ECT: Contraindications


Before discussing contraindications, it is important to first understand the physiologic effects of ECT. These include :

  • Large increases in cerebral blood flow and intracranial pressure
  • Initial parasympathetic discharge manifested by bradycardia, occasional asystole, premature atrial and ventricular contraction, hypotension and salivation
  • Following parasympathetic reaction is a sympathetic discharge associated with tachycardia, hypertension, premature ventricular contractions, and rarely, ventricular tachycardia and ECG changes, including ST-segment depression and T-wave inversion, may also be seen.
  • Glucose homeostasis is also affected. Hyperglycemia seen in insulin dependent patients

Absolute contraindications:

  • Known pheochromocytoma

Relative contraindications: The risk of the patient’s psychiatric illness, side effects of antidepressant medications must be weighed against the risk of ECT and anesthesia. These conditions include :

  • Increased intracranial pressure, ok if there is not a mass effect
  • Brain tumors, same recommendation as above
  • Recent stroke- ECT has been performed successfully
  • Cardiovascular conduction defects. Pacemaker is not a contraindication to ECT- AICD function can be deactivated and magnet should be available if needed
  • High-risk pregnancy- OB consult and fetal monitoring is recommended
  • Aortic and cerebral aneurysms
  • Asthma/COPD- some suggest that you should discontinue theophyline because of its potential to cause status epileptics


  • Delay ECT for patients with unstable angina, decompensated heart failure, or severe symptomatic valvular disease until these conditions are stabilized or optimized. Cardiology consultation may be of benefit
  • For high-risk neurosurgical lesions including recent stroke and brain tumor, neurosurgical consultation is recommended
  • Diabetic patients should hold oral hypoglycemic, short acting insulin and halve their long acting dose with fasting
  • Warfarin can be continued in high risk patients with INR <3.5
  • In severe GERD antacids can be taken or intubation considered


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