While working on a new Dutch Guideline for ECT I discovered this guideline: Australian and New Zealand Clinical Practice Guidelines for the Treatment of Depression.
You can download the complete guideline (pdf 1.1 mb) or a summary. ECT is the fourth option in the treatment of depression in this guideline. They suggest to start with unilateral treatment unless the patient’s prior response or urgency dictate otherwise. They even state that long-term maintenance ECT is not proven benefit. This made me wonder when this guideline was installed: 2004. We in The Netherlands are not doing that bad at all when considering our guidelines for the treatment of depression and ECT. Far more eye for the wish of the patient and symptoms, severity of illness of the depressed patient. In case of severe or psychotic depression ECT can be performed as first option