Depressive illness is the main indication. An MRC research study in 1965 showed that ECT is superior to antidepressant drugs for treating severe depression. Most depressed patients, however, are given drugs as the first-line treatment, ECT being reserved for use in the following circumstances:

• when life is threatened by suicidality

• when life and health are threatened by refusal of food and drink

• when antidepressant drugs have failed

• when antidepressant drugs are contraindicated for medical reasons, such as cardiac arrhythmia

• when unwanted effects of medication in the elderly, including some with cognitive impairment, may make drug treatment slower and riskier

• when a quick response is required, as in post-natal depression.

ECT is very occasionally used for inpatients with severe schizophrenia, especially catatonic schizophrenia, or mania that has not responded to intensive drug treatment. This indication is uncommon in the UK, although it remains prevalent in developing countries.

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