title: Position statement and guidelines on unmodified electroconvulsive therapy.
abstract: BACKGROUND
  In modern day psychiatric practice, it is assumed as a matter of fact that when electroconvulsive therapy (ECT) is administered, it will be administered under anesthesia and with succinylcholine (or its equivalent) modification. Yet, as surveys indicate, there is considerable practice of unmodified ECT in developing countries and, to a small extent, in the developed world, as well.
  
  
  METHODS
  This document examines historical and recent literature on the geographical practice, physiology, efficacy, and adverse effects of unmodified ECT. Particular attention is paid to musculoskeletal risks.
  
  
  RESULTS
  Although almost all the research is of poor methodological quality, there is a good reason to accept that unmodified ECT is associated with a wide range of adverse consequences, important among which are musculoskeletal complications, pre-ECT anxiety, and post-ECT confusion. However, it appears from recent data that these risks are not as large as historically portrayed. Possibly explanations are suggested, with seizure modification using parenteral benzodiazepines as a special possibility.
  
  
  CONCLUSIONS
  Under exceptional circumstances, if ECT is strongly indicated and seizure modification with succinylcholine is not feasible, unmodified ECT, especially benzodiazepine-modified ECT, may be a viable option. A detailed set of recommendations for such use of unmodified ECT is proposed along with necessary checks and balances. This document has been approved by the Indian Psychatric Society, the Indian Association of Biological Psychiatry, and the Indian Association of Private Psychiatry (which commissioned the preparation of the document).
authors.affiliation: Indian Association of Private Psychiatry Task Force on ECT, India.
authors.forename: Chittaranjan
authors.initials: C
authors.lastname: Andrade
authors.forename: N
authors.initials: N
authors.lastname: Shah
authors.forename: P
authors.initials: P
authors.lastname: Tharyan
authors.forename: M S
authors.initials: MS
authors.lastname: Reddy
authors.forename: M
authors.initials: M
authors.lastname: Thirunavukarasu
authors.forename: R A
authors.initials: RA
authors.lastname: Kallivayalil
authors.forename: R
authors.initials: R
authors.lastname: Nagpal
authors.forename: N K
authors.initials: NK
authors.lastname: Bohra
authors.forename: A
authors.initials: A
authors.lastname: Sharma
authors.forename: E
authors.initials: E
authors.lastname: Mohandas