ECT As An Essential Treatment: Commentary In The American Journal of Psychiatry

Out on PubMed, in the American Journal of Psychiatry, is this commentary:

Electroconvulsive Therapy Is an Essential Procedure.

Maixner DF, Weiner R, Reti IM, Hermida AP, Husain MM, Larsen D, McDonald WM.Am J Psychiatry. 2021 May 1;178(5):381-382. doi: 10.1176/appi.ajp.2020.20111647.PMID: 33979536 

And from the text:

To better understand the actual extent of the COVID-19 impact on patients and ECT practice in the United States, the ECT Task Group of the National Network of Depression Centers, a consortium of 27 U.S. academic institutions, surveyed members about the effects of COVID-19 on 20 ECT programs. During April and May of 2020, 80% (16 of 20) of ECT programs in the National Network of Depression Centers reported operating at less than 50% of regular clinical volume, and some reported substantially greater declines. ECT teams of psychiatrists and nurses scrambled to postpone or cancel appointments for many patients who were in acute or maintenance ECT courses. In addition, 95% of programs were required to delay or defer some new patients from starting ECT. Most importantly, our survey documented patient outcomes that were alarming: COVID-19 caused scheduling changes for ECT that led to decompensation and hospitalization (70% of institutions) or a need for new acute courses of ECT for patients whose maintenance ECT was stopped or curtailed (80% of institutions). There was one reported death by suicide, and 15% of sites reported at least one serious suicide attempt during ECT service reductions imposed by COVID-19.

...A resurgence of COVID-19 cases during the winter of 2020–2021 across the United States raised renewed concerns that the availability of ECT may again be affected, with disastrous implications for patients. Hospital administrators and medical leadership need to understand that ECT patients often fall into urgent and emergent categories and that disruption or deferral of ECT care increases risks of relapse, hospitalizations, and potential suicide in this vulnerable population. Thus, it is imperative that ECT continue to be considered an essential treatment when severe psychiatric illness is present, whether it is during this COVID-19 crisis or in any future pandemic.

This commentary, written by members of the National Network of Depression Centers, is important because it appears prominently in the American Journal of Psychiatry (impact factor:14.1). The content, while crucial, is not novel: ECT was initially curtailed during the pandemic, patients suffered, service accommodations were made, ECT needs to be recognized as an essential procedure. 

While many of us in the ECT community have closely followed the COVID ECT literature, this commentary may be the first time a wide swath of the general psychiatric audience has thought about ECT in the pandemic. For that reason alone, the authors of this brief commentary deserve much credit.