Interactive block 2: Difficult to treat depression

Interactive Case Discussion: Electroconvulsive Therapy in Treatment-Resistant Depression

This interactive case-based session guides participants through the clinical decision-making process surrounding electroconvulsive therapy (ECT) in a patient with severe treatment-resistant depression. Using audience polling and expert discussion, participants will apply current evidence to determine when ECT is indicated, evaluate predictors of treatment response [2], and compare ECT with other neuromodulation strategies.

The case follows the patient from referral through treatment planning, including pre-treatment assessment, electrode placement, stimulus dosing, and practical aspects of patient preparation and monitoring. Participants will discuss how treatment parameters influence efficacy and cognitive outcomes, and how common adverse effects can be anticipated and managed.

Following successful acute treatment, the discussion extends to relapse prevention, addressing continuation and maintenance ECT [1] alongside pharmacological strategies. Throughout, participants integrate current evidence with clinical reasoning at key decision points.

By the end of the session, participants will be able to identify indications for ECT, interpret predictors of response, apply principles of safe and effective ECT administration, recognize and manage adverse effects, and distinguish acute, continuation, and maintenance ECT.

[1] Rovers JJE, et al. A global Delphi-based expert consensus on relapse prevention strategies following successful electroconvulsive therapy for major depressive disorder. Am J Psychiatry. 2026;183(6):401-408. doi:10.1176/appi.ajp.20250641

[2] Loef D, et al. A prediction model for electroconvulsive therapy effectiveness in patients with major depressive disorder from the Dutch ECT Consortium (DEC). Mol Psychiatry. 2025;30(5):1915-1924. doi:10.1038/s41380-024-02803-2