The use of electroconvulsive therapy in suicidal patients.

Publications on the subjects of ECT and suicide stress the importance of ECT as a valuable treatment in appropriately selected cases of suicidal ideation or attempted suicide. There is no direct correlation between the degree of suicidality and the usefulness of ECT. In the management of cases with major affective disorder, particularly those showing delusions and vegetative signs, ECT should be considered early in the treatment. The presence of the potential for suicide provides an added incentive. However, suicidal threats or attempts on the part of patients with severe personality disorders are not likely to respond to ECT unless the picture is complicated by major depressive illness. In the absence of such affective illness, understanding and skilled psychotherapy are likely to be more effective. Antidepressant medication and ECT should be administered within a supportive, watchful, and compassionate setting.