Indications

• psychotic depression, for example delusions, hallucinations

• melancholic depression unresponsive to antidepressants

• substantial suicide risk

• ineffective antidepressant medication

• severe psychomotor depression o refusal to eat or drink o depressive stupor o severe personal neglect

Immediate referral for hospital admission is necessary in most of these circumstances. The usual course is 6-8 treatments over 3 weeks. All antidepressants can be used in combination with ECT and after ECT to prevent relapse.

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