<unk>  is used, where possible, with informed consent in treatment-resistant major depressive disorder, treatment-resistant catatonia, prolonged or severe mania, and in conditions where "there is a need for rapid, definitive response because of the severity of a psychiatric or medical condition (e.g., when illness is characterized by stupor, marked psychomotor retardation, depressive delusions or hallucinations, or life-threatening physical exhaustion associated with mania)." It has also been used to treat autism in adults with an intellectual disability, yet findings from a systematic review found this an unestablished intervention. Major depressive disorder For major depressive disorder, despite a Canadian guideline and some experts arguing for using<unk>  as a first line treatment,<unk>  is generally used only when one or other treatments have failed, or in emergencies, such as imminent suicide.<unk>  has also been used in selected cases of depression occurring in the setting of multiple sclerosis, Parkinson's disease, Huntington's chorea, developmental delay, brain arteriovenous malformations, and hydrocephalus. Efficacy A meta-analysis on the effectiveness of<unk>  in unipolar and bipolar depression was conducted in 2012. Results indicated that although patients with unipolar depression and bipolar depression responded to other medical treatments very differently, both groups responded equally well to<unk> . Overall remission rate for patients given a round of<unk>  treatment was 50.9% for those with unipolar depression and 53.2% for those with bipolar depression. The severity of each patient's depression was assessed at the same baseline in each group. Most of severely depressed patients respond to<unk> . In 2004, a meta-analytic review paper found in terms of efficacy, "a significant superiority of<unk>  in all comparisons:<unk>  versus simulated<unk> ,<unk>  versus placebo,<unk>  versus antidepressants in general,<unk>  versus tricyclics and<unk>  versus monoamine oxidase inhibitors." In 2003, The UK<unk>  Review Group published a systematic review and meta-analysis comparing<unk>  to placebo and antidepressant drugs. This meta-analysis demonstrated a large effect size (high efficacy relative to the mean in terms of the standard deviation) for<unk>  versus placebo, and versus antidepressant drugs. Compared with repetitive transcranial magnetic stimulation (rTMS) for people with treatment-resistant major depressive disorder,<unk>  relieves depression as shown by reducing the score on the Hamilton Rating Scale for Depression by about 15 points, while rTMS reduced it by 9 points. The response rate is from 50 to 60% in treatment-resistant patients. Efficacity does not depend on depression subtype. Follow-up There is little agreement on the most appropriate follow-up to<unk>  for people with major depressive disorder. When<unk>  is followed by treatment with antidepressants, about 50% of people relapsed by 12 months following successful initial treatment with<unk> , with about 37% relapsing within the first 6 months. About twice as many relapsed with no antidepressants. Most of the evidence for continuation therapy is with tricyclic antidepressants; evidence for relapse prevention with newer antidepressants is lacking. Lithium has also been found to reduce the risk of relapse; especially in younger patients. Catatonia<unk>  is generally a second-line treatment for people with catatonia who do not respond to other treatments, but is a first-line treatment for severe or life-threatening catatonia. There is a plethora of evidence for its efficacy, notwithstanding a lack of randomised controlled trials, such that "the excellent efficacy of<unk>  in catatonia is generally acknowledged". For people with autism spectrum disorders who have catatonia, there is little published evidence about the efficacy of<unk> ; as of 2014 there were twelve case reports. Mania<unk>  is used to treat people who have severe or prolonged mania; NICE recommends it only in life-threatening situations or when other treatments have failed and as a second-line treatment for bipolar mania. Schizophrenia<unk>  is widely used worldwide in the treatment of schizophrenia, but in North America and Western Europe it is invariably used only in treatment resistant schizophrenia when symptoms show little response to antipsychotics; there is comprehensive research evidence for such practice. It is useful in the case of severe exacerbations of catatonic schizophrenia, whether excited or stuporous. There are also case reports of<unk>  improving persistent psychotic symptoms associated with stimulant-induced psychosis.
Electroconvulsive therapy
Brief psychotherapy
Psychotherapy
Cognitive therapy
Suicide intervention
Institutional psychotherapy
Insight-oriented psychotherapy
MDMA-assisted psychotherapy