Electroconvulsive therapy

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Reason: Electroconvulsive therapy has been carried out for decades in such a way that seizures no longer occur. The statement that "prolonged seizures can occur" is therefore wrong, misleading and irresponsible.

Medical editors

The electroconvulsive therapy or electroconvulsive therapy ( ECT ) is used for treating intractable and severe depressive disorders . With current pulses lasting a few seconds under anesthesia with muscle relaxation , a brief neuronal overexcitation is triggered in the brain, which the patient cannot feel. The convulsive effect, which occurs directly during the treatment, which lasts about 30 seconds, can usually only be observed using measurements ( electroencephalography (EEG) ). It can also be registered by tying an arm so that the muscle relaxant does not get into the arm and hand via the bloodstream, and by observing muscle cramps in the hand. During the anesthesia, the patient is anesthetically monitored and ventilated with oxygen . 8 to 12 treatments with an interval of two to three days are common.

Pictorial representation of the ECT

scope of application

ECT is mainly used for severe, otherwise not or only risky treatable depression or for severe delusional depression, also for acute life-threatening spasms ( catatonia ) or otherwise not or only risky treatable schizophrenia . Severe manic episodes are another area of ​​application. According to the opinion of the Scientific Advisory Board of the German Medical Association, use is only indicated after a careful review of several criteria. Decisive for an appropriate assessment are "the diagnosis, the severity of the symptoms, the treatment history as well as the weighing up of benefits and risks, taking into account other treatment options." After a possible determination that an ECT would be appropriate ( indication ), the patient's wish is fulfilled consider.

Many patients require specific, repeated treatments in order to achieve permanent improvement. Despite the successes, the optimal conditions for these after-treatments are still being discussed and are the subject of special research.

The combination of ECT and medication is still the subject of research. However, it became apparent as early as 2010 that in the case of schizophrenia in patients where medication alone is unsuccessful, the combination with ECT would be useful, provided that possible additional undesirable side effects do not speak against it.

Legal situation for consent in Germany

If there is an urgent need (indication) for patients who are unable to give consent and who do not have a legally effective living will, ECT treatment can be carried out if a supervisor is appointed by the supervisory court (formerly: guardianship court) and he or she agrees to the treatment.

Whether in certain cases separate consent from the supervisory court is required before applying an ECT has been assessed differently in the case law up to now (as of 2014). If the doctor and the supervisor agree, the approval of the supervisory court is definitely not required. In the event of a disagreement, both the doctor and the supervisor have the option of submitting a complaint to the supervisory court.

If treatment is intended against the "natural will of the person being cared for (compulsory medical measure)", the carer can only consent if he has received approval from the supervising court for this specific case. In 2020, however, the BGH judged the consent of a supervisor to compulsorily perform an ECT in schizophrenia as "generally not approvable", as there was no broad medical consensus on this diagnosis.

A refusal of ECT treatment for possible future treatment situations is basically possible through an advance directive in accordance with Section 1901a BGB . For this, however, it is necessary that the disposition is made in the state of judgment and that the possible treatment situation is described in sufficient detail. Checking whether both conditions are met is particularly important in the case of mental illness.

effectiveness

The effectiveness of ECT is largely undisputed among experts, contrary to what the general public might suggest, and has been proven by a number of studies. Scientific studies show that ECT has an antidepressant effect in more than half of patients who do not respond or respond insufficiently to medication. In patients who also suffer from delusions, the effectiveness is even over 90 percent. A 2010 meta-analysis showed improvements in cognitive performance, including memory , 15 days after ECT .

In the guideline Unipolar Depression from 2017 by the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN), the following assessment was made:

“Electroconvulsive therapy (ECT) is recognized as an effective treatment for therapy-resistant and severe depressive disorders. The onset of action is usually quick. The area of ​​application of ECT includes around 80% therapy-resistant depression. If two treatments carried out lege artis (according to professional rules) with antidepressants of different classes of active substances have not led to any improvement, treatment with ECT is indicated (indicated). "

The German Medical Association writes in its “Statement on electroconvulsive therapy (ECT) as a psychiatric treatment measure” from 2003: “Refraining from ECT would mean an ethically unjustifiable restriction of the right of seriously ill patients, who are often at risk of suicides, to the best possible treatment, especially since ECT is retrospectively rated good to very good by the patient. "

criticism

Critical assessments of the ECT are based on study results that take into account the short-term therapeutic effects, the undesirable side effects and the complexity of the method. Meta studies from 2010 and 2017 do not confirm that electroconvulsive therapy has any positive benefits after weighing the advantages and disadvantages.

