Electroconvulsive Therapy Services Research Articles

Extended course accelerated intermittent theta burst stimulation as a substitute for depressed patients needing electroconvulsive therapy.

In response to restrictions on electroconvulsive therapy (ECT) access during COVID-19, we designed a trial to assess the clinical outcomes service impacts, employing an extended course of accelerated intermittent theta burst stimulation (aiTBS), in patients with moderate to severe depression in need of ECT. This open label clinical trial was comprised of 3 phases: (i) an acute phase, where iTBS treatments were administered 8 times daily, for up to 10 days; (ii) a tapering phase of 2 treatment days per week for 2 weeks, followed by 1 treatment day per week for 2 weeks; and (iii) a symptom-based relapse prevention phase, whereby treatments were scheduled based on symptom re-emergence, for up to 6 months. Of the 155 patients who completed the acute phase of the study, the remission rate was 16.1%. The mean reduction from baseline on the HRSD-24 was 29.4% (p < 0.001) and the response rate was 25.2%. Of the 110 patients who completed the tapering phase, the mean reduction from baseline was 42.6% (p < 0.001) and response and remission rates were 49.6% and 34.8%, respectively. Of the 61 patients who were eligible for the relapse prevention phase, 43 completed, with a mean reduction from baseline of 60.1% (p < 0.001); 7 patients relapsed during this phase. This study demonstrated that an extended aiTBS protocol safely led to meaningful clinical outcomes in patients with severe depression, who otherwise would have received ECT, and thus reduced pressure on ECT services during the pandemic. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04384965 ( https://clinicaltrials.gov/study/NCT04384965?term=NCT04384965&rank=1 ).

Gender Representation in the ECT Workforce in the United States From 2013 to 2021: A Medicare Physician Data Analysis.

Electroconvulsive therapy (ECT) is an effective treatment for a range of psychiatric disorders. Although much research has examined what patients receive ECT, there is less research describing those physicians who provide ECT services. This study examines the ECT workforce in the United States by analyzing publicly available Medicare billing records. Data regarding the providers performing ECT were accessed from the Medicare Physician and Other Supplier Data for the years 2013 through 2021 based on those physicians who billed the ECT procedural code 90870. During the study period, 1402 physicians performed ECT in at least 1 calendar year on a minimum of 11 Medicare beneficiaries, representing 3.9% of the 36,116 psychiatrists who billed Medicare during this period. Female physicians made up 39% of psychiatrists overall who bill Medicare, but 23% of psychiatrists billing for ECT. Fifty percent of billed ECT treatments were performed by 12% of ECT doctors; among these high-volume ECT providers, 16% were female. Only a small subset of psychiatrists who bill Medicare provide ECT services, and female physicians are under-represented in the ECT workforce and among high-volume ECT providers. Improving workforce equity and with it access to ECT requires further study of psychiatric training and practice environment that may impose barriers on female participation as ECT providers.

Availability of Electroconvulsive Therapy in Public Health Services in the Last Decade in Brazil.

To identify the current treatment options for electroconvulsive therapy (ECT) therapy in public services linked to the Unified Health System in Brazil and compare them with data published in 2012 based on their availability. In this retrospective observational study, we mapped institutions that perform ECT under public health services in Brazil. A questionnaire was administered to active and inactive service centers between August 2022 and June 2023. We identified 16 institutions that performed ECT, including 12 linked to public universities and 4 with various links. In the last decade, 2 new public services that perform ECT in the country have emerged, whereas 4 services have ceased function. In 2022, the number of individuals treated with ECT per 100,000 population was 1.86, whereas the number of procedures performed per 100,000 people was 6.55. Although 2 new public ECT services have been identified, 4 have turned inactive. Most services are linked to public universities, and inactive service points to financial issues as the main factor in service interruption. Brazil has one of the lowest rates of individuals treated with ECT per 100,000 population compared with countries in North America and Europe. Thus, it is essential to raise awareness to improve ECT adoption rates and bring it out of the shadows in Brazil.

COVID-19 Pandemic and the Provision for Electroconvulsive Therapy and Other Non-Invasive Brain Stimulation in India: A Template for Future Pandemics.

