Current clinical practice of electroconvulsive therapy and repetitive transcranial magnetic stimulation in psychiatry, a German sample


The purpose of the study was to evaluate the current clinical practice of Electroconvulsive Therapy and Repetitive Transcranial Magnetic Stimulation in German psychiatry. Case-based data (> 1.000.000 cases) were collected according to §21 of the German hospital remuneration law from January 2015 to December 2017. The study cohort comprises approximately 35–40% of the annual psychiatric cases and hospitals in Germany. Frequency of ECT and rTMS cases were investigated considering main diagnoses according to ICD-10 and treatment settings (inpatient vs. day-care). ECT cases with short-term hospitalization (≤ 4 days) were supposed to be maintenance ECT cases. A linear regression analysis was conducted to estimate trends in the use of ECT and rTMS. Different groups were compared using Chi-square tests. ECT and rTMS cases appear to increase in total during the observation period possibly due to facilities newly introducing ECT and rTMS but also to increased frequency of treatments. Both treatments were rarely performed in day-care settings (0.89% and 11.25%). ECT was performed in 1.72% of all cases with affective disorders and in 1.48% with major depressions, respectively. Age ≥ 65 years, females, severe and psychotic depression were significantly associated with a higher rate of ECT cases. > 40% of all ECT cases were possibly maintenance ECT cases. Only 0.60% of these were performed in day- care settings. rTMS was primarily performed in major depression (86,7% of all rTMS cases). This study suggests a growing demand for ECT and rTMS. Nevertheless, the use of ECT is still low compared to the high prevalence of treatment resistant depression. The use of rTMS is even lower and seems to be restricted to specialized institutions. Maintenance ECT is frequently carried out in an inpatient setting. Limitations of this study are the case- and group-based analysis, missing data on outpatient services and treatment sessions per case. Therefore, the database is not necessarily representative for the entire German healthcare system. Further studies are needed to verify the presented findings and should address the feasibility of ambulatory and day-care ECT services.

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CT, JV and PH conceived and designed the study. CT supervised all data collection and analysis and drafted the first version of the manuscript. All authors contributed to analysis and interpretation of data, critically revised the manuscript and approved the final version before submission.

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Correspondence to Charles Timäus.

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Conflict of interest

Stephan Gyßer is a full-time employee of GSG consultant. Jens Wiltfang is supported by an Ilídio Pinho professorship and iBiMED (UID/BIM/04501/2013) and FCT project PTDC/DTP_PIC/5587/2014 at the University of Aveiro, Portugal. Jens Wiltfang received honoraria for consulting activities, lectures or advisory board participation from Pfizer, Eli Lilly, Hoffmann-La-Roche, MSD Sharp + Dome, Janssen-Cilag GmbH, Immungenetics AG, Boehringer Ingelheim and Novartis. Jens Wiltfang holds patents EP1270592B1, US 6,849,416 B2, EP2095128B1 and EP3105589A1. Bernhard Kis received honoraria for authorships, publisher activities, advisory board participation and speaker fees from ecomed, Hogrefe, Medicine, Dt. Krankenhausgesellschaft and Shire. Claus Wolff-Menzler received honoraria for consulting activities from GSG, Vitro GmbH, LVR, Janssen, LWL, Mibeg-Institute, Agfa/Orbis, DKI, PKM, Asklepios, Alexianer, ID-Schwarz, LivaNova, Servier, ZEB and DKCT.

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Timäus, C., Vogelgsang, J., Kis, B. et al. Current clinical practice of electroconvulsive therapy and repetitive transcranial magnetic stimulation in psychiatry, a German sample. Eur Arch Psychiatry Clin Neurosci 271, 181–190 (2021).

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  • rTMS
  • ECT
  • Ambulatory
  • Neurostimulation
  • Brain stimulation
  • Noninvasive