The Role of ECT in OCD: A 10-Year Review (2014-2024)

Background: Obsessive-compulsive disorder (OCD) affects up to 2.5% of the population with significant impacts on everyday functioning and relationships. First-line treatment includes selective serotonin reuptake inhibitors (SSRI) and cognitive behavioral therapy; however, studies have found that up to 40-60% of patients do not respond to SSRIs. ECT is an alternative approach that has demonstrated limited efficacy in OCD. Objective: The current review aims to summarize the results of published work between 2014-2024 to assess the efficacy of ECT in the treatment of OCD. Methods: A literature review was conducted using eight studies from 2014-2024 to assess the effectiveness of ECT in the treatment of OCD as measured by the Yale-Brown Obsessive–Compulsive Scale (Y‐BOCS). ECT was administered adjunctively with medications, not as a standalone treatment. Results: Y-BOCS scores decreased by an average of 16.75 after ECT treatment. 77.7% participants reported a positive response immediately after ECT. 13.3% reported side effects including headaches, memory disturbances, emesis and post-treatment agitation. 20% reported recurrence of symptoms or a deteriorating disease course after ECT at different time periods and to varying magnitudes. Conclusion: Although decreased Y-BOCS scores were statistically significant and 77.7% of participants reported a positive response to ECT, limited long-term efficacy and adverse effects limit the effectiveness of ECT. Variable long-term effects were reported across all studies, highlighting the importance of assessing individual benefit-to-risk ratios. ECT may have greater benefit in those with comorbid psychiatric diagnoses, possibly due to more severe courses and resistance to medications.