The coronavirus disease (COVID-19) has emerged as a major public health concern worldwide. While containing the infection and caring for the ill has been a focus over the last 2 years, there has also been a burgeoning concern for mental health issues during this never-ending pandemic. The focus of health care machinery prioritized confronting and containing the pandemic that had majorly side-lined other aspects of public health. This also impacted persons with mental illness (PMI) requiring Electroconvulsive Therapy (ECT), an often essential and life-saving treatment and thus an essential procedure. ECT and other non-invasive brain stimulation (NIBS) services have seen a setback during this pandemic both in terms of its accessibility by the PMI and in effectively delivering its benefits by psychiatrists. In this article, we will be discussing the problems with provision and delivery of ECT services as well as other NIBS during this pandemic with a brief outline on the solutions for such with special focus on a developing country like India. This article will also endeavour in providing a roadmap in the delivery and provision of NIBS modalities of therapy for future pandemics, if any.

Impact on Electroconvulsive Therapy Services, Including Patient Relapse and Death, During the COVID-19 Pandemic: Quantitative Results From a Multinational Survey.

Electroconvulsive therapy (ECT) is important in the management of major, life-threatening, and treatment-resistant psychiatric illness. The COVID-19 pandemic has significantly disrupted ECT services. The need for new infection control measures, staff redeployment and shortages, and the perception that ECT is as an "elective" procedure have caused changes to, and reductions in, ECT delivery. The aim of this study was to explore the impact of COVID-19 on ECT services, staff, and patients globally. Data were collected using an electronic, mixed-methods, cross-sectional survey. The survey was open from March to November 2021. Clinical directors in ECT services, their delegates, and anesthetists were asked to participate. Quantitative findings are reported. One hundred and twelve participants worldwide completed the survey. The study identified significant impacts on services, staff, and patients. Importantly, most participants (57.8%; n = 63) reported their services made at least 1 change to ECT delivery. More than three-quarters (81.0%; n = 73) reported that their service had identified at least 1 patient who could not access ECT. More than two-thirds (71.4%; n = 67) reported that their service identified patients who experienced a relapse in their psychiatric illness due to lack of ECT access. Six participants (7.6%) reported that their service had identified at least 1 patient who died, by suicide or other means, due to lack of ECT access. All ECT practices surveyed were impacted by COVID-19 with decreases in capacity, staffing, changes in workflow, and personal protective equipment requirements with relatively little change to ECT technique. Lack of access to ECT resulted in significant morbidity and mortality, including suicide, internationally. This is the first multisite, international survey to explore the impacts of COVID-19 on ECT services, staff, and patients.

Strategies from A Multi-National Sample of Electroconvulsive Therapy (ECT) Services: Managing Anesthesia for ECT during the COVID-19 Pandemic

Electroconvulsive therapy (ECT) is important in the management of severe, treatment-resistant, and life-threatening psychiatric illness. Anesthesia supports the clinical efficacy and tolerability of ECT. The COVID-19 pandemic has significantly disrupted ECT services, including anesthesia. This study documents strategies for managing ECT anesthesia during the pandemic. Data were collected between March and November 2021, using a mixed-methods, cross-sectional, electronic survey. Clinical directors in ECT services, their delegates, and anesthetists worldwide participated. One hundred and twelve participants provided quantitative responses to the survey. Of these, 23.4% were anesthetists, and the remainder were ECT clinical directors. Most participants were from Australia, New Zealand, North America, and Europe. Most were located in a public hospital, in a metropolitan region, and in a ‘medium/high-risk’ COVID-19 hotspot. Half of the participants reported their services made changes to ECT anesthetic technique during the pandemic. Services introduced strategies associated with anesthetic induction, ventilation, use of laryngeal mask airways, staffing, medications, plastic barriers to separate staff from patients, and the location of extubation and recovery. This is the first multi-national, mixed-methods study to investigate ECT anesthesia practices during the COVID-19 pandemic. The results are vital to inform practice during the next waves of COVID-19 infection, ensuring patients continue to receive ECT.

Electroconvulsive Therapy Practice in Thailand: A Nationwide Survey.

