ECT in patients with major depressive disorder and low cardiac output.

Electroconvulsive therapy (ECT) in patients with impaired cardiac output may be associated with significant cardiovascular morbidity and mortality because of its hemodynamic effects. Many clinicians are reluctant to treat these patients with ECT because of the high risk associated with the treatment. In this report, we present a clinically appropriate protocol for ECT treatment of patients with impaired cardiac output and major depressive disorder. Three patients, ages 59-78 years, with resistant major depression and impaired cardiac output (ejection fraction 20-25%), were successfully treated with ECT according to this protocol.