2025 surveillance of electroconvulsive therapy (technology appraisal guidanceTA59, NICE guideline NG222, NICE guideline CG178, NICE guideline CG185, NICE guideline CG192)

Comment on chapter: Evidence considered when developing the guideline recommendationsEvidence considered when developing the guideline recommendations

NICE guidance TA59 was published in 2003 and updated in 2009, 2012 and 2014 (see update information) but the evidence based remained unchanged since its publication in 2003. The evidence in the original guidance was mainly based on the Final Assessment Report: Electroconvulsive therapy (ECT) for depressive illness, schizophrenia, catatonia and mania. The assessment report was based on a review of the available evidence at the time of publication, including two Cochrane reviews. Although the searches were conducted systematically, the quality of the evidence identified was not systematically assessed, and the most recent evidence in the document dates to 2002.

NICE guideline NG222 on depression replaced NICE guideline CG90 (published in October 2009) and underwent a full update in 2022. The update found limited evidence on ECT for both acute treatment and maintenance of depression. The recommendations were based on existing RCTs, observational studies, and clinical expertise. Due to limited evidence on maintenance ECT for relapse prevention, the guideline recommended further research in this area.