Mechanism of action

Thymatron II (Somatics) ECT device

In mental illness , improvements after spontaneous epileptic seizures have been observed for many centuries. Since the 1930s it has been shown in detail under controlled conditions that seizures are accompanied by an increased release of neurotransmitters and neurohormones . The effects observed were similar to those of antidepressant substances . In this way, neuroendocrinological disorders are normalized and the impaired signal transmission, in particular of the monoaminergic neurotransmitters serotonin, dopamine and norepinephrine, is restored.

Since the beginning of the 21st century, research has concentrated on the so-called neurotrophic hypothesis , according to which the structure and function of the neuronal networks of the brain are impaired in severe mental illness . Regenerative processes in the nerve tissue could therefore make a contribution to the treatment of these disorders. Whether the ECT is capable of this is the subject of research.

In January 2018, the directory of the US National Library of Medicine ( PubMed ) listed 354 studies for the search query electroconvulsive therapy mechanism . The latest findings on the mechanisms of action were summarized in a review article from 2017.

unwanted effects

The most common undesirable effects of ECT are memory disorders that affect the period before and after ECT use (retrograde and anterograde memory disorders) . These memory disorders occur more frequently after bilateral (bilateral) use of ECT than after unilateral (unilateral) use. Even with repeated use of ECT in a short period of time (high-frequency ECT) , memory disorders are more common. Since a high-frequency ECT cannot achieve a faster onset of effects, this is not recommended due to the increased rate of side effects. Other factors that influence the extent of the memory impairment are where the electrodes are placed, the age and socio-economic status of the patient, and any additional neurological diseases. As a rule, the memory disorders resolve spontaneously after a few hours to days. Retrograde amnesias such as B. Disorders of biographical memory can persist longer. Factors and conditions of neurocognitive side effects in general were systematically compiled in a 2014 review.

For methodological reasons, the long-term effects on memory of ECT treatment are difficult to assess. B. because the mental disorders to be treated with ECT can themselves lead to memory disorders, or because a loss of long-term memory content is in principle difficult to verify. Organic brain damage has not yet been described.

Treatment-related complications such as cardiac arrhythmias, blood pressure dysregulations, and prolonged (prolonged) seizures can occur. Headache, dizziness and sore muscles are common side effects that are treated symptomatically. A switch to hypomanic symptoms rarely occurs . Then further treatment should be given, as ECT is also anti-manic.

Very rare complications correspond to the complications of anesthesia with a mortality risk of 1: 100,000 to 1: 50,000 per single application. This rate corresponds to the death rate from tooth extraction under anesthesia. Overall, according to the opinion of the German Medical Association, ECT carried out lege artis is one of the safest treatment procedures under anesthesia.

Contraindications

Temporary increases in heart rate and blood pressure may occur during ECT. ECT must therefore not be performed if the patient has had a heart attack or cerebral infarction less than three months ago , a vascular sac in the main artery ( aortic aneurysm ), increased intracranial pressure or an acute attack of glaucoma . Even the most severe limitations of heart or lung function are such an absolute contraindication .

In the presence of coronary heart disease , pronounced high blood pressure , a history of stroke, or diseases of the lungs, the risks of the procedure must be weighed against the risks of failure to treat therapy (relative contraindications) . The same applies to cerebral aneurysms or new blood vessels in the brain (cerebral angiomas ).

Pregnancy, old age or the presence of a pacemaker are not contraindications to performing ECT.

history

ECT is a further development of the treatment of mental illnesses using drugs to induce seizures. Both pharmacological and electrical convulsive therapy were developed in the 1930s and, together with the insulin coma treatment developed a few years earlier, represented the first effective therapeutic measures in the treatment of schizophrenic and depressed patients. Occasionally, insulin shock therapy and (electrical) convulsive therapy were used as part of a "combination shock " connected with each other.

ECT quickly replaced pharmacological convulsive therapy, as this was associated with considerable undesirable effects of the drugs used for this purpose (initially camphor , later pentetrazole ).

