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Electroconvulsive Therapy in Bulgaria: A Snapshot of Past and Present

Hranov, Luchezar G. MD, PhD*; Hranov, Georgi MD*; Ungvari, Gabor S. MD, PhD; Gazdag, Gábor MD, PhD‡§

doi: 10.1097/YCT.0b013e318245ca05
Original Studies

Introduction Whereas the use of electroconvulsive therapy (ECT) has been frequently surveyed in Western Europe, information about the practice of ECT in Eastern Europe is limited. To date, there has been no information about the present state of ECT use in Bulgaria.

Objective The aim of this project was to survey current ECT practice in Bulgaria.

Materials and Methods A semi-structured questionnaire on the practice of ECT was mailed or e-mailed to all psychiatric inpatient facilities in Bulgaria seeking information about the year 2010.

Results Only 4 inpatient facilities (all university departments) located in Sofia confirmed the use of ECT in 2010. The main indication of ECT was depression, and most of the patients were women. Three of the 4 centers used modern machines for electroencephalographic and electromyographic monitoring.

Discussion This was the first nationwide survey of ECT practice in Bulgaria since 1982. The frequency of ECT use was similarly low as in other Eastern European countries. Approximately 12% of the psychiatric inpatient facilities in Bulgaria offered ECT in 2010, all in the capital city. The lack of availability of ECT outside the capital raises serious concerns about the accessibility of psychiatric care for patients with severe disorders responsive to ECT in other parts of the country.

From the *University Multiprofile Hospital for Active Treatment in Neurology and Psychiatry "Sveti Naum", Sofia, Bulgaria; †School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia; ‡Consultation-Liaison Psychiatric Service, Szent István and Szent László Hospitals, Budapest, Hungary; and §Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary.

Received for publication August 7, 2011; accepted August 23, 2011.

Reprints: Gabor Gazdag, MD, PhD, Consultation-Liaison Psychiatric Service, Szent István and Szent László Hospitals, Gyali ut 5-7. 1097 Budapest, Hungary (e-mail:

The authors have no conflicts of interest or financial disclosures to report.

© 2012 Lippincott Williams & Wilkins, Inc.