Electroconvulsive Therapy (ECT)

IF THE FACILITY IS CONCERNED ABOUT

Electroconvulsive therapy (ECT) can be a highly effective treatment for certain severe mental health conditions, but facilities may have concerns about its safety for individuals with bleeding disorders—particularly due to the potential risk of intracranial hemorrhage.

According to national guidance from the National Bleeding Disorders Foundation’s Medical and Scientific Advisory Council (MASAC) in Document 289 (approved October 2024), ECT can be safely used in individuals with bleeding disorders with appropriate planning and precautions. While the risk of bleeding is real, there are documented case reports of successful ECT administration in individuals with severe hemophilia A, as well as broader evidence supporting the safety of ECT in people on anticoagulant therapy.

To mitigate bleeding risk, MASAC strongly recommends that the mental health team consult with the bleeding disorder treatment team in advance of initiating ECT. Prior to each session, the individual’s treatment plan should include adequate hemostatic protection, similar to what would be provided before a major surgical procedure, to reduce the risk of intracranial bleeding or hemorrhage.

With proper interdisciplinary collaboration and proactive care planning, ECT can be administered safely and effectively to individuals with bleeding disorders when clinically indicated.

  • Reassuring Facilities About ECT and Bleeding Disorders

    • "I understand your team may be concerned about the safety of using ECT for someone with a bleeding disorder, particularly due to the potential risk of intracranial bleeding—that’s a valid concern."

    • "According to national guidance from the National Bleeding Disorders Foundation’s Medical and Scientific Advisory Council (MASAC), ECT can be safely used in people with bleeding disorders if proper precautions are in place."
      This guidance comes from MASAC Document 289, approved in October 2024.

    • "There are published case reports of individuals with severe hemophilia A who have safely undergone ECT, and studies showing it can also be used safely in people on anticoagulation therapy."

    • "To reduce the risk of bleeding, MASAC recommends that your team consult with the bleeding disorder treatment team in advance of starting ECT."
      We can help develop a plan that includes hemostatic treatment prior to each ECT session—similar to what we would do for a major surgical procedure.

    • "Our goal is to support you in providing the most effective psychiatric treatment while keeping the patient medically stable and safe."

    • "We’re available to help coordinate timing, dosing, and any necessary monitoring to make this process as seamless and safe as possible for your team and the patient."

  • MASAC Guidance on Electroconvulsive Therapy (ECT)

    To support safe and informed care planning for patients with bleeding disorders being considered for ECT, send the following:

    • MASAC Document 289 (Approved October 2024) – Include the relevant excerpt on ECT, which provides national expert guidance on:

      • The potential risk of intracranial hemorrhage,

      • Case reports demonstrating safe ECT use in individuals with bleeding disorders,

      • Recommendations for consultation with the bleeding disorder treatment team, and

      • The need for hemostatic protection prior to each ECT session, similar to preparation for major surgery.

    What to say:

    “I’m sharing an excerpt from MASAC Document 289, developed by the National Bleeding Disorders Foundation’s Medical and Scientific Advisory Council. It outlines considerations and safety measures for using ECT in individuals with bleeding disorders. With proper consultation and hemostatic planning, ECT can be safely administered when clinically indicated.”