The Hungarian physician Ladislas J. Meduna (1896–1964) assumed, based on clinical observations on patients and neuropathological findings in the 1920s, that there was an antagonism between schizophrenia and epilepsy. Based on this theory, Meduna carried out animal experiments with camphor from November 1933 . Camphor, a substance used in naturopathy, has long been known that its administration could lead to epileptic seizures. On January 23, 1934, Meduna first performed a camphor injection in a schizophrenic patient, whose condition suddenly improved after the drug-induced epileptic attack. Since the administration of camphor was sometimes accompanied by excruciating anxiety, nausea and muscle pain at the injection sites and an epileptic seizure could not always be safely triggered, Meduna began to use the synthetically manufactured cardiazole instead of camphor , which was easier to control. By 1936, Meduna had administered pharmacological convulsion therapy with Cardiazol in 110 patients. In half of the patients there was an improvement ( remission ). Mainly patients who had only recently developed the mental disorder benefited from the therapy. However, like the use of camphor, the use of cardiazole could lead to considerable undesirable effects. Many psychiatric clinics in Europe and America took over pharmacological convulsion therapy in the following years, until it was replaced by ECT.

The Italian neurologist and psychiatrist Ugo Cerletti (1877–1963), who had been investigating the consequences of electrically triggered epileptic seizures on the brain in animal experiments since the early 1930s, was impressed by Meduna's success and dedicated himself to the question of whether epileptic seizures in humans can also be safely electric could be initiated. Cerletti and his interns Lucio Bini , Ferdinando Accornero and Lamberto Longhi first carried out systematic animal experiments on dogs and pigs. These should clarify where the electrodes would best be attached and how high the currents and voltages to be administered should be in order to trigger epileptic seizures without endangering the patient. In April 1938 they used the new method for the first time on a schizophrenic patient. After eleven therapy sessions, the patient was discharged in an improved condition. After further use of ECT it became clear that it was not possible to cure schizophrenic symptoms. However, since the condition of many patients could be improved, ECT spread rapidly in psychiatric clinics in the following years. Lothar Kalinowsky, who was present at Cerletti's first EKT applications and who emigrated to Paris, then to England and finally to the USA after the outbreak of the Second World War, played a decisive role in the spread of ECT.

A Siemens EKT instrument from the 1960s in the Tekniska Museet Stockholm, developed by Jan-Otto Ottosson , Professor of Psychiatry 1963–1991 in Umeå and Gothenburg

In Germany, Friedrich Meggendorfer (1880–1953) performed the first ECT in his Erlangen clinic on December 1, 1939. By the end of May 1940, 52 patients had been treated there with a total of 790 individual applications. Among the sick there were not only schizophrenics, but also manic-depressive and “ melancholy ” people. From 1942 there was a general change in psychiatry from insulin shock therapy, which was banned on January 24, 1942 due to insulin deficiency caused by the war , to ECT. Meggendorfer himself believed the procedure in 1942 to be far from being the ideal therapy for schizophrenia, but especially in connection with the insulin cure, it was the most promising and, subjectively and objectively, the gentlest for the patient, despite the fractures occurring as complications .

Over the decades, technical improvements, strict safety regulations, quality assurance measures and legal frameworks have been introduced continuously. Medical societies from different countries have documented their positive attitude towards ECT in statements.

Current situation in Germany

In the today exclusively applied in Germany so-called "modified ECT", the treatment under general anesthesia, and muscle relaxation, and with a current of about 0.9  A at up to 480  V . With the exception of muscle twitching in a forearm that has been kept free of relaxants to monitor the cramps, there is no longer any motor cramp. The process is observed and documented with the help of an EEG recording. By changing the stimulus parameters (unipolar rectangular impulses instead of sinusoidal alternating current), the cognitive side effects of ECT are complained much less often, but not completely avoided.

A study from 2008 showed that ECT treatments are carried out at 183 of 423 psychiatric clinics in Germany. Every year around 30,000 ECT treatments are carried out on 2,800 to 4,000 people in Germany, which corresponds to around 0.4 ‰ of all those suffering from depression and 1% of those treated as inpatients. With regard to the acceptance of ECT, a representative study from 2013 showed that the therapy method has largely negative connotations in the German population and is not well known. At the same time it was found that an increased knowledge of the ECT goes hand in hand with an increased approval of the method.

