When do you refer patients with difficult-to-treat depression for ECT rather than other interventional psychiatric treatments, such as TMS or esketamine?  

First, you have to take into account the patient's wants. A decent amount of patients are scared of ECT and want to exhaust all pharmacological options possible. After I deem it necessary that ECT is in the best interest of the patient, I will explore their willingness. Also, access to ECT can be a ...

I would refer more patients for ECT if it were more readily available in Maryland. As it is now, there are only a few hospitals providing this treatment, and there is typically a long waiting list for patients to be admitted for ECT. Because of this, I tend to only refer severe catatonia patients fo...