To determine the characteristics of electroconvulsive therapy (ECT) practice in Thailand. A cross-sectional survey of ECT practice in Thailand was conducted. A questionnaire was sent to all 34 hospitals providing ECT services nationwide. ECT staff of each hospital were asked to complete the questionnaire. All 34 hospitals responded to the survey. The most common diagnosis was schizophrenia (5,958 patients/year), followed by bipolar disorder (982 patients/year) and major depressive disorder (869 patients/year). Brief pulse device was used in all hospitals. Bitemporal ECT was the most common type of electrode placement (88.2%), followed by bifrontal (44.1%) and right unilateral (38.2%) placement. The initial dose was determined by titration method in 24 hospitals (70.6%) and by age-based method in the remainder (29.4%). Modified ECT was always used in 25 hospitals (73.5%), including all university hospitals, 6 psychiatric hospitals (17.6%) and 10 general hospitals (29.4%). The primary anesthetics used were thiopentone (60.7%) and propofol (39.3%). Regarding acute ECT, ECT was performed three times per week in most hospitals (91.2%). The number of acute ECT treatment sessions in most hospitals was in the range of 4-6. In total, 22 hospitals (64.7%) performed continuation/maintenance ECT. Headache was the most common adverse event, followed by cognitive side effects and myalgia. ECT practice in Thailand has developed over the past two decades in many aspects. The most notable change is that the majority of patients are now treated with modified ECT. In addition, pre-treatment investigations, use of a device providing a brief pulse, unilateral electrode placement, and the monitoring of parameters during treatment are now used more widely in practice to maximize treatment efficacy while minimizing side effects. However, certain aspects of ECT can still be improved; promoting ECT education among psychiatrists and psychiatry residents could improve the quality of practice, for example.

"ECT should never stop": Exploring the experiences and recommendations of ECT clinical directors and anesthetists about ECT during the COVID-19 pandemic.

Electroconvulsive therapy (ECT) is an effective treatment option for severe, treatment-resistant, and life-threating psychiatric illness. The COVID-19 pandemic has significantly disrupted ECT services. Services across North America, Europe, and Australia have reported decreased ECT delivery, and changes in the ways ECT is delivered. This study aimed to identify the impacts of COVID-19 on ECT services globally by exploring clinicians' experiences about ECT during the pandemic, and their recommendations for reducing the negative impacts of the pandemic. Data were collected using an electronic, cross-sectional survey, which included elicitation of free-text responses. The survey was open from March to November 2021. Clinical directors in ECT services, their delegates, and anesthetists were invited to participate. This paper reports the qualitative analysis of responses provided. Fifty-two participants provided qualitative response/s; 74.5% were clinical directors or their delegates, and 25.5% were anesthetists. Greater than one-third of participants were from Australia/New Zealand, and there was also representation from North America, Europe, and the UK. Participants' responses were detailed, averaging 43 words. Three themes were identified: (1) Service provision, about the importance of ECT services continuing during the pandemic, (2) Preparedness, through guidelines and environmental design, and (3) Personal protection, about strategies to increase staff safety. This is the first multi-site, international study to document the experiences and recommendations of ECT clinical directors and anesthetists about the effect of COVID-19 on ECT practice. The findings inform evidence-based practice, and ensure people with major psychiatric illnesses continue to receive ECT during the pandemic.

Provision of Electroconvulsive Therapy During the COVID-19 Pandemic: A Survey Among Clinics in Germany, Austria, and Switzerland.

The coronavirus disease 2019 (COVID-19) pandemic has had a marked impact on psychiatry. Capacity reductions also affected electroconvulsive therapy (ECT), even though ECT is an essential rather than an elective procedure. We sent a survey to all 197 clinics in Germany, Austria, and Switzerland with an ECT service between March and May 2021 to provide an overview of the changes made to ECT services in these countries during the acute phase of the COVID-19 pandemic. More than a quarter of the clinics (27.0%) reported a temporary suspension of all ECT treatments, and 28.2% of the clinics reported reductions of up to 75%. Maintenance ECT was suspended in 46.7% of the clinics and reduced by up to 75% in 30.6% of the clinics. At the time of the survey, 40.8% of the clinics still reported lower numbers of ECT treatments compared with the prepandemic situation. Reasons for the reduced number of ECT treatments included patient safety and testing measures, personnel shortages in the anesthesiology departments, and limited availability of rooms. The COVID-19 pandemic had and continues to have a marked negative impact on the provision of ECT in clinics in Germany, Austria, and Switzerland. To avoid negative consequences for patients, ECT clinics should urgently take steps to provide ECT services without disruptions.

Historical Highlights on Electroconvulsive Therapy Practice in Iraq: A Brief Narrative.

