Electroconvulsive Therapy: Cornerstone of Indian Psychiatry, Systematic Review

Although ECT is recognized as one of the most powerful tools in psychiatry, its global use is paradoxically declining due to procedural variability and enduring social stigma. Previous research in India has been extensive but historically fragmented across five decades, leading Harsh Pathak and colleagues from the National Institute of Mental Health and Neurosciences (NIMHANS) and Fortis Hospitals to conduct this review to bridge the clinical gap and systematically map the diverse landscape of national literature.

Therefore, the scoping review utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) framework to evaluate literature across four major global databases and multiple Indian psychiatric journals up to August 2025. The authors examined a wide range of study designs focused on efficacy and procedural parameters, excluding animal research and non-original commentaries to ensure a clinical focus on primary and secondary outcomes related to patient safety and treatment response.

Key Clinical Findings of the Study Include:

• Clinical Success: The evidence highlights that treatment remains a high-yield intervention, particularly in bipolar disorder, where response rates were observed in approximately 90% of patients.

• Technical Optimization: Comparative data on electrode placement suggests bitemporal methods may be less effective than bifrontal approaches, which achieved a 95% response rate compared to 79% in specific clinical trials.

• Neurocognitive Recovery: Safety investigations provide reassurance that while acute memory issues may occur, these deficits are generally transient and tend to resolve entirely within roughly three months.

• Anesthetic Stability: Research into modern induction agents has identified that etomidate and propofol can effectively optimize seizure duration and maintain cardiovascular stability during the procedure.

• Perception Improvement: Findings indicate that knowledge gaps and social stigma can be successfully mitigated through targeted educational modules lasting just 15 to 60 minutes.

The results suggest that Indian research has significantly matured, moving from early efficacy trials to complex inquiries into neurobiology and procedural safety involving a diverse methodological base. The synthesized data confirms that modified treatment, when supported by modern anesthesia and precise stimulus dosing, offers a favorable risk-benefit profile for severe mental illnesses.

These findings imply that clinicians should actively integrate structured cognitive monitoring and brief educational interventions into routine practice to optimize patient outcomes and reduce the barriers to treatment acceptance.

A limitation of the current evidence base is the scarcity of long-term follow-up data regarding cost-effectiveness and relapse patterns, highlighting a mild need for future qualitative research into patient lived experiences and comparative studies with magnetic seizure therapy (MST) to further refine neuromodulation standards.

Reference

Pathak H, Baliga SP, Shibu A, Thirthalli J. Electroconvulsive therapy research in India: A scoping review. Indian J Psychiatry 2026;68:218-54.