Electroconvulsive therapy availability in the United States

Electroconvulsive therapy (ECT) was first administered in Rome by Ugo Cerletti and Lucio Bini in 1938 (Cerletti, 1950). Dr. Renato Almansi, an associate of Dr. Cerletti in Rome, brought a treatment apparatus from Italy to the United States, where it was used by Dr. David Impastato, an American psychiatrist, at Columbus Hospital in New York City in 1940 to perform ECT treatment (Impastato, 1960). Lebensohn (1999) describes the historical context of the introduction of ECT to American psychiatry. The ambivalence that the public and the psychiatric community have toward ECT has many explanations (see Chapters 9–12), and these presumably contribute to the regional variation in ECT use. During the past 60 years, ECT trends in the United States have fluctuated. Thompson et al. (1994) analyzed nationally representative data from the National Institute of Mental Health (NIMH) to evaluate trends in the use of ECT in psychiatric hospitals in the United States in 1975, 1980, and 1985. In 1975, the NIMH reported that 58,667 patients received ECT treatments. Despite a growing population, this number decreased to 31,514 in 1980, and remained unchanged (when accounting for population growth) in 1986 at 36,558 patients. ECT was used primarily in private hospitals, rather than public general, state, or county mental hospitals. In 1986, more than 90% of patients who received ECT were White, and 84% carried the diagnosis of a mood disorder.