Electroconvulsive therapy (ECT) is an established treatment option for severe psychiatric disorders. Electroconvulsive therapy practice began in Iraq in 1946, primarily to treat patients with schizophrenia. Since then, it has developed and expanded to treat mood disorders and major depression. Initially, both modified and unmodified ECT was administered to patients in Ibn Rushd and Al Rashad mental hospitals in Baghdad. The ongoing political turmoil from 3 wars, economic sanctions, and internal conflicts halted the development of mental health services across the country; ECT provision was not an exception. The practice of unmodified ECT-without general anesthesia-ceased in 2009, after the recommendations of the Royal College of Psychiatrists' Iraq Subcommittee. This closure reduced the availability and accessibility of ECT clinics nationwide because of limited access to general anesthesia. This article explores the nature of ECT services, in the context of Iraq's health care system, sociocultural norms, instability, and international codes of practice. This brief report uses the first author's work experience, few available data, and personal communication to describe the brief history of ECT practice in Iraq. This report is a baseline document for future ECT practice regulation in Iraq.

Electroconvulsive Therapy in Canada During the First Wave of COVID-19: Results of the "What Happened" National Survey.

The COVID-19 pandemic has disrupted the provision of essential and potentially life-saving procedural treatments such as electroconvulsive therapy (ECT). We surveyed ECT providers across Canada to understand how the first wave of the pandemic affected ECT delivery between mid-March 2020 and mid-May 2020. The survey was administered to ECT team members and decision makers at 107 Canadian health care centers with a focus on 5 domains: operations, decision-making, hospital resources, ECT procedure, and patient impact. Responses were obtained from 72 institutions, and collected answers were used to derive representative responses reflecting the situation at each ECT center. For specific domains, responses were split into 2 databases representing the perspective of psychiatrists (n = 67 centers) and anesthesiologists (n = 24 centers). Provision of ECT decreased in 64% centers and was completely suspended in 27% of centers after the onset of the pandemic. Outpatient and maintenance ECT were more affected than inpatient and acute ECT. Programs reported a high level of collaboration between psychiatry and hospital leadership (59%) but a limited input from clinical ethicists (18%). Decisions were mostly made ad hoc leading to variability across institutions in adopted resource allocation, physical location of ECT delivery, and triaging frameworks. The majority of centers considered ECT to be aerosol-generating and incorporated changes to airway management. Electroconvulsive therapy services in Canada were markedly disrupted by the COVID-19 pandemic. The variability in decision-making across centers warrants the development of a rational approach toward offering ECT in pandemic contexts.

Electroconvulsive therapy services during COVID-19 pandemic.

The COVID-19 pandemic has hit the electroconvulsive therapy (ECT) services hard worldwide as it is considered an elective procedure and hence has been given less importance. Other reasons include the risk of transmission of infections, lack of resources, and the scarcity of anesthesiologists due to their diversion to intensive care units to manage COVID-19 patients. However, ECT is an urgent and life-saving measure for patients diagnosed with depression and other severe mental illnesses who have suicidality, catatonia, or require a rapid therapeutic response. COVID-19 pandemic is a significant source of stress for individuals due to its impact on health, employment, and social support resulting in new-onset psychiatric illnesses and the worsening of a pre-existing disorder. Hence, a continuation of the ECT services during the COVID-19 pandemic is of paramount importance. In this narrative review, the authors from India have compiled the literature on the ECT practice during the COVID-19 pandemic related to the screening and testing protocol, necessity of personal protective equipment, modification in ECT Suite, electrical stmulus settings, and anesthesia technique modification. The authors have also shared their experiences with the ECT services provided at their institute during this pandemic. This description will help other institutes to manage the ECT services uninterruptedly and make ECT a safe procedure during the current pandemic.

Caring for Older Adults with Depression Receiving Electroconvulsive Therapy (ECT) During the 2020 Pandemic