In 2012, the responsible specialist societies in Germany, Austria, Switzerland and South Tyrol recommended in a joint statement the “timely and adequate use of ECT”. In other industrialized countries such as Australia, Denmark, Great Britain and the USA it is used considerably more frequently than in German-speaking countries.

literature

Guidelines

  • National Institute for Health and Care Excellence (NICE): Guidance on the use of electroconvulsive therapy. 2003, updated 2009, no change until 2014 after reviewing the literature, (PDF)
  • Canadian Psychiatric Association: Electroconvulsive Therapy: position paper. 2009. (PDF)
  • American Psychiatric Association : The Practice of Electroconvulsive Therapy. Recommendations for Treatment, Training, and Privileging (A Task Force Report of the American Psychiatric Association). American Psychiatric Pub, Washington DC 2001, ISBN 1-58562-787-9 .
  • DGPPN , BÄK , National Association of Statutory Health Insurance Physicians (KBV), AWMF : S3 guideline: National care guideline for unipolar depression. 2015, pp. 120–123. (PDF)
  • M. Grözinger, A. Conca, J. DiPauli and others: Electroconvulsive therapy: Psychiatric specialist societies from four countries recommend timely and adequate use. In: Neurologist. 83, 2012, pp. 919-921. PDF

science

  • Thomas C. Baghai, Richard Frey, Siegfried Kasper (eds.): Electroconvulsive therapy. Clinical and Scientific Aspects. Springer, Vienna 2003, ISBN 3-211-83879-1 .
  • Here W. Folkerts: Electroconvulsive Therapy. A practical guide for the clinic. Thieme, Stuttgart 1999, ISBN 3-432-27831-4 .
  • Neera Ghaziuddin, Garry Walter (Eds.): Electroconvulsive Therapy in Children and Adolescents. Oxford University Press, 2013, ISBN 978-0-19-993789-9 .
  • Ursula Köberle, Tom Bschor: The importance of electroconvulsive therapy - today. In: Medicinal prescription in practice. Volume 37, Issue 4, July 2010, pp. 77-79. (on-line)
  • SH Lisanby: Electroconvulsive therapy for depression. In: The New England Journal of Medicine . Volume 357, Number 19, November 2007, pp. 1939-1945, doi: 10.1056 / NEJMct075234 . PMID 17989386 . (Review).
  • Mehul V. Mankad, John L. Beyer, Richard D. Weiner, Andrew Krystal: Clinical Manual of Electroconvulsive Therapy. American Psychiatric Pub, Washington DC 2010, ISBN 978-1-58562-898-8 .
  • Jan-Otto Ottosson, Max Fink: Ethics in Electroconvulsive Therapy. Routledge, New York 2004, ISBN 1-135-94004-5 .

counselor

history

  • Jonathan Sadowsky: Electroconvulsive Therapy in America. The Anatomy of a Medical Controversy. (= Routledge Studies in Cultural History. 49). Routledge, New York 2016, ISBN 978-1-315-52283-8 .
  • Edward Shorter , David Healy: Shock Therapy: The History of Electroconvulsive Treatment in Mental Illness. Rutgers University Press, 2007, ISBN 978-0-8135-4169-3 .

