5 Recommendations for further research

5.1 There are a number of ongoing research projects that include studies of clinical and cost effectiveness in specific groups and an examination of the effects of seizure parameters.

5.2 Further research is urgently required to examine the long-term efficacy and safety of electroconvulsive therapy (ECT), including its use as a maintenance therapy and its use in particular subgroups who may be at increased risk, for example older people, children and young people, and during pregnancy. This research should reflect modern techniques and the use of ECT in comparison with and in conjunction with the antipsychotic and antidepressant drugs used in current practice. In addition to the use of appropriately validated psychometric scales, outcome measures should include user perspectives on the impact of ECT, the incidence and impact of important side effects such as cognitive functioning, and mortality.

5.3 Further research into the mechanism of action of ECT is encouraged, because it may provide important information on aetiology and future treatment strategies.

5.4 It is clear that the stimulus parameters impact on the safety and efficacy of the technique and recent research needs to be augmented. Further evaluation is needed of whether it is necessary to induce a full seizure for therapeutic effect, and how the efficacy and cognitive effects are influenced by the amount by which the applied electrical dose exceeds the seizure threshold.

5.5 More research is also needed to determine the cost effectiveness of ECT. In particular, better quality-of-life information is needed for people considered for, or who have received, ECT.