<h3>Introduction</h3> Caregivers are essential in providing valuable patient information to medical providers, such as recent changes in health, family history, previous hospitalizations, and medication reactions. Caring for elderly patients with a mental illness, in particular, is a unique and challenging job that may lead to caregiver stress and inability to provide proper care. As a result, patients with stressed caregivers are at increased risk of elder neglect and abuse. With limited available research investigating caregiver burden among those caring for patients receiving ECT and the new life challenges presented by the 2020 pandemic, it is more important than ever to take a closer look at the caregivers' experiences. <h3>Methods</h3> Emory's Wesley Woods Geriatric Hospital is one of the busiest ECT services in the country with around 2000 treatments completed every year. In this study, researchers are expecting to enroll and interview 25 caregivers of patients receiving ECT using the Zarit Caregiver Burden Interview. This assessment includes 22 questions assessing the nature and frequency of caregiver emotions when caring for their dependents in order to examine the impact of the patient's condition on caregiver wellbeing. The score ranges from 0 (no burden) to 88 (severe burden) and the questions cover information about the caregivers' current emotional state and struggles. Other objective assessments completed with ECT patients are BDI (Beck Depression Inventory), BDI Suicide, Sheehan Disability Scale, ECCA (Electrocompulsive Cognitive Assessment), GAD-7 (Generalized Anxiety Disorder Scale), and CGI (Clinical Global Impression). The purpose of these interviews is to investigate whether the higher severity of depression in patients correlates with higher levels of caregiver burden and whether the pandemic contributed to caregiver burden. <h3>Results</h3> The Zarit Caregiver Burden Interview has been administered on five patients (n=5) currently undergoing ECT for depressive symptoms. Additional patients are being interviewed in the ECT suite and further data collected will be presented at the 2021 AAGP Annual Meeting. <h3>Conclusions</h3> As the world adjusts to life in the COVID-19 era, caregivers face new challenges in providing care for vulnerable, at-risk populations. Caregivers of patients receiving ECT facilitate frequent COVID testing and limited visitation policies while continuing to provide care and emotional support to patients with advanced age and a mental illness. The main focus of the medical team is typically on patients; however, caregivers fill an essential role in the care of our geriatric patients receiving ECT and it is equally as important to be mindful of caregivers' experiences in order to catch and potentially prevent serious consequences resulting from caregiver burnout. Administrating the Zarit Caregiver Burden Interview can help providers look at the degree of burden in caregivers of patients receiving ECT for depressive symptoms and provide better caregiving strategies during the 2020 pandemic. <h3>Funding</h3> Not Applicable

Reflections on Advanced Practice of Nurse Administered ECT as a Treatment Resource during the COVID-19 Pandemic

Background: With Electro-Convulsive Therapy (ECT) during the COVID-19 pandemic at risk, nurse administered ECT has become a treatment resource. This study aims to investigate the experiences of two senior ECT nurses practicing Nurse Administered ECT. Method: Qualitative reflective interviews were conducted; the data was then analyzed and presented as corresponding themes for inductive data driven analysis. Each nurse was asked to recall positive and negative events from their practice and describe how their experiences have enabled them to cope. Results: Theme 1: The nurse’s competence is positively influenced by feedback, leading to enhancement of personal and professional development. Theme 2: During the COVID-19 pandemic, nurses report an increased sense of teamwork among staff, and feel that “we are all in this together”. Theme 3: The nurse’s ability to manage difficult situations is dependent on their education, individual knowledge, and experience. Limitations: The authors had the role of both researcher and participant. Conclusion: This study found that both nurses valued feedback above any medical and technical skills they had acquired. This strengthened their advanced practice enabling them to handle difficult situations with confidence. The COVID 19 pandemic has led to advanced nursing practice replacing the junior doctor role within ECT treatment. The nurses felt this had been recognised by their organisation and has led to an increased pride in their work. This paper would suggest that Nurse administered ECT is a valuable resource and that, future nurses could be at the forefront of delivering ECT services.

Electroconvulsive Therapy Practice Changes in Older Individuals Due to COVID-19: Expert Consensus Statement

The ubiquitous coronavirus 2019 (COVID-19) pandemic has required healthcare providers across all disciplines to rapidly adapt to public health guidelines to reduce risk while maintaining quality of care. Electroconvulsive therapy (ECT), which involves an aerosol-generating procedure from manual ventilation with a bag mask valve while under anesthesia, has undergone drastic practice changes in order to minimize disruption of treatment in the midst of COVID-19. In this paper, we provide a consensus statement on the clinical practice changes in ECT specific to older adults based on expert group discussions of ECT practitioners across the country and a systematic review of the literature. There is a universal consensus that ECT is an essential treatment of severe mental illness. In addition, there is a clear consensus on what modifications are imperative to ensure continued delivery of ECT in a manner that is safe for patients and staff, while maintaining the viability of ECT services. Approaches to modifications in ECT to address infection control, altered ECT procedures, and adjusting ECT operations are almost uniform across the globe. With modified ECT procedures, it is possible to continue to meet the needs of older patients while mitigating risk of transmission to this vulnerable population.