Web links

Commons : Electroconvulsive Therapy  - Collection of Images

Medical institutions

Media reports

German speakers

English speakers

Videos

Individual evidence

  1. ↑ Ursula Köberle, Tom Bschor: The importance of electroconvulsive therapy - today. 2010, p. 78.
  2. ↑ a b c d e f g Scientific Advisory Board of the German Medical Association: Electroconvulsive Therapy - Statement on electroconvulsive therapy (ECT) as a psychiatric treatment measure. In: Deutsches Ärzteblatt. Issue 3, March 2003 (PDF).
  3. ^ JE Berg: Intractable schizo-affective disorder successfully treated with electroconvulsive treatment over six years. In: Mental illness. Volume 4, number 2, July 2012, p. E20, doi: 10.4081 / mi.2012.e20 . PMID 25478121 , PMC 4253378 (free full text) (review).
  4. ^ A b R. F. Haskett, C. Loo: Adjunctive psychotropic medications during electroconvulsive therapy in the treatment of depression, mania, and schizophrenia. In: The journal of ECT. Volume 26, Number 3, September 2010, pp. 196-201, doi: 10.1097 / YCT.0b013e3181eee13f . PMID 20805728 , PMC 2952444 (free full text) (review).
  5. ↑ G. Petrides, KG Tobias, CH Kellner, MV Rudorfer: Continuation and maintenance electroconvulsive therapy for mood disorders: review of the literature. In: Neuropsychobiology. Volume 64, number 3, 2011, pp. 129-140, doi: 10.1159 / 000328943 . PMID 21811083 , PMC 3178101 (free full text) (review).
  6. ^ Walter Zimmermann: Care law from AZ: Around 470 keywords on current law. 5th, completely revised edition. CH Beck, Munich 2014, ISBN 978-3-406-66340-6 , preview Google Books .
  7. ↑ § 1906a (2) BGB.
  8. ↑ Federal Court of Justice, decision of January 15 , 2020, file number XII ZB 381/19 , official guidelines : “a) Only compulsory medical measures can be considered necessary, the implementation of which corresponds to a broad medical-scientific consensus. Such a consensus can express itself in particular in scientific statements of the advisory board of the German Medical Association as well as through medical guidelines. b) If the person being cared for with schizophrenia expressly objects to electroconvulsive therapy / electroconvulsive therapy (ECT), the consent of the carer to its compulsory implementation is usually not approvable. "
  9. ↑ Thomas Lorz: Care for mental illnesses: A medical-legal guide with 15 case studies. Kohlhammer, Stuttgart 2015, ISBN 978-3-17-026082-5 , preview Google Books .
  10. ^ B. Micallef-Trigona: Comparing the effects of repetitive transcranial magnetic stimulation and electroconvulsive therapy in the treatment of depression: a systematic review and meta-analysis. In: Depression research and treatment. Volume 2014, p. 135049, doi: 10.1155 / 2014/135049 . PMID 25143831 , PMC 4131106 (free full text) (review).
  11. ^ B. Dierckx, WT Heijnen, WW van den Broek, TK Birkenhäger: Efficacy of electroconvulsive therapy in bipolar versus unipolar major depression: a meta-analysis. In: Bipolar disorders. Volume 14, Number 2, March 2012, pp. 146-150, doi: 10.1111 / j.1399-5618.2012.00997.x . PMID 22420590 (Review), PDF (accessed December 23, 2017).
  12. ↑ D. Pagnin, V. de Queiroz, S. Pini, GB Cassano: Efficacy of ECT in depression: a meta-analytic review. In: The journal of ECT. Volume 20, Number 1, March 2004, pp. 13-20. PMID 15087991 (Review).
  13. ^ Swedish Council on Health Technology Assessment: Treatment of Depression: A Systematic Review [Internet]. PMID 28876724 (free full text).
  14. ↑ The renaissance of electroconvulsive therapy - electric shocks not only help depressed people. (aerztezeitung.de)
  15. ↑ M. Semkovska, DM McLoughlin: Objective cognitive performance associated with electroconvulsive therapy for depression: a systematic review and meta-analysis. In: Biological psychiatry. Volume 68, Number 6, September 2010, pp. 568-577, doi: 10.1016 / j.biopsych.2010.06.009 . PMID 20673880 (Review).
