Barcelona snapshots

Prof. Colleen K. Loo

Colleen K. Loo psychiatrist Controversias Psiquiatry Barcelona
University of New South Wales, Australia
Talk Role of ECT for treatment-resistant affective disorders
Date Friday, April 26th, 2019
Time 16:30 to 17:15
Round Table Treatment-resistance in affective disorders


Colleen Loo, MBBS (Hons), FRANZCP, MD (research doctorate), is a clinical psychiatrist and Professor of Psychiatry at the University of New South Wales, Sydney; Australia. She is an internationally recognised clinical expert and researcher in the field of electroconvulsive therapy and has published on ultrabrief pulse ECT, anaesthesia and ECT, and computational modelling to understand electrode placement and pulse width in ECT. She has established an internationally recognized research program investigating novel clinical treatments for psychiatric disorders, including Transcranial Magnetic Stimulation, transcranial Direct Current Stimulation and ketamine, and their effects on brain functioning. She has over 200 peer reviewed publications and has received grant funding as lead investigator or collaborator from the Australian NHMRC, US-based NARSAD and Stanley Foundations, UK NHS/MRC and Singapore NMC.

She has been an invited plenary and symposium speaker at conferences in Australia, US, UK, Europe and Asia. She is active in ECT, Neurostimulation and novel treatments research, practice and policy, and is an expert adviser to Australian government health departments and the Royal Australian and New Zealand College of Psychiatrists (RANZCP), as well as advising on policy and practice internationally. She is the first international member to be appointed as an Executive Officer of the International Society for ECT and Neurostimulation and is currently ISEN President. She served for over a decade on the Editorial Board of the Journal of ECT and is currently on the editorial board of Brain Stimulation. She teaches ECT, TMS and tDCS in courses established in Sydney.


ECT is a highly effective treatment for depression and is also used to treat treatment refractory mania. Much of the published literature on ECT has been on its use in treatment resistant depression. Predictors of response analyses overall show reduced efficacy with increasing treatment resistance, as is the case also for other treatments. Nevertheless, data from ECT studies, including those conducted in real life clinical settings show good efficacy with approximately 50% remission rates even in patients with treatment resistant depression. Treatment guidelines typically place ECT as a second or third line treatment after other treatments have failed, recognising its superior efficacy. ECT is a cost effective treatment with some analyses suggesting that treatment costs may be reduced by earlier use of ECT. The high efficacy of ECT in affective disorders may be related to its profound effect on brain functioning. Studies on mechanisms of action include volumetric increases in grey matter, changes in functional connectivity and inflammatory markers. The practice of ECT is undergoing continual improvement and evolution. New treatment approaches aim to preserve its high efficacy with less cognitive side effects. These strategies include ultra-brief pulse stimulation and electrode montages that minimise memory side effects. For example, ultrabrief pulse RUL ECT has been shown to have slightly reduced efficacy but considerably lesser cognitive side effects. As new forms of ECT with minimal cognitive side effects emerge, the role of ECT may become broader, from a third line treatment for the most treatment resistant illness, to a treatment that may be appropriate to use earlier in treatment algorithms.


[web] Prudic J, Olfson M, Marcus SC, Fuller RB, Sackeim HA (2004). Effectiveness of electroconvulsive therapy in community settings. Biol Psychiatry. 2004 Feb 1;55(3):301-12.

[web] Tor PC, Bautovich A, Wang MJ, Martin D, Harvey S, Loo CK (2015). A Systematic Review and Meta–Analysis of Brief versus Ultrabrief Right Unilateral Electroconvulsive Therapy for Depression. J Clin Psychiatry 76(9):e1092-e1098.

[web] Bai, S, Gálvez V, Dokos S, Martin D, Bikson M, Loo CK (2017). Computational models of Bitemporal, Bifrontal and Right Unilateral ECT predict differential stimulation of brain regions associated with efficacy and cognitive side effects. Eur Psychiatry, 2016; 29 (41):21-29.