Practice of electroconvulsive therapy in Nepal: nationwide online survey

Electroconvulsive therapy (ECT) is considered among the safest and most effective treatments for mental disorders. In Nepal, ECT is practised but data regarding its use, techniques and protocols are limited. The use of non-modified ECT in Nepal is also debatable concerning ethical issues and its outcomes. To explore the characteristics of ECT practice, its availability in psychiatric services and to determine the standards and techniques of ECT practice in Nepal. A cross-sectional, descriptive study via an online survey with a questionnaire was used. All hospitals providing in-patient psychiatric services in Nepal were included in the study. Data were collected using Google Forms with a URL link. Questionnaires were sent to the psychiatrist at each facility. Ethical approval was obtained from Nepal Health Research Council (reference no. 2352). Of 32 centres, 31 responded (96.9%). ECT practice was employed in 23 (74.2%) of these; 14 (60.9%) had a written ECT protocol and 95.7% obtained written family consent. Pre-ECT work-up was performed in all cases. Brief-pulse devices were used in 81.8% ( n = 18), with bitemporal placement being most common. Modified ECT was practised in 16 (69.6%) centres; 4 (17.4%) used both modified and unmodified ECT and 3 (13%) used only unmodified ECT – mainly due to lack of either equipment or an anaesthesiologist. Propofol (82.8%, n = 18) and ketamine (31.8%, n = 7) were the most commonly used anaesthetics, and all centres used succinylcholine for modified ECT. Catatonia (95.7%, n = 22) was recorded as the most common indication. This nationwide survey shows that ECT is widely used in Nepal, mainly in the form of modified bitemporal ECT, although some centres are still relying on unmodified ECT due to limited resources.