove to be a very effective treatment method that is safe and has relatively few side effects due to current standards and technology. Its prejudiced and negative perception and evaluation is therefore surprising. The very frequent assessment of ECT as a last resort means that in many cases it is only used at a very late stage in the course of the disease – despite recommendations to the contrary, for example the S3 Guideline Unipolar Depression of the DGPPN. The indication range for ECT is clearly defined and there are only few absolute contraindications; a combination of ECT with other treatment procedures is also possible and sensible. The central concern of this article is the necessary removal of taboos: ECT should be offered as a possible treatment option as part of a comprehensive therapy plan. In many cases, it is the only way to overcome depressive blockages, to deal with biographically relevant conflict issues, dysfunctional coping mechanisms, traumatic experiences, and also the «existential issue of lost lifetime» as a result of therapy-resistant depression.