Electroconvulsive Therapy Is an Essential Procedure

Back to table of contents Previous article Next CommentaryFull AccessElectroconvulsive Therapy Is an Essential ProcedureDaniel F. Maixner, M.D., Richard Weiner, Ph.D., Irving M. Reti, M.B.B.S., Adriana P. Hermida, Mustafa Husain, Dane Larsen, B.A., William McDonald, M.D.Daniel MaixnerSearch for more papers by this author, WeinerSearch RetiSearch HermidaSearch HusainSearch LarsenSearch McDonaldSearch M.D.Published Online:12 May 2021https://doi.org/10.1176/appi.ajp.2020.20111647AboutSectionsView articleView PDFView EPUB ToolsAdd favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View articleThe COVID-19 pandemic is dramatically affecting mental health and the treatment psychiatric illness. Isolation stress are associated with worsening symptoms, substance abuse, suicidality (1). For those most severe forms depression other illnesses, electroconvulsive therapy (ECT) a critical often lifesaving strategy, but COVID-19, administration ECT has been markedly disrupted.Because need bag mask ventilation during anesthesia, patients highly infectious respiratory conditions poses substantial risk care workers patients, given potential aerosolizing viral droplets. Early in pandemic, Centers Medicare Medicaid Services issued guidance focused on limiting nonemergent elective medical conserve resources reduce infection rates within tiered acuity framework (2). Many institutions classified as procedure or were concerned about scarce personal protective equipment anesthesiology resources, leading flurry concerns from clinicians, families (3). These led APA National Network Depression publish position statements calling continued availability (4, 5).To better understand actual extent impact practice United States, Task Group Centers, consortium 27 U.S. academic institutions, surveyed members effects 20 programs. During April 2020, 80% (16 20) programs reported operating at less than 50% regular clinical volume, some substantially greater declines. teams psychiatrists nurses scrambled postpone cancel appointments many who acute maintenance courses. In addition, 95% required delay defer new starting ECT. Most importantly, our survey documented patient outcomes that alarming: caused scheduling changes decompensation hospitalization (70% institutions) courses whose was stopped curtailed (80% institutions). There one death suicide, 15% sites least serious suicide attempt service reductions imposed COVID-19. What may never be known any untoward among did not receive timely consultations.Fortunately, late spring along improved equipment, testing protocols, increasingly productive collaborations prevention teams, half able ramp up 75% typical load early June 2020. Our demonstrates despite worldwide vulnerable can sophisticated safety protocols developed providers.A resurgence cases winter 2020–2021 across States raised renewed again affected, disastrous implications patients. Hospital administrators leadership fall into urgent emergent categories disruption deferral increases risks relapse, hospitalizations, population. Thus, it imperative continue considered essential when illness present, whether crisis future pandemic.Department Psychiatry, University Michigan, Ann Arbor (Maixner); Department Psychiatry Behavioral Sciences, Duke School Medicine, Durham, N.C. (Weiner); Johns Hopkins Baltimore (Reti); Emory Atlanta (Hermida, McDonald); Texas Southwestern Medical Center, Dallas (Husain); Arbor, Mich. (Larsen).Send correspondence Dr. Maixner ([email protected]).Dr. received research support study ketamine travel expenses development he funding Neuronetics St. Jude Medical. Reti grant Brain Behavior Research Foundation, Dana Defense, Hope NIH, Patient-Centered Outcomes Institute, Simons Foundation Autism Initiative, had contracts BrainsWay, John Wiley & Sons, Neuronetics. Hermida Institute Aging. Husain and/or BRAIN NIMH, Aging, Neurological Disorders Stroke, Stanley Foundation. Mr. Larsen serves executive director Centers. McDonald member Council representing neuromodulation therapies; receives compensation chair data monitoring board Aging; Wounded Warrior Project part Veterans Program; royalties Oxford Press; Skyland Trail 3Keys; paid consultant Signant Health Parallel Georgia; J.B. Fuqua Cervel Neurotherapeutics, Neuronetics, NeoSync, Soterix, Weiner reports no financial relationships commercial interests.References1 Czeisler MÉ , Lane RI Petrosky E et al. : Mental health, use, suicidal ideation pandemic: 24–30, 2020 . MMWR Morb Mortal Wkly Rep ; 69 1049 – 1057 Crossref, Medline, Google Scholar2 (CMS): Non-emergent, services, recommendations. CMS, Baltimore, (https://www.cms.gov/files/document/cms-non-emergent-elective-medical-recommendations.pdf)Google Scholar3 Espinoza RT Kellner CH McCall WV Electroconvulsive COVID-19: procedure: maintaining viability accessibility J 36 78 79 Scholar4 American Psychiatric Association (APA): procedure. APA, Washington, DC, (https://www.psychiatry.org/psychiatrists/covid-19-coronavirus)Google Scholar5 (NNDC): NNDC urges officials consider service. NNDC, Mich, (https://nndc.org/nndc-urges-medical-officials-to-consider-ect-an-essential-medical-service)Google Scholar FiguresReferencesCited byDetailsCited ByScientific Advances Supporting New Improved Treatment Strategies PsychiatryNed H. Kalin, M.D.12 2021 | Journal Vol. 178, No. 5 Volume 178Issue 01, 2021Pages 381-382 Metrics KeywordsCoronavirus/COVID-19Electroconvulsive History Accepted 22 December Published online 12 print 1