Accelerated Intermittent Theta Burst Stimulation in Late-Life Depression: A Possible Option for Older Depressed Adults in Need of ECT During the COVID-19 Pandemic

Electroconvulsive therapy (ECT) is an essential psychiatric service with an important role in treating older adults with severe or treatment-resistant depression. During the COVID-19 pandemic, ECT services have be constrained by infection control measures. We report a case of a 66-year-old female patient with a severe major depressive episode who had previously responded to right unilateral ECT and was treated with two modified accelerated intermittent theta-burst stimulation (aiTBS) protocols. The two aiTBS courses consisted of eight daily sessions over five consecutive days, followed by gradual tapering, using 1,800 pulses per session pre-COVID-19 (first course), and 600 pulses per session during the pandemic (second course). Moderate to severe baseline depressive symptoms reached remission levels after both courses. The 600-pulses aiTBS treatment protocol reported here warrants further study and evaluation, but may be a potential option in cases where older adults with severe depressive symptoms cannot access ECT during the COVID-19 pandemic.

Safety and Fidelity in Electroconvulsive Therapy (SAFE ECT): A Novel Virtual Reality-Based Training Program in Electroconvulsive Therapy (Phase 1).

Safety and Fidelity in Electroconvulsive Therapy (SAFE ECT): A Novel Virtual Reality-Based Training Program in Electroconvulsive Therapy (Phase 1).

Impact of COVID-19 pandemic and lockdown on the state of mental health services in the private sector in India.

Background:No information is available about the impact of lockdown and COVID-19 pandemic on the mental health services in the private practice in India.Aim:The current study is aimed to assess the impact of the COVID-19 pandemic and lockdown on the state of Mental Health Services in the Private Sector in India.Materials and Methods:An online survey was carried out using the Survey Monkey platform during the period of 1st to 15th May 2020 among the members of the Indian Psychiatric Society.Results:Three hundred and ninety six responses were analysed. There was a reduction in revenue generation by about 70%. All kinds of services, including outpatient services, inpatient services, psychotherapy services, consultation-liaison, and electroconvulsive therapy (ECT) services, were severely affected. One-third of the participants were using the teleservices during the pandemic. The most common problem faced in running the services included modifying the psychological treatment to maintain social distancing, and managing the staff. Besides providing clinical care to the patients, the majority of the mental health professionals reported that they were involved in increasing awareness about the mental health consequences of pandemic and the lockdown and addressing myths related to the spread of infection.Conclusion:The pandemic and the lockdown have markedly impacted mental health services in the private sector. ECT services, inpatient services, psychotherapy services and outpatient services are the most affected. However, the COVID-19 pandemic and lockdown have led to the expansion of teleconsultation services.

Geographical Access to Electroconvulsive Therapy Services in Texas

In the present work the constitutive model of 316L and 304 stainless steel subjected to mechanical loading at cryogenic temperatures is derived. Three main coupled dissipative phenomena taking place in the material: plastic flow, plastic strain-induced transformation from the primary phase (γ) to the secondary phase (α′), and evolution of micro-damage are considered using a thermodynamically consistent framework. The approach based on total energy equivalence, originally developed for damaged materials, is here extended to modelling not only damage but also phase transformation, in a consistent manner. The proposed model is implemented numerically and validated by means of parametric studies, and by comparison with the experimental results. Very good qualitative and quantitative results are obtained.

Clinical Practice Recommendations for Continuation and Maintenance Electroconvulsive Therapy for Depression: Outcomes From a Review of the Evidence and a Consensus Workshop Held in Australia in May 2017.

Continuation or maintenance electroconvulsive therapy (ECT) is often provided as a strategy for post-ECT relapse prevention. However, the evidence has been insufficient until recently to produce clear consensus on what best practice maintenance ECT (mECT) should be like in a real world ECT clinical service. The aims of this article are to help fill this gap and to provide a comprehensive set of practical, clinically-based recommendations for ECT clinicians and services. A workshop was held at the Royal Australian and New Zealand College of Psychiatry Congress in Adelaide on April 30, 2017. This workshop was hosted by the authors. After a presentation on the state of the evidence, the 30 participants were asked to work in small groups to develop consensus recommendations on different aspects of mECT. These were then collated into one comprehensive set of clinical recommendations for the practice of mECT. These best practice recommendations are set out below. These recommendations will assist ECT services and clinicians to provide best practice mECT according to currently available evidence.