  16. ↑ S3-guideline / National care guideline Unipolar Depression, short version, 2nd edition. 2017.
  17. ^ Read, John; Arnold, Chelsea: Is Electroconvulsive Therapy for Depression More Effective Than Placebo? A Systematic Review of Studies Since 2009 . In: thical Human Psychology and Psychiatry . tape 19 , no. 1 . Springer Publishing Company, 2017, p. 5-23 , doi : 10.1891 / 1559-4343.19.1.5 .
  18. ↑ Read John, Bentall Richard: The effectiveness of electroconvulsive therapy: A literature review . In: Epidemiology and Psychiatric Sciences . tape 19 , no. 04 , December 2010, p. 333-347 , doi : 10.1017 / S1121189X00000671 ( cambridge.org ).
  19. ^ E. Shorter, D. Healy: Shock Therapy: A History of Electroconvulsive Treatment in Mental Illness. Rutgers University Press, 2012, ISBN 978-0-8135-5425-9 , Chapter 2.
  20. ↑ J. Scharfetter, R. Frey, S. Kasper: Biological foundations of EKT. In: T. Baghai, H. Möller, R. Frey, S. Kasper: Electroconvulsion Therapy : Clinical and Scientific Aspects. 1st edition. Springer, Vienna 2004, ISBN 3-211-83879-1 .
  21. ^ TG Bolwig: How does electroconvulsive therapy work? Theories on its mechanism. In: Canadian journal of psychiatry. Revue canadienne de psychiatrie. Volume 56, Number 1, January 2011, pp. 13-18. PMID 21324238 (Review).
  22. ↑ K. Ishihara, M. Sasa: Mechanism underlying the therapeutic effects of electroconvulsive therapy (ECT) on depression. In: Japanese journal of pharmacology. Volume 80, Number 3, July 1999, pp. 185-189. PMID 10461762 (Free full text) (Review).
  23. ↑ RS Duman, LM Monteggia: A neurotrophic model for stress-related mood disorders. In: Biological psychiatry. Volume 59, Number 12, June 2006, pp. 1116-1127, ISSN  0006-3223 . doi: 10.1016 / j.biopsych.2006.02.013 . PMID 16631126 . (Review).
  24. ↑ D. Taliaz, V. Nagaraj, S. Haramati, A. Chen, A. Zangen: Altered Brain-Derived Neurotrophic Factor Expression in the Ventral Tegmental Area, but not in the Hippocampus, Is Essential for Antidepressant-Like Effects of Electroconvulsive Therapy . In: Biological psychiatry. August 2012, ISSN  1873-2402 . doi: 10.1016 / j.biopsych.2012.07.025 . PMID 22906519 .
  25. ↑ A. Minelli, R. Zanardini, M. Abate, M. Bortolomasi, M. Gennarelli, L. Bocchio-Chiavetto: Vascular Endothelial Growth Factor (VEGF) serum concentration during electroconvulsive therapy (ECT) in treatment resistant depressed patients. In: Progress in Neuro-Psychopharmacology & Biological Psychiatry . Volume 35, Number 5, July 2011, pp. 1322-1325, ISSN  1878-4216 . doi: 10.1016 / j.pnpbp.2011.04.013 . PMID 21570438 .
  26. ^ M. Wennström, J. Hellsten, A. Tingström: Electroconvulsive seizures induce proliferation of NG2-expressing glial cells in adult rat amygdala. In: Biological psychiatry. Volume 55, Number 5, March 2004, pp. 464-471, ISSN  0006-3223 . doi: 10.1016 / j.biopsych.2003.11.011 . PMID 15023573 .
  27. ↑ A. Singh, SK Kar: How Electroconvulsive Therapy Works ?: Understanding the Neurobiological Mechanisms. In: Clinical psychopharmacology and neuroscience: the official scientific journal of the Korean College of Neuropsychopharmacology. Volume 15, number 3, August 2017, pp. 210-221, doi: 10.9758 / cpn.2017.15.3.210 . PMID 28783929 , PMC 5565084 (free full text) (review).
  28. ↑ LM Fraser, RE O'Carroll, KP Ebmeier: The effect of electroconvulsive therapy on autobiographical memory: a systematic review . In: J ECT . tape 24 , no. 1 , March 2008, p. 10-17 , doi : 10.1097 / YCT.0b013e3181616c26 , PMID 18379329 ( wkhealth.com ).
  29. ↑ D. Rose, P. Fleischmann, T. Wykes, M. Leese, J. Bindman: Patients' perspectives on electroconvulsive therapy: systematic review . In: BMJ . tape 326 , no. 7403 , June 2003, p. 1363 , doi : 10.1136 / bmj.326.7403.1363 , PMID 12816822 , PMC 162130 (free full text).
  30. ↑ Harold A. Sackeim, Joan Prudic, Rice Fuller, John Keilp, Philip W Lavori, Mark Olfson: The Cognitive Effects of Electroconvulsive Therapy in Community Settings . In: Neuropsychopharmalogy . No. 32 , 23 August 2006, p. 244-254 ( nature.com ).
