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Regulation of Electroconvulsive Therapy: A Systematic Review of US State Laws

Livingston, Robin, MD*; Wu, Chester, MD*; Mu, Kathy, DO*; Coffey, M., Justin, MD*†

doi: 10.1097/YCT.0000000000000460

Objectives The goal of this study was to systematically review current US state laws on electroconvulsive therapy (ECT) in order to provide a comprehensive resource to educate practitioners, potential patients, and lawmakers.

Methods Individual state legislative Web sites were searched by 2 independent authors using the following search terms: “electroconvulsive therapy,” “convulsive therapy,” “electroconvulsant therapy,” “electroshock therapy,” and “shock therapy” from March 2017 to May 2017. All sections of state law pertaining to ECT were reviewed, and pertinent data regarding consent, age restrictions, treatment limitations, required reporting, defined qualified professionals, fees, and other information were extracted.

Results State regulation on ECT widely varied from none to stringent requirements. There were 6 states without any laws pertaining to ECT. California, Illinois, Massachusetts, Missouri, New York, South Dakota, Tennessee, and Texas were noted to be the most regulatory on ECT.

Conclusions There are no US national laws on ECT leaving individual state governments to regulate treatment. Whereas some states have detailed restrictions on use, other states have no regulation at all. This variation applies to multiple areas of ECT practice, including who can receive ECT, who can provide informed consent, who can prescribe or perform ECT, and what administrative requirements (eg, fees, reporting) must be met by ECT practitioners. Knowledge of these state laws will help providers not only to be aware of their own state's regulations, but also to have a general awareness of what other states mandate for better patient care and utilization of ECT.

From the *Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine; and †The Menninger Clinic, Houston, TX.

Received for publication July 24, 2017; accepted August 14, 2017.

Reprints: Robin Livingston, MD, Baylor College of Medicine, One Baylor Plaza, MS: BCM350, Houston, TX 77030 (e-mail:

J.C. reports royalties from UpToDate and MedLink Neurology. The other authors have no conflicts of interest or financial disclosures to report.

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