Electroconvulsive therapy (ECT) may be associated with adverse events. There is no absolute contraindication to the procedure. However, the decision to administer therapy should be based on a careful evaluation of potential benefits and risks from the procedure versus the potential risks if the procedure is not performed.


Conditions associated with an increased risk for an adverse outcome from ECT:

(1) severe cardiovascular disease: recent myocardial infarction, unstable angina, poorly compensated congestive heart failure, and severe valvular disease

(2) aneurysms or vascular malformations

(3) conditions resulting in increased intracranial pressure (tumors, other space occupying lesions)

(4) recent cerebral infarction

(5) severe pulmonary disease, including chronic obstructive pulmonary disease (COPD), asthma, or pneumonia

(6) patients classified as ASA level 4 (poor health with at least 1 incapacitating diseases) or 5 (moribund with danger of imminent death)


A patient with one or more of these conditions should be carefully evaluated prior to administration of therapy:

(1) Medications should be administered or adjusted to reduce the risk for an adverse event (prevention of elevated or depressed blood pressure, hyperthyroidism, bronchodilators, etc.)

(2) Insertion of a pacemaker may be an aid for a patient with cardiac dysrhythmia.

(3) Diabetic may require careful monitoring of blood glucose levels during the procedure.

(4) Electrolyte disorders should be corrected prior to therapy.

(5) The patient should give informed consent based on an accurate presentation of potential risks and benefits.


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