  31. ↑ SM McClintock, J. Choi, ZD Deng, LG Appelbaum, AD Krystal, SH Lisanby: Multifactorial determinants of the neurocognitive effects of electroconvulsive therapy. In: The journal of ECT. Volume 30, Number 2, June 2014, pp. 165-176, doi: 10.1097 / YCT.0000000000000137 . PMID 24820942 , PMC 4143898 (free full text) (review).
  32. ↑ German Medical Association: Electroconvulsive Therapy ( Memento from July 1, 2007 in the Internet Archive )
  33. ↑ DGPPN, BÄK, KBV, AWMF: S3 Guideline / National Care Guideline Unipolar Depression. Long version. 2nd Edition. Version 5, 2015, p. 122 (PDF)
  34. ↑ a b c d e f g h i U. Grundmann, SO Schneider: Anesthesia for electroconvulsive therapy. In: The anesthesiologist. Volume 62, Number 4, April 2013, pp. 311-322, doi: 10.1007 / s00101-013-2152-3 . PMID 23558716 (Review).
  35. ↑ H.-J. Möller, TC Baghai: Current information. (PDF; 65 kB) Ludwig Maximilians University Munich , accessed on August 14, 2012 .
  36. ↑ Deutsches Ärzteblatt. 100, 2003, pp. A-504.
  37. ↑ Otto Benkert, Hanns Hippius : Compendium of Psychiatric Pharmacotherapy . 10th edition. Springer, Berlin / Heidelberg 2015, ISBN 978-3-642-54769-0 , pp. 39 ( limited preview in Google Book search).
  38. ↑ Michael Grözinger, Andreas Conca, Thomas Nickl-Jockschat, Jan Di Pauli: Electroconvulsion therapy compact: For referring physicians and users. Springer-Verlag, 2014, p. 9, preview in (books.google.de)
  39. ^ A b c Edward Shorter : History of Psychiatry. Rowohlt Verlag, Reinbek 2003, ISBN 3-499-55659-6 , pp. 326-335.
  40. ↑ Thomas C. Baghai, Richard Frey, Siegfried Kasper: electroconvulsive therapy. Clinical and Scientific Aspects . Springer, Vienna 2004, p. 12; Cornelius Borck: brain waves. A cultural history of electroencephalography . Wallstein, Göttingen 2005, pp. 253-255.
  41. ↑ Scientific Advisory Board of the German Medical Association: Statement on electroconvulsive therapy (ECT) as a psychiatric treatment measure. In: Deutsches Ärzteblatt . 100 (8), pp. A504-A506.
  42. ↑ M. Grözinger, A. Conca, J. DiPauli and others: Electroconvulsive therapy: Psychiatric specialist societies from four countries recommend timely and adequate use. In: Neurologist. 83, 2012, pp. 919-921. (PDF)
  43. ^ A. Conca et al.: Official EKT consensus paper of the ÖGPP - The electroconvulsive therapy: theory and practice. (PDF).
  44. ^ Richard D. Weiner: The Practice of Electroconvulsive Therapy. A Task Force Report of the American Psychiatric Association. (= APA Guidelines ). In: Amer Psychiatric. 2nd Edition. 2001, ISBN 0-89042-206-0 .
  45. ↑ DGPPN , BÄK , National Association of Statutory Health Insurance Physicians (KBV), AWMF : S3 guideline: National care guideline for unipolar depression. 2015, pp. 120–123. (PDF)
  46. ^ List of ECT clinics
  47. ↑ M. Grozinger, A. Conca, T. Nickl-Jockschat, J. Di Pauli (eds.): Elektrokonvulsionstherapie Kompakt. For referring physicians and users. Springer Verlag, Heidelberg 2013, ISBN 978-3-642-25628-8 , p. 28.
  48. ^ HW Folkerts: Electroconvulsive therapy - indication, implementation and treatment results. In: The neurologist. 1/2011. Springer Verlag, Heidelberg.
  49. ^ S. Wilhelmy, V. Rolfes, M. Grözinger, Y. Chikere, S. Schöttle, D. Groß: Knowledge and attitudes on electroconvulsive therapy in Germany: A web based survey. In: Psychiatry Research. Volume 262, April 2018, pp. 407-412, doi: 10.1016 / j.psychres.2017.09.015
  50. ↑ M. Grözinger, A. Conca, J. DiPauli and others: Electroconvulsive therapy: Psychiatric specialist societies from four countries recommend timely and adequate use. In: Neurologist. 83, 2012, pp. 919-921. (PDF)
  51. ↑ Michael Grözinger, Andreas Conca, Thomas Nickl-Jockschat, Jan Di Pauli: Elektrokonvulsionstherapie compact. For referring physicians and users. Springer-Verlag, Berlin 2013, ISBN 978-3-642-25629-5 .